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Klin Padiatr 2020; 232(04): 203-209
DOI: 10.1055/a-1128-0524
Original Article

Screening for Third-Generation Cephalosporin-Resistant Bacteria Reduces the Incidence on Late-Onset Sepsis and Antibiotic use in Neonates

Screening auf Drittgeneration-Cephalosporin-resistente Bakterien reduziert Inzidenz von late-onset Infektion und Antibiotikaverbrauch bei Neugeborenen
Ann Carolin Longardt
1   Neonatology, Charité Universitätsmedizin Berlin, Berlin
,
Brar Piening
2   Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin
,
Katharina von Weizsäcker
3   Obstetrics, Charité Universitätsmedizin Berlin, Berlin
,
Christof Dame
1   Neonatology, Charité Universitätsmedizin Berlin, Berlin
,
Christoph Bührer
1   Neonatology, Charité Universitätsmedizin Berlin, Berlin
,
Lars Garten
1   Neonatology, Charité Universitätsmedizin Berlin, Berlin
› Author Affiliations Funding: No specific funding has been received for this work. The data have been generated as part of our clinical routine work and quality assessment.
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Abstract

Background The extensive use of antibiotics is reflected by an increasing prevalence of infections with multidrug-resistant bacteria, including third-generation cephalosporin-resistant bacteria (3GCRB). For neonatal intensive care units screening and enhanced barrier precautions are recommended to control the spread of multidrug-resistant Gram-negative bacteria, while evidence for efficacy of barrier precautions remains scarce in a non-outbreak setting.

Objective To determine the impact of a screening program for maternal 3GCRB colonization and the effects of contact precautions and cohort nursing, concerning the risk of neonatal late-onset sepsis (LOS) and antibiotic use rates (AURs).

Study Design In a retrospective matched-pair cohort study, data of neonates exposed to maternal 3GCRB colonization were compared with findings in non-exposed neonates.

Results Of 3,144 neonates admitted, 184 neonates born to 3GCRB-positive mothers were eligible. Among them, 37 (20%) became 3GCRB positive during hospital stay. 3GCRB-exposed infants had a lower rate of LOS (6.5 vs. 14.1%, p=0.03) and lower AURs in that time period compared to controls (mean 0.009 vs. 0.025, p=0.006). When started within the first 72h after birth, days of therapy with meropenem were significantly lower in non-exposed vs. 3GCRB-exposed infants (mean 0.13 vs. 0.42; p=0.002). No invasive infections with 3GCRB occurred.

Conclusions Neonates of 3GCRB-positive mothers do not have an increased a priori risk for invasive 3GCRB infection and may benefit from enhanced contact precautions measures.

Zusammenfassung

Hintergrund Der zunehmende Einsatz von Antibiotika führt zu einem Anstieg von Infektionen mit multiresistenten Erregern wie z. B. Drittgeneration Cephalosporin-resistenten Bakterien (3GCRB). Empfehlungen zu Screening- und Kohortierungsmaßnahmen auf neonatologischen Intensivstationen zielen auf die Prävention von horizontaler Transmission und invasiven Infektionen ab. Für Nicht-Ausbruchssituationen ist die Evidenz für Hygienemaßnahmen und Screeningprogrammen unzureichend.

Ziel Evaluation eines Screening für mütterliche 3GCRB-Besiedlung mit nachfolgender Isolation bzw. Kohortenpflege des Neugeborenen (NG) unter Bezug auf das Risiko einer Late-Onset-Sepsis (LOS) und die Anzahl der Antibiotika-Tage (AUR).

Studiendesign In einer retrospektiven Fall-Kontroll-Kohortenstudie wurden Daten von NG mit maternaler 3GCRB-Besiedelung im Vergleich zu einer Kontrollgruppe mit unauffälligem Screening analysiert.

Ergebnisse In einer Kohorte von 3144 NG fanden sich 184 NG von 3GCRB-besiedelten Müttern. Bei 37 (20%) wurde im Verlauf eine Besiedelung mit 3GCRB nachgewiesen. In der Gruppe der 3GCRB-exponierten NG kam es seltener zu einer LOS (6,5 vs. 14,1%, p=0,03). Zwischen dem 4. Lebenstag und der Entlassung hatten 3GCRB-exponierte NG eine niedrigere AUR (Mittelwert 0,009 vs. 0,025, p=0,006) als die Kontrollgruppe. Die Behandlungstage mit Meropenem (Start in den ersten 3 Lebenstagen), war in der Kontrollgruppe signifikant geringer als in der 3GCRB-exponierten Gruppe (Mittelwert 0,13 vs. 0,43 Tage; p=0,002). In beiden Gruppen trat keine invasive Infektion mit 3GCRB auf.

Schlussfolgerung Neugeborene, deren Mütter 3GCRB besiedelt sind, haben kein erhöhtes a priori Risiko für eine invasive Infektion mit 3GCRB Erregern und profitieren wahrscheinlich von erweiterten Kohortierungs- und Isolationsmaßnahmen.

Keywords

Antibiotic stewardship - bacterial colonization - nosocomial infection - neonatal intensive care unit - multidrug-resistant Gram-negative bacteria

Schlüsselwörter

Antibiotic Stewardship - bakterielle Kolonisation - neonatologische Intensivstation - nosokomiale Infektion - multiresistente gramnegative Stäbchen


Publication History

Article published online:
14 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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