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Molecular and Descriptive Epidemiology of Multidrug-Resistant Enterobacteriaceae in Hospitalized Infants

Published online by Cambridge University Press:  02 January 2015

Brian Anderson ,
Sarah Nicholas ,
Bruce Sprague ,
Joseph Campos ,
Billie Short  and
Nalini Singh
Brian Anderson
Affiliation:
George Washington University School of Medicine, Washington, DC
Sarah Nicholas
Affiliation:
George Washington University School of Medicine, Washington, DC
Bruce Sprague
Affiliation:
Center for Health Services and Community Research, Washington, DC
Joseph Campos
Affiliation:
George Washington University School of Medicine, Washington, DC Departments of Laboratory Medicine, Washington, DC Children's National Medical Center, Departments of Pediatrics, Washington, DC Pathology, Washington, DC Microbiology, Immunology, and Tropical Medicine, Washington, DC
Billie Short
Affiliation:
George Washington University School of Medicine, Washington, DC Neonatology, Washington, DC Children's National Medical Center, Departments of Pediatrics, Washington, DC
Nalini Singh*
Affiliation:
George Washington University School of Medicine, Washington, DC Infectious Disease, Washington, DC George Washington University School of Public Health, Departments of Epidemiology and Global Health, Washington, DC Children's National Medical Center, Departments of Pediatrics, Washington, DC
*
Division of Infectious Disease, Children's National Medical Center, 111 Michigan Ave., NW, Washington, DC 20010 (Nsingh@cnmc.org)
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Abstract

Objective.

To investigate the epidemiology of multidrug-resistant Enterobacteriaceae (MDRE) in hospitalized infants.

Methods.

From 2000 through 2005, active surveillance cultures for MDRE were performed for patients admitted to a 40-bed neonatal intensive care unit (NICU) that provides care for critically ill infants 6 months of age or younger. MDRE epidemiology and the genetic relatedness of MDRE strains determined by repetitive-sequence polymerase chain reaction were analyzed.

Results.

Active surveillance cultures revealed that 759 (23%) of 3,370 NICU infants (or approximately 1 in 5) developed MDRE colonization or infection and that 613 (72%) of the 853 isolates with epidemiologic data available were healthcare acquired. MDRE colonization occurred more frequently (in 653 infants [86%]) than did MDRE infection (in 106 [14%]). Of the 653 infants with MDRE colonization, 119 (18%) eventually became infected, with 29 (4%) acquiring sterile site infections. The most commonly isolated organisms were the Enterobacter species, accounting for 612 (71%) of the 862 isolates. Molecular epidemiologic analysis revealed that genetic-relatedness clustering (related clusters defined as having a genetic similarity coefficient greater than 95%) varied depending on microbial species. Clustering was detected for 36 (78%) of the 46 Enterobacter aerogenes isolates, 22 (45%) of the 49 Enterobacter cloacae isolates, and 13 (59%) of the 22 Klebsiella pneumoniae isolates.

Conclusion.

Hospitalized infants are at significant risk of acquiring MDRE, specifically Enterobacter species, at the study institution. Active surveillance cultures identified colonized patients who likely contributed to the institutional reservoir of MDRE. Molecular epidemiologic studies suggest that both patient-to-patient transmission and de novo acquisition of resistance play a role in the acquisition of these organisms, and that the clinical significance of such acquisition varies by species. The high percentage of E. aerogenes isolates that demonstrated genetic clustering suggests that monitoring the prevalence of this organism could serve as a useful measure of compliance with infection control procedures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 3 , March 2008 , pp. 250 - 255
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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