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Reassessing the need for active surveillance of extended-spectrum beta-lactamase–producing Enterobacteriaceae in the neonatal intensive care population

Published online by Cambridge University Press:  22 October 2018

Xiaoyan Song ,
Lamia Soghier Open the ORCID record for Lamia Soghier [Opens in a new window] ,
Tara Taylor Floyd ,
Tracie R. Harris ,
Billie L. Short Open the ORCID record for Billie L. Short [Opens in a new window]  and
Roberta L. DeBiasi
Xiaoyan Song*
Affiliation:
Children’s National Health System, Washington, DC The George Washington University School of Medicine and Health Sciences, Washington, DC
Lamia Soghier
Affiliation:
Children’s National Health System, Washington, DC The George Washington University School of Medicine and Health Sciences, Washington, DC
Tara Taylor Floyd
Affiliation:
Children’s National Health System, Washington, DC
Tracie R. Harris
Affiliation:
Children’s National Health System, Washington, DC
Billie L. Short
Affiliation:
Children’s National Health System, Washington, DC The George Washington University School of Medicine and Health Sciences, Washington, DC
Roberta L. DeBiasi
Affiliation:
Children’s National Health System, Washington, DC The George Washington University School of Medicine and Health Sciences, Washington, DC
*
Author for correspondence: Xiaoyan Song, Children’s National Health System, West Wing 3.5 Suite 100, 111 Michigan Ave NW, Washington, DC 20010. E-mail: xsong@cnmc.org
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Abstract

Objective

To determine the continued need for active surveillance to prevent extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-E) transmission in a neonatal intensive care unit (NICU).

Design

This retrospective observational study included patients with ESBL-E colonization or infection identified during their NICU stay at our institution between 1999 and March 2018. Active surveillance was conducted between 1999 and March 2017 by testing rectal swab specimens collected upon admission and weekly thereafter. The overall incidence rates, of ESBL-E colonization or infection (including hospital acquired) before and after active surveillance were calculated. The cost associated with active surveillance was then estimated.

Results

Overall, 171 NICU patients were found to have ESBL-E colonization or infection, and 150 of those patients (87.7%) were detected by active surveillance. The overall incidence rate was 1.4 per 100 patient admissions. The hospital-acquired incidence rate was 0.41 per 1,000 patient days, and this rate had decreased since 2002, with an average of 6 cases detected annually. A significant decrease was observed in 2009 when the unit moved to a new single-bed unit featuring private rooms. Active surveillance was discontinued with no increase in the number of infections. Of the 150 ESBL-E colonized patients, 14 (9.3%) subsequently developed an infection. Active surveillance resulted in a total of 50,950 specimen collections and a cost of $127,187 for processing, an average of $848 to detect 1 ESBL-E colonized patient.

Conclusion

ESBL-E transmission and infection in our NICU remains uncommon. Active surveillance may have contributed to the decline of ESBL-E transmission when used in conjunction with contact precautions and private rooms, but its relatively high cost could be prohibitive.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 12 , December 2018 , pp. 1436 - 1441
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Song X, et al. (2018). Reassessing the need for active surveillance of extended-spectrum beta-lactamase–producing Enterobacteriaceae in the neonatal intensive care population. Infection Control & Hospital Epidemiology 2018, 39, 1436–1441. doi: 10.1017/ice.2018.260

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