Stapleton Patrick J M, Murphy Madeleine, McCallion Naomi, Brennan Marion, Cunney Robert, Drew Richard J
Department of Microbiology, Temple Street Children's University Hospital, Dublin, Ireland.
Department of Neonatology, Rotunda Hospital, Dublin, Ireland.
Arch Dis Child Fetal Neonatal Ed. 2016 Jan;101(1):F72-8. doi: 10.1136/archdischild-2015-308707. Epub 2015 Sep 14.
To establish the number of outbreaks of extended spectrum beta-lactamase (ESBL) producing organisms in neonatal intensive care units (NICUs), to determine causes, mortality rates, proportions of infants colonised and infected and the interventions that terminated outbreaks.
A systematic review of the literature in English, Spanish and French was undertaken with searches in four databases. The review conformed to the PRISMA guidelines, and the data extraction was modelled on the ORION criteria for studies of nosocomial infection.
75 studies fulfilled the inclusion criteria. There were 1185 cases of colonisation, 860 infections and 139 deaths. The median outbreak duration was 6.2 months (IQR 2.0-7.5 months). Klebsiella pneumoniae was the most frequently implicated pathogen. Understaffing was the most frequent risk factor for outbreaks. The most commonly identified source was admission of an ESBL-colonised infant with subsequent horizontal dissemination. The main interventions described were improved infection-control procedures and screening of staff and the environment. 26 studies were included in the quantitative analysis. Random effects meta-analysis indicated high mortality rates in infants who developed infection (31%, 95% CI 20% to 43%).
ESBL outbreaks in NICUs are associated with significant mortality and prolonged disruption. Understaffing is a major risk factor, but is infrequently addressed by interventions. Poor infection-control procedures are frequently implicated as contributing to ESBL spread. Better reporting of outbreaks may help clarify the role for routine ESBL screening in NICUs.
确定新生儿重症监护病房(NICU)中产超广谱β-内酰胺酶(ESBL)微生物的暴发次数,查明原因、死亡率、定植和感染婴儿的比例以及终止暴发的干预措施。
对英文、西班牙文和法文文献进行系统综述,检索四个数据库。该综述符合PRISMA指南,数据提取以医院感染研究的ORION标准为模型。
75项研究符合纳入标准。有1185例定植病例、860例感染病例和139例死亡病例。暴发的中位持续时间为6.2个月(四分位间距2.0 - 7.5个月)。肺炎克雷伯菌是最常涉及的病原体。人员配备不足是暴发最常见的危险因素。最常确定的源头是收治一名携带ESBL的定植婴儿,随后发生水平传播。描述的主要干预措施是改进感染控制程序以及对工作人员和环境进行筛查。26项研究纳入了定量分析。随机效应荟萃分析表明,发生感染的婴儿死亡率很高(31%,95%置信区间20%至43%)。
NICU中的ESBL暴发与显著的死亡率和长期的干扰相关。人员配备不足是一个主要危险因素,但干预措施很少涉及这一点。感染控制程序不佳常常被认为是导致ESBL传播的原因。更好地报告暴发情况可能有助于阐明NICU中常规ESBL筛查的作用。