Nurjadi Dennis, Eichel Vanessa M, Pöschl Johannes, Gille Christian, Kranig Simon, Heeg Klaus, Boutin Sébastien
Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany.
Department of Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany.
Microbiol Spectr. 2023 Sep 22;11(5):e0203823. doi: 10.1128/spectrum.02038-23.
Third-generation cephalosporin-resistant Enterobacterales is a major threat for newborns in neonatal intensive care units (NICUs). The route of acquisition in a non-outbreak setting should be investigated to implement adequate infection prevention measures. To identify risk factors for colonization with and to investigate the transmission pattern of third-generation cephalosporin-resistant Enterobacterales in a NICU setting. This monocentric observational cohort study in a tertiary NICU in Heidelberg, Germany, enrolled all hospitalized neonates screened for cephalosporin-resistant Enterobacterales. Data were collected from 1 January 2018 to 31 December 2021. Weekly screening by rectal swabs for colonization with third-generation cephalosporin-resistant Enterobacterales was performed for all newborns until discharge. Whole-genome sequencing was performed for molecular characterization and transmission analysis. In total, 1,287 newborns were enrolled. The median length of stay was 20 (range 1-250) days. Eighy-eight infants (6.8%) were colonized with third-generation cephalosporin-resistant Enterobacterales. Low birth weight [<1500 g (adjusted odds ratio, 5.1; 95% CI 2.2-11.5; < 0.001)] and longer hospitalization [per 30 days (adjusted odds ratio, 1.7; 95% CI 1.5-2.0; < 0.001)] were associated with colonization or infection with drug-resistant Enterobacterales in a multivariate analysis. complex was the most prevalent third-generation cephalosporin-resistant Enterobacterales detected, 64.8% (59 of 91). Whole-genome sequencing, performed for the available 85 of 91 isolates, indicated 12 transmission clusters involving 37 patients. This cohort study suggests that transmissions of third-generation cephalosporin-resistant Enterobacterales in newborns occur frequently in a non-outbreak NICU setting, highlighting the importance of surveillance and preventive measures in this vulnerable patient group. IMPORTANCE Preterm newborns are prone to infections. Therefore, infection prevention should be prioritized in this vulnerable patient group. However, outbreaks involving drug-resistant bacteria, such as third-generation resistant Enterobacterales, are often reported. Our study aims to investigate transmission and risk factors for acquiring third-generation cephalosporin-resistant Enterobacterales in a non-outbreak NICU setting. Our data indicated that premature birth and low birth weight are significant risk factors for colonization/infection with third-generation cephalosporin-resistant Enterobacterales. Furthermore, we could identify putative transmission clusters by whole-genome sequencing, highlighting the importance of preemptive measures to prevent infections in this patient collective.
耐第三代头孢菌素的肠杆菌科细菌对新生儿重症监护病房（NICUs）中的新生儿构成重大威胁。应调查在非暴发环境中的感染途径，以实施适当的感染预防措施。为了确定耐第三代头孢菌素的肠杆菌科细菌定植的危险因素，并调查其在新生儿重症监护病房环境中的传播模式。这项在德国海德堡一家三级新生儿重症监护病房进行的单中心观察性队列研究，纳入了所有接受头孢菌素耐药肠杆菌科细菌筛查的住院新生儿。数据收集时间为2018年1月1日至2021年12月31日。对所有新生儿进行每周一次的直肠拭子筛查，以检测是否定植耐第三代头孢菌素的肠杆菌科细菌，直至出院。对分离菌株进行全基因组测序，以进行分子特征分析和传播分析。总共纳入了1287名新生儿。中位住院时间为20（范围1 - 250）天。88名婴儿（6.8%）定植了耐第三代头孢菌素的肠杆菌科细菌。低出生体重[<1500 g（调整后的优势比，5.1；95%可信区间2.2 - 11.5；<0.001）]和较长的住院时间[每30天（调整后的优势比，1.7；95%可信区间1.5 - 2.0；<0.001）]在多变量分析中与耐药肠杆菌科细菌的定植或感染相关。肺炎克雷伯菌复合体是检测到的最常见的耐第三代头孢菌素的肠杆菌科细菌，占64.8%（91株中的59株）。对91株分离菌株中的85株进行了全基因组测序，结果显示有12个传播簇，涉及37名患者。这项队列研究表明，在非暴发的新生儿重症监护病房环境中，耐第三代头孢菌素的肠杆菌科细菌在新生儿中频繁传播，凸显了对这一脆弱患者群体进行监测和预防措施的重要性。重要性 早产新生儿容易感染。因此，在这个脆弱的患者群体中应优先进行感染预防。然而，涉及耐药细菌的暴发，如耐第三代头孢菌素的肠杆菌科细菌，经常被报道。我们的研究旨在调查在非暴发的新生儿重症监护病房环境中获得耐第三代头孢菌素的肠杆菌科细菌的传播情况和危险因素。我们的数据表明，早产和低出生体重是耐第三代头孢菌素的肠杆菌科细菌定植/感染的重要危险因素。此外，我们可以通过全基因组测序识别假定的传播簇，凸显了采取先发制人措施预防该患者群体感染的重要性。
