Yeshiwas Almaw Genet, Bayeh Gashaw Melkie, Tsega Tilahun Degu, Tsega Sintayehu Simie, Gebeyehu Asay Alamneh, Asmare Zufan Alamrie, Anteneh Rahel Mulatie, Ejigu Amare Genetu, Ahmed Ahmed Fentaw, Yigzaw Zeamanuel Anteneh, Temesgen Abathun, Enawgaw Anley Shiferaw, Yirdaw Getasew, Desalegn Wosenyelesh, Yenew Chalachew
Department of environmental health, college of medicine and health science, Injibara University, Injibara, Ethiopia.
Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.
Antimicrob Resist Infect Control. 2025 Feb 21;14(1):15. doi: 10.1186/s13756-025-01520-x.
Antimicrobial resistance (AMR) in neonatal intensive care units (NICUs) complicates treatment of healthcare-associated infections, causing high morbidity and mortality, especially among low-birth-weight and critically ill infants. This study evaluates AMR prevalence, risk factors, outcomes and infection control measures at Felege Hiwot Hospital, aiming to guide clinical practices, antimicrobial stewardship, and improved neonatal health outcomes.
This mixed-methods study (Oct 2022-Jun 2023) assessed AMR in NICU neonates by analyzing 420 blood samples, environmental swabs, and staff insights. Bivariable and multivariable regressions identified significant variables, and content analysis was used for qualitative data.
Out of 420 samples, 35% tested positive for AMR pathogens, with Coagulase-Negative Staphylococci (16.7%), Klebsiella pneumoniae (12.9%), and Acinetobacter spp. (5.6%) being the most prevalent. Resistance rates for Gentamicin, Cotrimoxazole, and Ciprofloxacin were alarmingly high (98-100%), while Amikacin demonstrated low resistance (3.0-5.56%), indicating potential efficacy. Among the neonates admitted, 91.8% survived, and 8.2% succumbed. Risk factor analysis revealed that improper PPE usage (AOR 3.90, p < 0.001), non-functional handwashing sinks (AOR 3.20, p < 0.001), and inadequate disinfection practices (AOR 2.70, p < 0.001) were strongly associated with microbial contamination. Environmental factors, including cockroach presence (AOR 1.80, p = 0.040) and high traffic flow (AOR 2.10, p = 0.005), were also significant contributors. The qualitative data analysis confirmed that improper PPE use, inadequate disinfection practices, pest control challenges, and non-functional handwashing sinks significantly contributed to microbial contamination risks in the NICU, aligning with the quantitative findings.
This study underscores key factors driving AMR in NICUs, such as inadequate IPC practices and environmental contamination, alongside high resistance to Cotrimoxazole and Ciprofloxacin. Amikacin shows promise as an effective treatment for CONS. Urgent actions, including strengthened IPC measures, staff training, and environmental management, are crucial to combat AMR, ensuring improved neonatal care and outcomes.
新生儿重症监护病房（NICU）中的抗菌药物耐药性（AMR）使医疗相关感染的治疗变得复杂，导致高发病率和死亡率，尤其是在低体重和重症婴儿中。本研究评估了费莱格·希沃特医院的AMR流行情况、危险因素、结局及感染控制措施，旨在指导临床实践、抗菌药物管理并改善新生儿健康结局。
这项混合方法研究（2022年10月至2023年6月）通过分析420份血样、环境拭子以及工作人员的见解来评估NICU新生儿中的AMR。双变量和多变量回归确定了显著变量，并使用内容分析法对定性数据进行分析。
在420份样本中，35%的样本检测出AMR病原体呈阳性，其中凝固酶阴性葡萄球菌（16.7%）、肺炎克雷伯菌（12.9%）和不动杆菌属（5.6%）最为常见。庆大霉素、复方新诺明和环丙沙星的耐药率高得惊人（98 - 100%），而阿米卡星的耐药率较低（3.0 - 5.56%），显示出潜在疗效。在入院的新生儿中，91.8%存活，8.2%死亡。危险因素分析显示，个人防护装备（PPE）使用不当（调整后比值比[AOR] 3.90，p < 0.001）、洗手池无法正常使用（AOR 3.20，p < 0.001）以及消毒措施不足（AOR 2.70，p < 0.001）与微生物污染密切相关。环境因素，包括蟑螂的存在（AOR 1.80，p = 0.040）和高流量（AOR 2.10，p = 0.005），也是重要因素。定性数据分析证实，PPE使用不当、消毒措施不足、虫害控制挑战以及洗手池无法正常使用显著增加了NICU中的微生物污染风险，与定量研究结果一致。
本研究强调了NICU中导致AMR的关键因素，如感染预防与控制（IPC）措施不足和环境污染，以及对复方新诺明和环丙沙星的高耐药性。阿米卡星有望成为治疗凝固酶阴性葡萄球菌（CONS）的有效药物。包括加强IPC措施、工作人员培训和环境管理在内的紧急行动对于对抗AMR至关重要，可确保改善新生儿护理及结局。
