High Frequency of Multidrug‐Resistant Gram‐Negative Rods in 2 Neonatal Intensive Care Units in the Philippines

• Published in: Infection control and hospital epidemiology 2009-06, Vol.30 (6), p.543-549
• Main Authors: Litzow, Jennifer M., Gill, Christopher J., Mantaring, Jose B. V., Fox, Matthew P., MacLeod, William B., Mendoza, Myrna, Mendoza, Sookee, Scobie, Rebecca, Huskins, Charles W., Goldman, Donald A., Hamer, David H.
• Format: Article
• Language: English
• Subjects: Acinetobacter; Anti-Bacterial Agents - pharmacology; Antibiotics; Bacteremia; Bacteremia - epidemiology; Bacteremia - microbiology; Biological and medical sciences; Birth weight; Carrier State - epidemiology; Carrier State - microbiology; Drug Resistance, Multiple, Bacterial; Enterobacter; Female; Gram-Negative Bacteria - classification; Gram-Negative Bacteria - drug effects; Gram-Negative Bacteria - isolation & purification; Gram-Negative Bacterial Infections - epidemiology; Gram-Negative Bacterial Infections - microbiology; Humans; Infant, Extremely Low Birth Weight; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - epidemiology; Infant, Premature, Diseases - microbiology; Infants; Infections; Intensive Care Units, Neonatal; Klebsiella; Male; Medical sciences; Microbial colonization; Microbial Sensitivity Tests; Miscellaneous; Newborns; Nursing; Original Article; Pathogens; Philippines - epidemiology; Pseudomonas aeruginosa; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Sepsis; Southeast Asian culture
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/597512

Although hospital-acquired infections appear to be a growing threat to the survival of newborns in the developing world, the epidemiology of this problem remains poorly characterized. During a 10-month period, we conducted prospective longitudinal surveillance for colonization and bloodstream infection caused by gram-negative rods among all infants hospitalized in the 2 largest neonatal intensive care units in Manila, the Philippines. We determined antibiotic susceptibilities and calculated adjusted odds ratios for risk factors for bacteremia by means of multivariate logistic regression. Of 1,831 neonates enrolled during a 10-month period, 1,017 (55.5%) became newly colonized and 358 (19.6%) became bacteremic with a drug-resistant gram-negative rod, most commonly Klebsiella species, Enterobacter species, Acinetobacter species, and Pseudomonas aeruginosa. Of the invasive isolates, 20% were resistant to imipenem, 41% to trimethoprim-sulfamethoxazole, 52% to amikacin, 63% to ampicillin-sulbactam, 67% to ceftazidime, and 80% to tobramycin. The factors significantly associated with an increased risk of bacteremia were mechanical ventilation and prematurity. Additionally, colonization with a drug-resistant gram-negative rod was an independent risk factor for bacteremia (odds ratio, 1.4 [95% confidence interval, 1.0-1.9]). Colonization with a drug-resistant gram-negative rod was an independent risk factor for sepsis. If our data are typical, the unusually high intensity of colonization pressure and disease caused by multidrug-resistant gram-negative rods at these 2 neonatal intensive care units indicates an emerging healthcare crisis in the developing world. Improved infection control methods are therefore critically needed in developing countries.