Reduction in colonization and nosocomial infection by multiresistant bacteria in a neonatal unit after institution of educational measures and restriction in the use of cephalosporins

• Published in: American journal of infection control 2001-06, Vol.29 (3), p.133-138
• Main Authors: Calil, Roseli, Marba, Sérgio Tadeu Martins, von Nowakonski, Angela, Tresoldi, Antonia Teresinha
• Format: Article
• Language: English
• Subjects: Analysis of Variance; Bacterial Infections - epidemiology; Bacterial Infections - microbiology; Bacterial Infections - prevention & control; Biological and medical sciences; Brazil - epidemiology; Cephalosporins - therapeutic use; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - prevention & control; Cross-Sectional Studies; Drug Resistance, Multiple; Enterobacter cloacae; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - prevention & control; General aspects; Humans; Infant, Newborn; Infection Control - organization & administration; Inservice Training; Intensive Care Units, Neonatal; Medical sciences; Planification. Prevention (methods). Intervention. Evaluation; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1067/mic.2001.114223

Introduction: Previous administration of third-generation cephalosporins predisposes to colonization and infections by multiresistant Enterobacter sp. The emergence of multiresistant bacteria infections in a neonatal unit during 1995, especially Enterobacter cloacae , stimulated this study. Objective: To evaluate the efficacy of measures to control colonization and nosocomial infection by multiresistant bacteria in a neonatal unit. Setting: A tertiary care university hospital. Patients and Methods: This study was conducted from October 1995 through December 1999 in 4 phases: a cross-sectional study, a longitudinal study with intervention measures, monthly cross-sectional studies, and determination of nosocomial infections caused by multiresistant bacteria (oxacillin-resistant Staphylococcus aureus and gram-negative bacteria resistant to either aminoglycosides or third-generation cephalosporins). Specimens for surveillance culture were obtained through umbilical and rectal swabs, and tracheal aspirates from intubated babies. The intervention measures were as follows: (1) appropriated training of the whole health care team, emphasizing measures to reduce cross-colonization, and the importance of rational usage of antibiotics and (2) suppression of usage of third-generation cephalosporins. Risk factors were analyzed through univariate and multivariate logistic regression. Results: In the first phase, 32% (10/31) of the patients were colonized by multiresistant bacteria (29% by multiresistant E cloacae ). In the second phase, 342 patients were evaluated; 33% of them were colonized by E cloacae, and a multiresistant strain was isolated in 10.8% (37/342) of the babies. A logistic regression model indicated parenteral nutrition and antibiotic usage as risk factors for colonization by multiresistant E cloacae. In the third phase, for 6 months, only 2 patients were colonized by multiresistant E cloacae. In the fourth phase, the analysis of bacterial resistance profile indicated a reduction of nosocomial infections due to multiresistant bacteria from 18 cases in 1995 to 2 cases per year until 1999. Conclusion: These results have shown that the measures adopted were effective. (Am J Infect Control 2001;29:133-8)