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Molecular Epidemiology of Antibiotic-Resistant Gram-Negative Bacilli in a Neonatal Intensive Care Unit During a Nonoutbreak Period
Gram-negative organisms that are resistant to parenteral antibiotics are a growing threat to hospitalized patients. This study was conducted to define the epidemiologic characteristics of these organisms during a nonoutbreak period in a neonatal intensive care unit (NICU). Nasopharyngeal and rectal...
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| Published in: | Pediatrics (Evanston) 2001-11, Vol.108 (5), p.1143-1148 |
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| creator | Toltzis, Philip Dul, Michael J Hoyen, Claudia Salvator, Ann Walsh, Michele Zetts, Laura Toltzis, Hasida |
| description | Gram-negative organisms that are resistant to parenteral antibiotics are a growing threat to hospitalized patients. This study was conducted to define the epidemiologic characteristics of these organisms during a nonoutbreak period in a neonatal intensive care unit (NICU).
Nasopharyngeal and rectal swab specimens were obtained 3 times a week from every infant in a tertiary care NICU during a 12-month period. Specimens were processed to identify aerobic Gram-negative species resistant to gentamicin, piperacillin-tazobactam, or ceftazidime. Selected clinical parameters were tested for their association with colonization with a resistant organism. Restriction endonuclease digests of genomic DNA were derived from isolates of the most frequently occurring species. The fragments were analyzed by pulsed-field gel electrophoresis (PFGE) to determine the genetic relatedness of the various isolates and thereby determine the length of colonization, the frequency of horizontal transmission, and the size and duration of clusters.
A total of 101 infants (8.6%) of 1180 admissions were colonized with at least 1 antibiotic-resistant bacillus before NICU discharge. Multiple parameters indicating a prolonged, complicated NICU course were associated with resistant colonization, including gestational age, length of stay, and exposure to several classes of antibiotics. Colonization with resistant bacilli occurred as early as the first NICU day, but acquisition continued throughout the infants' stay. A total of 436 isolates were analyzed by PFGE. On the basis of this molecular analysis, it was determined that duration of colonization was usually very short; the median for all species tested was |
| doi_str_mv | 10.1542/peds.108.5.1143 |
| format | article |
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Nasopharyngeal and rectal swab specimens were obtained 3 times a week from every infant in a tertiary care NICU during a 12-month period. Specimens were processed to identify aerobic Gram-negative species resistant to gentamicin, piperacillin-tazobactam, or ceftazidime. Selected clinical parameters were tested for their association with colonization with a resistant organism. Restriction endonuclease digests of genomic DNA were derived from isolates of the most frequently occurring species. The fragments were analyzed by pulsed-field gel electrophoresis (PFGE) to determine the genetic relatedness of the various isolates and thereby determine the length of colonization, the frequency of horizontal transmission, and the size and duration of clusters.
A total of 101 infants (8.6%) of 1180 admissions were colonized with at least 1 antibiotic-resistant bacillus before NICU discharge. Multiple parameters indicating a prolonged, complicated NICU course were associated with resistant colonization, including gestational age, length of stay, and exposure to several classes of antibiotics. Colonization with resistant bacilli occurred as early as the first NICU day, but acquisition continued throughout the infants' stay. A total of 436 isolates were analyzed by PFGE. On the basis of this molecular analysis, it was determined that duration of colonization was usually very short; the median for all species tested was <1 week. In addition, cross-colonization occurred in only 12% of all PFGE-analyzed isolates. Most clusters of cross-colonized infants were small, with the majority involving only 2 patients.
During endemic periods, acquisition of antibiotic-resistant Gram-negative bacilli in the NICU may occur very soon after admission, but colonization continues over many weeks of NICU stay. The duration of colonization with resistant bacilli is short, and horizontal transmission is unusual. These characteristics suggest a gradual but temporary incorporation of these organisms from the NICU environment into the nascent newborn microflora over time with little cross-colonization. These observations may aid the rational development of infection-control strategies to contain the reservoir of resistant Gram-negative organisms in the NICU.antibiotic resistance, Gram-negative bacilli, neonatal intensive care, antibiotic utilization, colonization, pulsed-field gel electrophoresis.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.108.5.1143</identifier><identifier>PMID: 11694694</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Elk Grove Village, IL: Am Acad Pediatrics</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anti-Bacterial Agents - pharmacology ; Antibiotics ; Babies ; Biological and medical sciences ; Carrier state (Communicable diseases) ; Ceftazidime - pharmacology ; Critical care ; DNA, Bacterial - analysis ; Drug resistance in microorganisms ; Drug Resistance, Microbial - genetics ; Electrophoresis, Gel, Pulsed-Field ; Emergency and intensive care: neonates and children. Prematurity. Sudden death ; Enterobacteriaceae - drug effects ; Enterobacteriaceae - genetics ; Epidemiology ; Gentamicins - pharmacology ; Gram-negative bacteria ; Gram-Negative Bacteria - drug effects ; Gram-Negative Bacteria - genetics ; Health aspects ; Humans ; Infants (Newborn) ; Intensive care medicine ; Intensive Care Units, Neonatal ; Medical sciences ; Microbial drug resistance ; Molecular Epidemiology ; Neonatal care ; Newborn infants ; Organisms ; Pediatrics ; Penicillanic Acid - analogs & derivatives ; Penicillanic Acid - pharmacology ; Piperacillin - pharmacology ; Prospective Studies ; Tazobactam</subject><ispartof>Pediatrics (Evanston), 2001-11, Vol.108 (5), p.1143-1148</ispartof><rights>2002 INIST-CNRS</rights><rights>COPYRIGHT 2001 American Academy of Pediatrics</rights><rights>COPYRIGHT 2001 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Nov 2001</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c601t-5d4c6eeb41f9b7c779f1b172f289847526c72c944c34387d59ce1e2b3e1cd3e53</citedby><cites>FETCH-LOGICAL-c601t-5d4c6eeb41f9b7c779f1b172f289847526c72c944c34387d59ce1e2b3e1cd3e53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14124802$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11694694$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Toltzis, Philip</creatorcontrib><creatorcontrib>Dul, Michael J</creatorcontrib><creatorcontrib>Hoyen, Claudia</creatorcontrib><creatorcontrib>Salvator, Ann</creatorcontrib><creatorcontrib>Walsh, Michele</creatorcontrib><creatorcontrib>Zetts, Laura</creatorcontrib><creatorcontrib>Toltzis, Hasida</creatorcontrib><title>Molecular Epidemiology of Antibiotic-Resistant Gram-Negative Bacilli in a Neonatal Intensive Care Unit During a Nonoutbreak Period</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>Gram-negative organisms that are resistant to parenteral antibiotics are a growing threat to hospitalized patients. This study was conducted to define the epidemiologic characteristics of these organisms during a nonoutbreak period in a neonatal intensive care unit (NICU).
Nasopharyngeal and rectal swab specimens were obtained 3 times a week from every infant in a tertiary care NICU during a 12-month period. Specimens were processed to identify aerobic Gram-negative species resistant to gentamicin, piperacillin-tazobactam, or ceftazidime. Selected clinical parameters were tested for their association with colonization with a resistant organism. Restriction endonuclease digests of genomic DNA were derived from isolates of the most frequently occurring species. The fragments were analyzed by pulsed-field gel electrophoresis (PFGE) to determine the genetic relatedness of the various isolates and thereby determine the length of colonization, the frequency of horizontal transmission, and the size and duration of clusters.
A total of 101 infants (8.6%) of 1180 admissions were colonized with at least 1 antibiotic-resistant bacillus before NICU discharge. Multiple parameters indicating a prolonged, complicated NICU course were associated with resistant colonization, including gestational age, length of stay, and exposure to several classes of antibiotics. Colonization with resistant bacilli occurred as early as the first NICU day, but acquisition continued throughout the infants' stay. A total of 436 isolates were analyzed by PFGE. On the basis of this molecular analysis, it was determined that duration of colonization was usually very short; the median for all species tested was <1 week. In addition, cross-colonization occurred in only 12% of all PFGE-analyzed isolates. Most clusters of cross-colonized infants were small, with the majority involving only 2 patients.
During endemic periods, acquisition of antibiotic-resistant Gram-negative bacilli in the NICU may occur very soon after admission, but colonization continues over many weeks of NICU stay. The duration of colonization with resistant bacilli is short, and horizontal transmission is unusual. These characteristics suggest a gradual but temporary incorporation of these organisms from the NICU environment into the nascent newborn microflora over time with little cross-colonization. These observations may aid the rational development of infection-control strategies to contain the reservoir of resistant Gram-negative organisms in the NICU.antibiotic resistance, Gram-negative bacilli, neonatal intensive care, antibiotic utilization, colonization, pulsed-field gel electrophoresis.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Antibiotics</subject><subject>Babies</subject><subject>Biological and medical sciences</subject><subject>Carrier state (Communicable diseases)</subject><subject>Ceftazidime - pharmacology</subject><subject>Critical care</subject><subject>DNA, Bacterial - analysis</subject><subject>Drug resistance in microorganisms</subject><subject>Drug Resistance, Microbial - genetics</subject><subject>Electrophoresis, Gel, Pulsed-Field</subject><subject>Emergency and intensive care: neonates and children. Prematurity. Sudden death</subject><subject>Enterobacteriaceae - drug effects</subject><subject>Enterobacteriaceae - genetics</subject><subject>Epidemiology</subject><subject>Gentamicins - pharmacology</subject><subject>Gram-negative bacteria</subject><subject>Gram-Negative Bacteria - drug effects</subject><subject>Gram-Negative Bacteria - genetics</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Infants (Newborn)</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units, Neonatal</subject><subject>Medical sciences</subject><subject>Microbial drug resistance</subject><subject>Molecular Epidemiology</subject><subject>Neonatal care</subject><subject>Newborn infants</subject><subject>Organisms</subject><subject>Pediatrics</subject><subject>Penicillanic Acid - analogs & derivatives</subject><subject>Penicillanic Acid - pharmacology</subject><subject>Piperacillin - pharmacology</subject><subject>Prospective Studies</subject><subject>Tazobactam</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><recordid>eNpt0kFv0zAUB_AIgVgZnLkhCwnEYelsx26SYymjTCobQuxsOc5L5uHane0Au_LJcdRKXVFlS46TX_y3nl6WvSZ4Sjij5xtow5TgasqnhLDiSTYhuK5yRkv-NJtgXJCcYcxPshch3GGMGS_p8-yEkFnN0pxkf786A2ow0qOLjW5hrZ1x_QNyHZrbqBvtolb5dwg6RGkjWnq5zq-gl1H_AvRRKm2MRtoiia7AWRmlQZc2gg3j94X0gG6sjujT4LXtR-WsG2LjQf5E38Br177MnnXSBHi1W0-zm88XPxZf8tX18nIxX-VqhknMecvUDKBhpKubUpVl3ZGGlLSjVV2xktOZKqmqGVMFK6qy5bUCArQpgKi2AF6cZu-35268ux8gRLHWQYEx0oIbgigp5TNelwm-_Q_eucHbdDdBaVVwlrITOtuiXhoQ2nYueql6sOClcRY6nV7PK0wpqckYnh_haYwlV8f8hwOfSIQ_sZdDCKJarg7o2TGqnDHQg0g1XFwf8PMtV96F4KETG6_X0j8IgsXYVGJsqrSpBBdjU6U_3uzqMTRraPd-10UJvNsBGZQ0nZdW6bB3jFCW8vfRt7q__a09jFFaRq9VePT4KPofBPHj7A</recordid><startdate>20011101</startdate><enddate>20011101</enddate><creator>Toltzis, Philip</creator><creator>Dul, Michael J</creator><creator>Hoyen, Claudia</creator><creator>Salvator, Ann</creator><creator>Walsh, Michele</creator><creator>Zetts, Laura</creator><creator>Toltzis, Hasida</creator><general>Am Acad Pediatrics</general><general>American Academy of Pediatrics</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20011101</creationdate><title>Molecular Epidemiology of Antibiotic-Resistant Gram-Negative Bacilli in a Neonatal Intensive Care Unit During a Nonoutbreak Period</title><author>Toltzis, Philip ; Dul, Michael J ; Hoyen, Claudia ; Salvator, Ann ; Walsh, Michele ; Zetts, Laura ; Toltzis, Hasida</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c601t-5d4c6eeb41f9b7c779f1b172f289847526c72c944c34387d59ce1e2b3e1cd3e53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Antibiotics</topic><topic>Babies</topic><topic>Biological and medical sciences</topic><topic>Carrier state (Communicable diseases)</topic><topic>Ceftazidime - pharmacology</topic><topic>Critical care</topic><topic>DNA, Bacterial - analysis</topic><topic>Drug resistance in microorganisms</topic><topic>Drug Resistance, Microbial - genetics</topic><topic>Electrophoresis, Gel, Pulsed-Field</topic><topic>Emergency and intensive care: neonates and children. Prematurity. Sudden death</topic><topic>Enterobacteriaceae - drug effects</topic><topic>Enterobacteriaceae - genetics</topic><topic>Epidemiology</topic><topic>Gentamicins - pharmacology</topic><topic>Gram-negative bacteria</topic><topic>Gram-Negative Bacteria - drug effects</topic><topic>Gram-Negative Bacteria - genetics</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Infants (Newborn)</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units, Neonatal</topic><topic>Medical sciences</topic><topic>Microbial drug resistance</topic><topic>Molecular Epidemiology</topic><topic>Neonatal care</topic><topic>Newborn infants</topic><topic>Organisms</topic><topic>Pediatrics</topic><topic>Penicillanic Acid - analogs & derivatives</topic><topic>Penicillanic Acid - pharmacology</topic><topic>Piperacillin - pharmacology</topic><topic>Prospective Studies</topic><topic>Tazobactam</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Toltzis, Philip</creatorcontrib><creatorcontrib>Dul, Michael J</creatorcontrib><creatorcontrib>Hoyen, Claudia</creatorcontrib><creatorcontrib>Salvator, Ann</creatorcontrib><creatorcontrib>Walsh, Michele</creatorcontrib><creatorcontrib>Zetts, Laura</creatorcontrib><creatorcontrib>Toltzis, Hasida</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Toltzis, Philip</au><au>Dul, Michael J</au><au>Hoyen, Claudia</au><au>Salvator, Ann</au><au>Walsh, Michele</au><au>Zetts, Laura</au><au>Toltzis, Hasida</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Molecular Epidemiology of Antibiotic-Resistant Gram-Negative Bacilli in a Neonatal Intensive Care Unit During a Nonoutbreak Period</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2001-11-01</date><risdate>2001</risdate><volume>108</volume><issue>5</issue><spage>1143</spage><epage>1148</epage><pages>1143-1148</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>Gram-negative organisms that are resistant to parenteral antibiotics are a growing threat to hospitalized patients. This study was conducted to define the epidemiologic characteristics of these organisms during a nonoutbreak period in a neonatal intensive care unit (NICU).
Nasopharyngeal and rectal swab specimens were obtained 3 times a week from every infant in a tertiary care NICU during a 12-month period. Specimens were processed to identify aerobic Gram-negative species resistant to gentamicin, piperacillin-tazobactam, or ceftazidime. Selected clinical parameters were tested for their association with colonization with a resistant organism. Restriction endonuclease digests of genomic DNA were derived from isolates of the most frequently occurring species. The fragments were analyzed by pulsed-field gel electrophoresis (PFGE) to determine the genetic relatedness of the various isolates and thereby determine the length of colonization, the frequency of horizontal transmission, and the size and duration of clusters.
A total of 101 infants (8.6%) of 1180 admissions were colonized with at least 1 antibiotic-resistant bacillus before NICU discharge. Multiple parameters indicating a prolonged, complicated NICU course were associated with resistant colonization, including gestational age, length of stay, and exposure to several classes of antibiotics. Colonization with resistant bacilli occurred as early as the first NICU day, but acquisition continued throughout the infants' stay. A total of 436 isolates were analyzed by PFGE. On the basis of this molecular analysis, it was determined that duration of colonization was usually very short; the median for all species tested was <1 week. In addition, cross-colonization occurred in only 12% of all PFGE-analyzed isolates. Most clusters of cross-colonized infants were small, with the majority involving only 2 patients.
During endemic periods, acquisition of antibiotic-resistant Gram-negative bacilli in the NICU may occur very soon after admission, but colonization continues over many weeks of NICU stay. The duration of colonization with resistant bacilli is short, and horizontal transmission is unusual. These characteristics suggest a gradual but temporary incorporation of these organisms from the NICU environment into the nascent newborn microflora over time with little cross-colonization. These observations may aid the rational development of infection-control strategies to contain the reservoir of resistant Gram-negative organisms in the NICU.antibiotic resistance, Gram-negative bacilli, neonatal intensive care, antibiotic utilization, colonization, pulsed-field gel electrophoresis.</abstract><cop>Elk Grove Village, IL</cop><pub>Am Acad Pediatrics</pub><pmid>11694694</pmid><doi>10.1542/peds.108.5.1143</doi><tpages>6</tpages></addata></record> |
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| ispartof | Pediatrics (Evanston), 2001-11, Vol.108 (5), p.1143-1148 |
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| language | eng |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Bacterial Agents - pharmacology Antibiotics Babies Biological and medical sciences Carrier state (Communicable diseases) Ceftazidime - pharmacology Critical care DNA, Bacterial - analysis Drug resistance in microorganisms Drug Resistance, Microbial - genetics Electrophoresis, Gel, Pulsed-Field Emergency and intensive care: neonates and children. Prematurity. Sudden death Enterobacteriaceae - drug effects Enterobacteriaceae - genetics Epidemiology Gentamicins - pharmacology Gram-negative bacteria Gram-Negative Bacteria - drug effects Gram-Negative Bacteria - genetics Health aspects Humans Infants (Newborn) Intensive care medicine Intensive Care Units, Neonatal Medical sciences Microbial drug resistance Molecular Epidemiology Neonatal care Newborn infants Organisms Pediatrics Penicillanic Acid - analogs & derivatives Penicillanic Acid - pharmacology Piperacillin - pharmacology Prospective Studies Tazobactam |
| title | Molecular Epidemiology of Antibiotic-Resistant Gram-Negative Bacilli in a Neonatal Intensive Care Unit During a Nonoutbreak Period |
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