A Nursery Outbreak of Multiple-Aminoglycoside-ResistantEscherichia coli

Abstract

In the neonatal intensive care unit (NICU) of one hospital, 16 infants became colonized or infected with multiply-resistant Escherichia coli (MR-E.coli) over an 8-month period. Isolates were obtained from blood, urine, and sputum of three patients and from rectal surveillance cultures of 13 patients. The one patient with the blood isolate died. A matched case-control study identified continuous feeding (nine of 16 cases vs. one of 16 controls, p less than or equal to 0.001) and receipt of aminoglycosides (p less than or equal to 0.03) as risk factors. For case-babies not exposed to continuous feeding, duration of bolus feeding was significantly greater than for their controls (cases, 22 days; controls, 7 days; p less than or equal to 0.02). All 16 isolates were the same serotype and were resistant to amikacin, tobramycin, kanamycin, and gentamicin. The epidemiologic investigation suggested that MR-E. coli may have spread from person-to-person on the hands of personnel and that MR-E. coli persisted in the NICU for 8 months until effective control measures were instituted.

Prior antibiotic use and acquisition of multidrug-resistant organisms in hospitalized children: A systematic review

“…The articles included in this review were all observational studies: 12 were cohort studies (7 retrospective studies [19][20][21][22][23][24] and 5 prospective studies [25][26][27][28][29] ) and 17 were case-control studies. [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] The study sample for all articles were hospitalized children, although their ages differed among the studies. Seven studies included specific age ranges, 20,23,25,27,30,41,42 10 studies included only neonates, 19,21,24,26,28,29,32,37,38,47 and 12 studies did not provide an age range for the children included.…”

“…[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] The study sample for all articles were hospitalized children, although their ages differed among the studies. Seven studies included specific age ranges, 20,23,25,27,30,41,42 10 studies included only neonates, 19,21,24,26,28,29,32,37,38,47 and 12 studies did not provide an age range for the children included. 22,31,[33][34][35][36]39,40,[43][44][45][46] Organisms included in the articles were Enterobacteriaceae (n = 10), 19,22,26,…”

“…Seven studies included specific age ranges, 20,23,25,27,30,41,42 10 studies included only neonates, 19,21,24,26,28,29,32,37,38,47 and 12 studies did not provide an age range for the children included. 22,31,[33][34][35][36]39,40,[43][44][45][46] Organisms included in the articles were Enterobacteriaceae (n = 10), 19,22,26,35,36,[41][42][43][44][45] Klebsiella pneumoniae (n = 8), 21,23,27,28,34,38,46,47 Escherichia coli (n = 5), 23,33,37,46...…”

“…[19][20][21][30][31][32] Furthermore, 5 studies examined HACs only, 26,34,39,43,45 and 8 studies did not distinguish between HAIs and HACs. 28,33,[35][36][37][38]40,44 Ascertainment of antibiotic exposure differed across studies: 86% (n = 25) abstracted antibiotic use from the medical record, 19,20,[22][23][24][26][27][28][29][31][32][33][34][35][37][38][39][40][41][42][43][44][45][46][47] 3% (n = 1) utilized both parental recall and the medical record, 25 and 10% (n = 3) did not explicitly state how antibiotic exposure was ascertained. 21,30,36 Each study varied in its definitions of antibiotic use and HAI and/or HAC with an MDRO.…”

“…21,30,36 Each study varied in its definitions of antibiotic use and HAI and/or HAC with an MDRO. For antibiotic exposure, measures of use included previous receipt of particular antibiotic classes or drugs (n = 21), 19,20,[23][24][25][26][27]29,32,[34][35][36][37][38][39][40][41]43,[45][46][47] receipt of any antibiotics (n = 10), 20,21,23,25,30,33,39,41,43,45 duration of antibiotic therapy (n = 11), 19,22,28,29,31,33,39,42,44,45,47 and number of antibiotics received (n = 3). 19,42,44 In 14 studies, the period of exposure varied from 2 weeks to 6 months 20,<...>…”