Antibiotic Resistance in the Neonatal Intensive Care Unit

Abstract

Antibiotic-resistant bacteria are an increasing problem in the NICU. Ineffective empiric antibiotic therapy is associated with increased risk for morbidity and mortality. Organisms that are resistant to multiple antimicrobial agents (multidrug-resistant organisms) are particularly problematic. These organisms may be transmitted to infants if infection control practices are not adhered to, or they may be created by antibiotic exposure. Therefore, meticulous infection prevention—including hand hygiene, surveillance cultures, contact precautions, and selective decolonization—and antibiotic stewardship are important strategies to minimize drug resistance in the NICU.

The ongoing challenge of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Europe: an epidemiological analysis of bloodstream infections

“…This may be explained by the lower frequency of hospital admission and/or lower consumption of antibiotics among children and adolescents in Europe compared to other age groups [44]. Increasing VREFm proportions in infants not neonates and elderly patients is of concern since ineffective antibiotic therapies are associated with increased mortality and morbidity in these vulnerable patient groups [45][46][47].…”

Review of Drug Utilization Studies in Neonatal Units: A Global Perspective

“…Authors suggest that this is driven by the high levels of ampicillin resistance and prohibition of gentamicin use due to the high risk of hearing loss in the population. Against this backdrop, the widespread availability and antimicrobial use in neonates and the contribution of antimicrobial resistance as a complicating factor in neonatal sepsis becomes extremely important and rather than increasing use of antibiotics, infection prevention measures such as hand hygiene, surveillance cultures, contact precautions and antibiotic stewardship should be implemented [86].…”

Impact of Probiotic B. Infantis EVC001 Feeding in Premature Infants on the Gut Microbiome, Nosocomially Acquired Antibiotic Resistance, and Enteric Inflammation

“…The majority of the ARGs identified in this study are known to be present in potentially pathogenic bacterial species, including Klebsiella and Enterobacter spp., which are responsible for nosocomial infections as well as more severe morbidities including NEC [52,K 53] and late-onset sepsis [52,K 53]. In addition, we detected unique ARG signatures transferred to infants, and were able to observe the rapid acquisition of site-specific ARGs, which highlights the NICU environment as a source of antibiotic resistance microbes that can be transferred between NICUs [54]. We also found that infants acquire these ARGs throughout their NICU stay, suggesting that reducing hospitalization times may limit the acquisition of nosocomially acquired antibiotic-resistant bacteria.…”