Incidence of Healthcare-Associated Infections in a Neonatal Intensive Care Unit before and during the COVID-19 Pandemic: A Four-Year Retrospective Cohort Study

Ceparano, Mariateresa; Sciurti, Antonio; Isonne, Claudia; Baccolini, Valentina; Migliara, Giuseppe; Marzuillo, Carolina; Natale, Fabio; Terrin, Gianluca; Villari, Paolo

doi:10.3390/jcm12072621

Cited by 6 publications

(1 citation statement)

References 51 publications

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“…As for upper tract MDROs, our study showed a significant reduction in MSSA carriage. Contrarily, MRSA carriage significantly increased in NICU C, as a study performed by Meschiari et al showed a significant increase in the rate of MRSA, probably due to a clonal spread during the SARS-CoV-2 pandemic [38]; the same results were registered by Ceparano et al [39]. The rise in the carriage of MRSA during the pandemic period was probably due both to the high rate of empirical antibiotic use among infected patients, and to the reduction in active surveillance rates, isolation of MRSA carriers, and contact precautions by healthcare providers [26,40].…”

Section: Discussionsupporting

confidence: 64%

Surveillance of Multidrug-Resistant Pathogens in Neonatal Intensive Care Units of Palermo, Italy, during SARS-CoV-2 Pandemic

Graziano,

Notarbartolo,

Priano

et al. 2023

Antibiotics

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Background: Antimicrobial resistance (AMR) is a topic of concern, especially in high-level care departments like neonatal intensive care units (NICUs). The systematic use of an “active” epidemiological surveillance system allows us to observe and analyze any changes in microbial distribution, limiting the risk of healthcare-associated infection (HAI) development. Methods: We have conducted a longitudinal observational study in the five NICUs of Palermo, comparing the “pre-pandemic period” (March 2014–February 2020) with the “pandemic” one (March 2020–February 2022). The primary aim of the study was to evaluate the cumulative prevalence of carriage from multi-drug resistant (MDR) bacteria in the cumulative NICUs (NICU C). Results: During the “pre-pandemic period”, 9407 swabs were collected (4707 rectal, 4700 nasal); on the contrary, during the “pandemic period”, a total of 2687 swabs were collected (1345 rectal, 1342 nasal). A statistically significant decrease in MDR-Gram-negative bacteria (GNB) carriage prevalence was detected during the pandemic. At the same time, there was a general worsening of the carriage of carbapenemase-forming MDR-GNB (CARBA-R+) and methicillin-resistant Staphylococcus aureus (MRSA) during the pandemic period. A significant reduction in methicillin-susceptible Staphylococcus aureus (MSSA) carriage was detected too. Conclusions: The surveillance of MDRO carriage in NICUs is fundamental for limiting the social and economic burden of HAIs.

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Section: Discussionsupporting

confidence: 64%

Surveillance of Multidrug-Resistant Pathogens in Neonatal Intensive Care Units of Palermo, Italy, during SARS-CoV-2 Pandemic

Graziano,

Notarbartolo,

Priano

et al. 2023

Antibiotics

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Unraveling the epidemiology of urinary tract infections in neonates: Perspective from a Brazilian NICU

Ferreira,

Menezes,

Jesus

et al. 2024

American Journal of Infection Control

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Epidemiology, Risk Factors, and Outcomes of Health Care-Associated Infections in the Neonatal Intensive Care Unit: 6-Year Surveillance at a University Hospital in Türkiye

Erayman,

Bulut,

Kandemir

et al. 2024

J Pediatr Infect Dis

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Objective Health care-associated infections (HAIs) are important causes of morbidity and mortality in neonatal intensive care units (NICUs). This study aimed to evaluate the frequency of HAIs and related factors in the NICU. Methods HAIs detected and monitored by daily active surveillance by the Infection Control Team at Necmettin Erbakan University Faculty of Medicine NICU between January 1, 2017 and December 31, 2022 were evaluated retrospectively. There were a total of 43 incubators in our hospital's NICU (19 secondary level units and 24 tertiary level). Between 2017 and 2022, there was an average of 982 admissions to the NICU per year. Results A total of 5,895 newborns and 74,726 patient days were monitored in the study. The average HAIs rate for all study years was 3.4% and the incidence density was 2.68 per thousand patient days. The highest HAI rate was in newborns with birth weights < 750 g. A total of 201 HAIs were detected in 172 patients. Bloodstream infection (BSI) was the most frequent HAI. The most frequent pathogens were Klebsiella spp. (44.8%), methicillin-resistant coagulase-negative staphylococci (CoNS) (24.4%), and Acinetobacter spp. (11.6%). Note that 88.5% of Enterobacterales were extended-spectrum beta-lactamase producers, and 26% of Klebsiella spp. were carbapenem-resistant. No colistin resistance was detected in Pseudomonas aeruginosa and Acinetobacter spp. Methicillin resistance was detected in 86.5% of CoNS and 50% of Staphylococcus aureus. The vancomycin resistance rate in Enterococcus spp. was 40%. Note that 16.7% of Candida spp. were fluconazole-resistant; no resistance to caspofungin was found. The most common risk factors for development of HAI were prematurity, umbilical catheter use, total parenteral nutrition, and mechanical ventilation. The mortality rate in patients with HAIs was 20.9%. Conclusion HAIs, including those caused by multidrug-resistant Gram-negative bacteria, are an important problem in our hospital, and also globally. Active surveillance should be continued, and changes over the years evaluated. Infection control programs should be executed by determining the risk and mortality factors attributed to infection and their implementation should be closely monitored. These practices will increase success in the fight against HAIs and antimicrobial resistance.

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Incidence of Healthcare-Associated Infections in a Neonatal Intensive Care Unit before and during the COVID-19 Pandemic: A Four-Year Retrospective Cohort Study

Cited by 6 publications

References 51 publications

Surveillance of Multidrug-Resistant Pathogens in Neonatal Intensive Care Units of Palermo, Italy, during SARS-CoV-2 Pandemic

Surveillance of Multidrug-Resistant Pathogens in Neonatal Intensive Care Units of Palermo, Italy, during SARS-CoV-2 Pandemic

Unraveling the epidemiology of urinary tract infections in neonates: Perspective from a Brazilian NICU

Epidemiology, Risk Factors, and Outcomes of Health Care-Associated Infections in the Neonatal Intensive Care Unit: 6-Year Surveillance at a University Hospital in Türkiye

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