Intense intestinal carriage and subsequent acquisition of multidrug-resistant enterobacteria in neonatal intensive care unit in Morocco

Abstract

This study was conducted in order to know the colonization rate of MDR enterobacteria in neonates during their hospitalization in neonatal intensive care unit (NICU). Furthermore, we investigated risk factors for potential colonization and molecular epidemiology of isolated resistant bacteria. This prospective study was carried out in the neonatology and intensive care unit department of the University Hospital of Fez (Morocco) from February 2013 to July 2015. All consecutive admitted newborns were screened for intestinal and nasal carriage of MDR enterobacteria at admission of the babies and during the hospitalization. During the study period, a total of 641 Enterobacteriaceae were isolated and Klebsiella pneumoniae was the predominated bacteria. Bacterial identification and antibiograms were performed according to the international standards. On admission, 455 newborns were screened. A median age of these newborns was 1 day with an extended 147 days and their average weight was 2612 ± 1023 grams. 22.4% of neonates were found colonized by an ESBL producing Enterobacteriaceae (ESBL-E), 8.7% by a carbapenemases producing Enterobacteriaceae (CPE). During hospitalization, 207 of newborns were included in the acquisition study. 59.4% of newborns acquired an ESBL-E during their stay, 12.5% has acquired CPE. The blaCTXM-15 gene was the most frequently detected (81.2%) among ESBL-E. While, all CPE has expressed the blaOXA-48 gene exclusively. Two risk factors have been significantly associated with MDR enterobacteria colonization at admission which are newborns admission from maternity of the university hospital (95% CI, 1.859–5.129, P = 0.000) and neurological distress (95% CI, 1.038 to 4.694, P = 0.040). During hospitalization, the none risk factor was significantly associated with the carriage of MDR-E. The high rate of colonization, the MDR enterobacteria and the resistance genes found represent good indicator of cross-transmission in the NICU. An active strategy to control the spread of MDR enterobacteria should be applied.

Multi-resistant Bacteria to Antibiotics in Hospitals: The Case of Neonatology Services of the University Hospitals Centers of Abidjan, Côte d'Ivoire

“…The distribution of MDRs by origin of samples showed relatively high rates in blood cultures (37.7%) and rectal carriage (35.2%) in neonates. These results are in conformity with that of Zou et al, 2021 in China and Arhoune et al, 2021in Morocco [12,13]. Several works have, in addition, shown that the main correlative risk factors for the emergence of MDRs in newborns have been low birth weight, gestational age, long hospital stay associated with prematurity and cumulative antibiotic exposure, among others [14][15][16].…”

“…In our study, more than 45% of E-ESBL were isolated from neonatal rectal carriage. Studies conducted in Morocco have shown prevalence of 22.4% at the time of admission of newborns to the neonatal unit and 92.4% during their stay in the unit [13]. Other authors have reported a rate of 77% of rectal carriage E-ESBL in this age group [27].…”

Colonization with Multidrug-Resistant Bacteria in the First Week of Life among Hospitalized Preterm Neonates in Serbia: Risk Factors and Outcomes

“…In general, prevalence of MDR colonization in hospitalized neonates varies widely, with rates in Western countries varying from 1% in USA [23], to up to 25% in Germany [9] and 30% in Italy [21]. Much higher frequencies were recorded in less developed countries such as Morocco (60%) [24], Ethiopia (74%) [25] and Madagascar (>70%) [26]. Unlike other studies, we focused on early MDR colonization in the first week of life among hospitalized preterm neonates.…”

Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers

“…In Serbia (2017-2018), gut carriage with ESBL-producing Kp (ESBL-Kp) or ESBL-producing Ec (ESBL-Ec) was recorded in 59% of the hospitalized pre-term neonates; previous hospitalization, delivery by cesarean section, and mechanical ventilation were associated with colonization [68]. In a study from Morocco (2013Morocco ( -2015, up to 59.4% and 12.5% of the neonatal ICU (NICU)-patients were colonized with ESBL-Ent and CPE, respectively [69]. CPE carriage was also observed in 8.6% of inpatients in a pediatric hospital in China (2019), with those colonized having a history of invasive procedures and antibiotic exposures [70].…”