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Abstract
IntroductionInfections due to extended spectrum beta-lactamase producing organisms (ESBL) have emerged as the leading cause of sepsis among hospitalized neonates in Botswana and much of sub-Saharan Africa and south Asia. Yet, ESBL reservoirs and transmission dynamics within the neonatal intensive care unit (NICU) environment are not well-understood. This study aimed to assess the efficiency and feasibility of a chromogenic-culture-media-based environmental sampling approach to characterize the ESBL bioburden within a NICU.MethodsA series of four point-prevalence surveys were conducted at a 36-bed NICU at a public tertiary referral hospital in Botswana from January-June 2021. Samples were collected on 4 occasions under semi-sterile technique using 1) flocked swabs & templates (flat surfaces); 2) sterile syringe & tubing (water aspiration); and 3) structured swabbing techniques (hands & equipment). Swabs were transported in physiological saline-containing tubes, vortexed, and 10 µL was inoculated onto chromogenic-agar that was selective and differential for ESBL (CHROMagar™ ESBL, Paris, France), and streaking plates to isolate individual colonies. Bacterial colonies were quantified and phenotypically characterized using biochemical identification tests.ResultsIn total, 567 samples were collected, 248 (44%) of which grew ESBL. Dense and consistent ESBL contamination was detected in and around sinks and certain high-touch surfaces, while transient contamination was demonstrated on medical equipment, caregivers/healthcare worker hands, insects, and feeding stations (including formula powder). Results were available within 24–72 h of collection. To collect, plate, and analyse 50 samples, we estimated a total expenditure of $269.40 USD for materials and 13.5 cumulative work hours among all personnel.ConclusionsUsing basic environmental sampling and laboratory techniques aided by chromogenic culture media, we identified ESBL reservoirs (sinks) and plausible transmission vehicles (medical equipment, infant formula, hands of caregivers/healthcare workers, & insects) in this NICU environment. This strategy was a simple and cost-efficient method to assess ESBL bioburden and may be feasible for use in other settings to support ongoing infection control assessments and outbreak investigations.
Highlights
Infections due to extended spectrum beta-lactamase producing organisms (ESBL) have emerged as the leading cause of sepsis among hospitalized neonates in Botswana and much of sub-Saharan Africa and south Asia
Bacteria in the Enterobacterales (e.g. Klebsiella, Enterobacter spp.) and Pseudomonadales (e.g. Acinetobacter, Pseudomonas spp.) orders are well suited to survive in moist and warm settings and emerging data suggest that damp reservoirs within the hospital environment, such as sink drains, washbasins, and oxygen humidifiers, could contribute to the acquisition of ESBL among patients [8,9,10]
Little is known about potential ESBL reservoirs within neonatal intensive care unit (NICU) and whether they contribute to neonatal colonization and disease
Summary
Infections due to extended spectrum beta-lactamase producing organisms (ESBL) have emerged as the leading cause of sepsis among hospitalized neonates in Botswana and much of sub-Saharan Africa and south Asia. ESBL reservoirs and transmission dynamics within the neonatal intensive care unit (NICU) environment are not well-understood. Infections due to multidrug resistant (MDR) enteric organisms have emerged as the leading causes of neonatal sepsis in sub-Saharan Africa and south Asia [1,2,3]. Over 80% of neonatal bloodstream Klebsiella isolates in this setting are reported to be extended spectrum beta-lactamase producing 1[4]. Infection prevention efforts are often thwarted because the ecology and transmission dynamics of these organisms within the neonatal intensive care unit (NICU) are not well understood. Little is known about potential ESBL reservoirs within NICUs and whether they contribute to neonatal colonization and disease
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