Abstract

The aim of this prospective cohort study was to determine the prevalence of gut colonization with multidrug-resistant (MDR) bacteria, risk factors for colonization, infection risk, and outcomes among preterm neonates hospitalized at a tertiary-care center in Serbia. During the period from December 2017 to April 2018, 103 neonates were screened for rectal carriage at admission and on the seventh day of life. Characterization of MDR strains was done by conventional microbiology and molecular methods. Out of 61 (59.2%) colonized neonates, 12 (11.6%) were found colonized at admission, while 49 (47.6%) became colonized at the study site. Among a total of 72 MDR isolates, extended-spectrum beta-lactamase (ESBL)-producing enterobacteria prevailed (56/72, 77%), followed by Acinetobacter baumannii (14/72, 19%). The majority of ESBL-producing strains carried multiple genes (blaTEM/blaCTX-M-15 or blaTEM/blaSHV). Longer previous hospitalization and delivery by cesarean section were associated with MDR colonization, while mechanical ventilation was a risk factor for colonization at the study site. Infections due to MDR bacteria were more frequent among colonized than non-colonized neonates, but not significantly, and mortality was low (1%) in the studied neonates. These results indicate that hospitalized preterm neonates in Serbia are rapidly colonized with a diversity of MDR species and resistance phenotypes/genotypes.

Highlights

  • The increasing health threat posed by multi-drug resistant (MDR) bacteria emerged alongside the rise and global dissemination of antimicrobial resistance

  • Of 103 randomly selected infants screened on admission during the first week of life, 61 were found to be colonized with MDR bacteria (11 with two different MDR bacteria); 42 were not colonized and served as a control group (Supplementary Materials Table S1)

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Summary

Introduction

The increasing health threat posed by multi-drug resistant (MDR) bacteria emerged alongside the rise and global dissemination of antimicrobial resistance. Premature neonates (born before 37 weeks of gestation) comprise a vulnerable population often requiring long-term hospitalization due to the overall immaturity, underdeveloped organ systems and need for invasive manipulations.

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