Impact of transition from open bay to single room design neonatal intensive care unit on multidrug-resistant organism colonization rates

A Van Der Hoeven,V Bekker,S.J Jansen,B Saccoccia,R.J.M Berkhout,E Lopriore,K.E Veldkamp,M.T Van Der Beek

doi:10.1016/j.jhin.2021.12.006

A Van Der Hoeven, V Bekker + Show 6 more

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https://doi.org/10.1016/j.jhin.2021.12.006

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Abstract

The influence of the neonatal intensive care unit (NICU) design on the acquisition of multidrug-resistant organisms (MDROs) has not been well-documented. To examine the effect of single room unit (SRU) versus open bay unit (OBU) design on the incidence of colonization with MDROs and third-generation cephalosporin-resistant bacteria (3G-CRB) in infants admitted to the NICU. Retrospective cohort study, including all infants admitted to the NICU of a tertiary care academic hospital two years prior to and two years following the transition from OBU to SRU in May 2017. Weekly cultures of throat and rectum were collected to screen for MDRO carriership. Incidence of colonization (percentage of all infants and incidence density per 1000 patient-days) with MDROs and 3G-CRB were compared between OBU and SRU periods. Incidence analysis of 1293 NICU infants, identified 3.2% MDRO carriers (2.5% OBU, 4.0% SRU, not significant), including 2.3% extended-spectrum β-lactamase-producing Enterobacterales carriers, and 18.6% 3G-CRB carriers (17% OBU, 20% SRU, not significant). No differences were found in MDRO incidence density per 1000 patient-days between infants admitted to OBU (1.56) compared to SRU infants (2.63). Transition in NICU design from open bay to SRUs was not associated with a reduction in colonization rates with MDROs or 3G-CRB in our hospital. Further research on preventing the acquisition and spread of resistant bacteria at high-risk departments such as the NICU, as well as optimal ward design, are needed.

Highlights

Antibiotic resistance is an increasing problem, even more so in intensive care units, where patients frequently have antibiotics prescribed.[1, 2] Infants admitted to the neonatal intensive care unit (NICU) are affected by antibiotic treatment and resistance because of their newly developing gut microbiota
The aim of this study was to determine whether colonization with Gram-negative multidrug resistant organisms (MDRO), including extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), and thirdgeneration cephalosporin resistant bacteria (3G-CRB) in infants admitted to the NICU would be reduced following the transition to single room units
In 1,433 infants screening cultures were collected, whom were subsequently included in the infection analyses (759 in open bay units (OBU), 673 in single room units (SRU), 1 infant admitted on the day of unit transition)

Summary

Introduction

Antibiotic resistance is an increasing problem, even more so in intensive care units, where patients frequently have antibiotics prescribed.[1, 2] Infants admitted to the neonatal intensive care unit (NICU) are affected by antibiotic treatment and resistance because of their newly developing gut microbiota. Journal Pre-proof towards more intrinsically resistant gut microbiota and may increase the risk for multidrug resistant organisms (MDRO) acquisition.[3] Bacterial colonization of the infant’s gut is a natural process, and is influenced by dietary and medical factors.[4,5,6] Colonization with MDRO in infants has multiple risk factors, of which an important one is maternal MDRO colonization.[7] Other sources of MDRO acquisition for infants admitted to the NICU may be the hospital environment, health care workers (HCWs) and other caregivers. Since outbreaks with intrinsically resistant Gram-negative rods, such as Serratia marcescens and Enterobacter species have been described in NICU settings[10, 11], these may be influenced by unit design as well

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