Bacterial Invasive infections in a neonatal intensive care unit: a 13 years microbiological report from a tertiary referral centre
Vol. 61 No. 2 (2020), Infectious Diseases
Vol. 61 No. 2 (2020)

Bacterial Invasive infections in a neonatal intensive care unit: a 13 years microbiological report from a tertiary referral centre

Infectious Diseases
https://doi.org/10.15167/2421-4248/jpmh2020.61.1.1401
Published 2020-03-03
Marcello Mariani
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Italy
Roberto Bandettini
Istituto Giannina Gaslini
Daniela La Masa
Istituto Giannina Gaslini
Diego Minghetti
Istituto Giannina Gaslini
Ivana Baldelli
Simona Serveli
Alessio Mesini
Istituto Giannina Gaslini
Luca A. Ramenghi
Istituto Giannina Gaslini
Elio Castagnola
Istituto Giannina Gaslini Children's Hospital
pdf

Keywords

NICU, invasive infections, colonization, Staphylococcus aureus

Abstract

Introduction: To evaluate the aetiology of neonatal invasive diseases (positive cultures from blood or cerebrospinal fluid) due to bacteria other than coagulase-negative staphylococci in a large third-level centre and compare with results of surveillance cultures.

Methods: Retrospective analysis of microbiological data of children admitted in neonatal intensive care unit (NICU) of a large third-level centre from 2005 to 2018.

Results: 230 bacterial strains, 223 from blood and 7 from CSF, were detected as cause of invasive infections, while 152 were detected in surveillance cultures.

Methicillin-susceptible Staphylococcus aureus (MSSA) was the most frequently isolated pathogen both in invasive infections (18%) and colonizations (23%) followed by Escherichia coli (16% on invasive disease and 20% of colonizations). Other common bacteria include Enterococcus faecalis and Streptococcus agalactiae for invasive disease and Meticillin-resistant Stapylococcus aureus (MRSA) with regard to colonization. Disease was due to a pathogen detected in surveillance cultures flora in 33%. In more than 50% of invasive diseases the identified pathogen was not present in surveillance cultures.

Conclusion: The high percentage of invasive infections due to bacteria not previously identified in surveillance cultures raises doubts about the efficiency of this procedure and highlights the need to search for alternative infection sources. This finding and the high prevalence of invasive infections due to nosocomial pathogens such as Staphylococcus aureus could be the result of horizontal transmission between patients through the hands of health care professionals, emphasizing once again the importance of applying stringent hand hygiene procedures and isolation standards.

https://doi.org/10.15167/2421-4248/jpmh2020.61.1.1401
pdf

References

[1] Vergnano S, Sharland M, Kazembe P, Mwansambo C, Heath PT. Neonatal sepsis: an international perspective. Arch Dis Child Fetal Neonatal Ed 2005; 90: F220-F224. doi: 10.1136/adc.2002.022863
[2] Wynn JL, Wong HR, Shanley TP, Bizzarro MJ, Saiman L, Polin RA. Time for a neonatal-specific consensus definition for sepsis. Pediatr Crit Care Med 2014; 15: 523-528. doi: 10.1097/PCC.0000000000000157.
[3] Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev 2014; 27: 21-47. doi: 10.1128/CMR.00031-13.
[4] Golden J, Zagory JA, Gayer CP, Grikscheit TC, Ford HR. Neonatal sepsis. Newborn Surgery, Fourth Ed 2017; 390: 217-232. doi: 10.4324/9781315113968.
[5] Yalaz M, Cetin H, Akisu M, Aydemir S, Tunger A, Kültürsay N. Neonatal nosocomial sepsis in a level-III NICU: evaluation of the causative agents and antimicrobial susceptibilities. Turk J Pediatr 2006; 48: 13-18.
[6] Swinscow TD. Statistics at square one. IX--Percentages. Br Med J 1976; 2: 166-167.
[7] Manzoni P, De Luca D, Stronati M, et al. Prevention of nosocomial infections in neonatal intensive care units. Am J Perinatol 2013; 30: 81-88. doi: 10.1055/s-0032-1333131.
[8] Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006; 6: 130. doi: 10.1186/1471-2334-6-130.
[9] Joseph CJ, Lian W Bin, Yeo CL. Nosocomial infections (late onset sepsis) in the neonatal intensive care unit (NICU). Proc Singapore Healthc 2012; 21: 238-244.
[10] Rana D, Abughali N, Kumar D, Super DM, Jacobs MR, Kumar ML. Staphylococcus aureus, including community-acquired methicillin-resistant S. aureus, in a level III NICU: 2001 to 2008. Am J Perinatol 2012; 29: 401-408. doi: 10.1055/s-0032-1304819.
[11] Jiang JH, Chiu NC, Huang FY, et al. Neonatal sepsis in the neonatal intensive care unit: characteristics of early versus late onset. J Microbiol Immunol Infect 2004; 37: 301-306.
[12] Risso FM, Castagnola E, Bandettini R, Minghetti D, Pagani L, Ramenghi LA. Group B Streptococcus late onset sepsis in very low birth weight newborns: 10 years experience. J Matern Fetal Neonatal Med 2018; 31: 18-20. doi: 10.1080/14767058.2016.1242121.
[13] Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics 2005; 116: 595-602. doi: 10.1542/peds.2005-0552.
[14] Sypsa V, Psichogiou M, Bouzala GA, Hadjihannas L, Hatzakis A, Daikos GL. Transmission dynamics of carbapenemase-producing Klebsiella pneumoniae and anticipated impact of infection control strategies in a surgical unit. PLoS One 2012; 7: e41068. doi: 10.1371/journal.pone.0041068.
[15] Tatarelli P, Lorenzi I, Caviglia I, Sacco RA, LA Masa D, Castagnola E. Estimation of mean number of daily hand hygiene procedures per patient can represent an effective and easy understandable method to evaluate adherence experience in a tertiary care pediatric hospital of Northern Italy. J Prev Med Hyg 2016; 57: E185-E189.
[16] Risso FM, Minghetti D, Mariani M, et al. Behaviours monitoring and infection control in neonatal intensive care unit: how to improve ourselves? J Prev Med Hyg 2019; 60: E226-E228.
[17] McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. More than hand hygiene is needed to affect methicillin-resistant Staphylococcus aureus clinical indicator rates: clean hands save lives, part IV. Med J Aust 2009; 191: S26-S31.