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High Frequency of Multidrug-Resistant Gram-Negative Rods in 2 Neonatal Intensive Care Units in the Philippines

Published online by Cambridge University Press:  02 January 2015

Jennifer M. Litzow
Affiliation:
Department of Pediatrics, Boston Medical Center, Boston, Massachusetts Boston University School of Medicine, the Department of Medicine, Children's Hospital Boston, Boston, Massachusetts
Christopher J. Gill*
Affiliation:
Infectious Diseases Section, Department of Medicine, Boston, Massachusetts Center for International Health and Development, Department of International Health, Boston University School of Public Health, Boston, Massachusetts
Jose B. V. Mantaring
Affiliation:
Department of Neonatal Medicine, Manila, the Philippines
Matthew P. Fox
Affiliation:
Center for International Health and Development, Department of International Health, Boston University School of Public Health, Boston, Massachusetts
William B. MacLeod
Affiliation:
Center for International Health and Development, Department of International Health, Boston University School of Public Health, Boston, Massachusetts
Myrna Mendoza
Affiliation:
Microbiological Research Laboratory, Manila, the Philippines
Sookee Mendoza
Affiliation:
Philippines General Hospital, and the Department of Neonatology, Jose Fabella Memorial Hospital, Manila, the Philippines
Rebecca Scobie
Affiliation:
Department of Microbiology, University of Leicester, Leicester, United Kingdom
Charles W. Huskins
Affiliation:
College of Medicine, Mayo Clinic, Rochester, Minnesota, Manila, the Philippines
Donald A. Goldman
Affiliation:
Boston University School of Medicine, the Department of Medicine, Children's Hospital Boston, Boston, Massachusetts
David H. Hamer
Affiliation:
Infectious Diseases Section, Department of Medicine, Boston, Massachusetts Center for International Health and Development, Department of International Health, Boston University School of Public Health, Boston, Massachusetts
*
801 Massachusetts Ave., Boston, MA 02118 (cgill@bu.edu)

Abstract

Background.

Although hospital-acquired infections appear to be a growing threat to the survival of newborns in the developing world, the epidemiology of this problem remains poorly characterized.

Methods.

During a 10-month period, we conducted prospective longitudinal surveillance for colonization and bloodstream infection caused by gram-negative rods among all infants hospitalized in the 2 largest neonatal intensive care units in Manila, the Philippines. We determined antibiotic susceptibilities and calculated adjusted odds ratios for risk factors for bacteremia by means of multivariate logistic regression.

Results.

Of 1,831 neonates enrolled during a 10-month period, 1,017 (55.5%) became newly colonized and 358 (19.6%) became bacteremic with a drug-resistant gram-negative rod, most commonly Klebsiella species, Enterobacter species, Acinetobacter species, and Pseudomonas aeruginosa. Of the invasive isolates, 20% were resistant to imipenem, 41% to trimethoprim-sulfamethoxazole, 52% to amikacin, 63% to ampicillin-sulbactam, 67% to ceftazidime, and 80% to tobramycin. The factors significantly associated with an increased risk of bacteremia were mechanical ventilation and prematurity. Additionally, colonization with a drug-resistant gram-negative rod was an independent risk factor for bacteremia (odds ratio, 1.4 [95% confidence interval, 1.0-1.9]).

Conclusions.

Colonization with a drug-resistant gram-negative rod was an independent risk factor for sepsis. If our data are typical, the unusually high intensity of colonization pressure and disease caused by multidrug-resistant gram-negative rods at these 2 neonatal intensive care units indicates an emerging healthcare crisis in the developing world. Improved infection control methods are therefore critically needed in developing countries.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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