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Conjunctival Colonization of Infants Hospitalized in a Neonatal Intensive Care Unit: A Longitudinal Analysis

Published online by Cambridge University Press:  02 January 2015

Craig H. Raskind ,
Barbara E. Sabo ,
Deborah A. Callan ,
Patricia A. Farrel ,
Louise-Marie Dembry  and
Patrick G. Gallagher
Craig H. Raskind
Affiliation:
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
Barbara E. Sabo
Affiliation:
Department of Pediatric Nursing, Yale-New Haven Hospital, New Haven, Connecticut
Deborah A. Callan
Affiliation:
Quality Improvement Services, Yale-New Haven Hospital, New Haven, Connecticut
Patricia A. Farrel
Affiliation:
Quality Improvement Services, Yale-New Haven Hospital, New Haven, Connecticut
Louise-Marie Dembry
Affiliation:
Quality Improvement Services, Yale-New Haven Hospital, New Haven, Connecticut
Patrick G. Gallagher*
Affiliation:
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
*
Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, P.O. Box 208064, New Haven, CT 06520-8064
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Abstract

Objectives:

To determine the frequency of conjunctival colonization, identify the colonizing flora, and correlate culture results with physical findings in infants in a NICU

Design:

Surveillance study.

Setting:

Level III NICU of a large university teaching hospital.

Patients:

All infants admitted for longer than 24 hours during a 26-week period.

Methods:

Weekly bacterial conjunctival cultures were performed for all infants. The conjunctival appearance at the time of culture was recorded. The frequency, identity, and correlation of culture results with physical findings were determined.

Results:

One thousand ninety-one cultures were performed for 319 infants: 133 (42%) had no positive cultures and 186 (58%) had at least one positive culture. Culture analysis revealed that 411 (38%) were positive and yielded 494 isolates comprising more than 18 bacterial species. Bacteria most commonly isolated included coagulase-negative Staphylococcus (CoNS) (75%), viridans group streptococci (8.7%), Staphylococcus aureus (3.8%), Enterococcus species (2.6%), and Serratia marcescens (2.4%). The frequency of non-CoNS isolates increased significantly during the first 6 weeks of patient hospital stay (6% [1 to 3 weeks] to 12% [4 to 6 weeks]; P = .01), with an increasing trend to 15 weeks (18%). Correlation of bacteriologic results with physical findings demonstrated that infants with non-CoNS isolates exhibited conjunctival edema, erythema, or exudates more frequently than did infants with CoNS alone (30% vs 13%; P = .0001).

Conclusions:

Conjunctival colonization was common among infants in a NICU. Prolonged hospitalization predisposes to colonization with potentially pathogenic organisms. Physical findings were more likely in patients with non-CoNS conjunctival isolates.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 3 , March 2004 , pp. 216 - 220
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Hammerschleg, MR. Neonatal conjunctivitis. Pediatr Ann 1993;22:346.CrossRefGoogle Scholar
2.Egoz, N, Michaeli, D. A program for surveillance of hospital-acquired infection in a general hospital: a two-year experience. Reviews of Infectious Diseases 1981;3:649–657.CrossRefGoogle Scholar
3.Maderova, E, Kestnerova, V, Cervenka, J, Pucekova, C. Prevalence of nosocomial infections in selected hospitals. Journal of Hygiene, Epidemiology, Microbiology and Immunology 1987;31:365–374.Google ScholarPubMed
4.Barroso-Aguirre, J, Fernandez-Carrocera, LA, Martinez-Sanchez, , Udaeta-Mora, E, Arredondo-Garcia, JL, Karchmer, S. Nosocomial infection in the neonatal period at a third level care center. Boletin Medico del Hospital Infantil de Mexico 1992;49:666–670.Google Scholar
5.Gaynes, RP, Edwards, JR, Jarvis, WR, Culver, DH, Tolson, JS, Martone, WJ. Nosocomial infections among neonates in high-risk nurseries in the United States. Pediatrics 1996;98:357–361.CrossRefGoogle ScholarPubMed
6.Yoder, MC, Polin, RA. The immune system. In: Faranoff, AA, Martin, RJ, eds. Neonatal-Perinatal Medicine, ed. 6. St. Louis, MO: Mosby; 1977:685–811.Google Scholar
7.Marcy, SM, Overturf, GD. Focal bacterial infections. In: Remington, JS, Klein, JO, eds. Infectious Diseases of the Fetus and Newborn Infant. Philadelphia: W. B. Saunders; 1995:935–979.Google Scholar
8.Weiss, AH. Conjunctivitis in the neonatal period (ophthalmia neonatorum). In: Long, SS, Pickering, LK, Prober, CG, eds. Principles and Practice of Pediatric Infectious Diseases. New York: Churchill Livingstone; 1997:550–554.Google Scholar
9.Feigin, RD. Pseudomonas infections. In: Feigin, RD, Cherry, JD, eds. Textbook of Pediatric Infectious Diseases, ed. 3. Philadelphia: W. B. Saunders; 1992:1229–1236.Google Scholar
10.Mustafa, MM, McCracken, GH Jr. Perinatal bacterial diseases. In: Feigin, RD, Cherry, JD, eds. Textbook of Pediatric Infectious Diseases, ed. 3. Philadelphia: W. B. Saunders; 1992:891–924.Google Scholar
11.King, S, Devi, SP, Mindorff, C, Patrick, ML, Gold, R, Ford-Jones, EL. Nosocomial Pseudomonas aeruginosa conjunctivitis in a pediatric hospital. Infect Control Hosp Epidemiol 1988;9:77–80.CrossRefGoogle Scholar
12.Isenberg, SJ, Apt, L, Yoshimori, R, Alvarez, SR. Bacterial flora of the conjunctiva at birth. J Pediatr Ophthalmol Strabismus 1986;23:284–286.CrossRefGoogle ScholarPubMed
13.Brook, I, Barrett, CT, Brinkman, CR 3rd, Martin, WJ, Finegold, SM. Aerobic and anaerobic bacterial flora of the maternal cervix and newborn gastric fluid and conjunctiva: a prospective study. Pediatrics 1979;63:451–455.CrossRefGoogle ScholarPubMed
14.Rao, K, Ramji, S, Thirupuram, S, Prakash, K. Clinical and bacteriological study of normal and inflamed neonatal conjunctivae. Indian Pediatr 1992;29:161–165.Google ScholarPubMed
15.Sandstrom, KI, Bell, TA, Chandler, JW, et al. Microbial causes of neonatal conjunctivitis. J Pediatr 1984;105:706.CrossRefGoogle ScholarPubMed
16.Prentice, MJ, Hutchinson, GR, Taylor-Robinson, D. A microbiological study of neonatal conjunctivae and conjunctivitis. Br J Ophthalmol 1977;61:601–607.CrossRefGoogle ScholarPubMed
17.Fahmy, JA, Moller, S, Bentzon, MW. Bacterial flora of the normal conjunctiva: II. Methods of obtaining cultures. Acta Ophthalmological 1974;53:237–253.CrossRefGoogle Scholar
18.Almuneef, MA, Baltimore, RS, Farrel, PA, Reagan-Cirincione, P, Dembry, LM. Molecular typing demonstrating transmission of gram-negative rods in a neonatal intensive care unit in the absence of a recognized epidemic. Clin Infect Dis 2001;32:220–227.CrossRefGoogle Scholar
19.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
20.Asbell, PA, Alcaraz-Micheli, LG. Bacterial conjunctivitis. In: Kaufman, HE, Barron, BA, McDonald, M, eds. The Cornea, ed. 2. Newton, MA: Butterworth–Heineman; 1998:147–155.Google Scholar