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. 2021 May 12;3(3):100147.
doi: 10.1016/j.infpip.2021.100147. eCollection 2021 Sep.

Carbapenem-resistant Enterobacterales colonization and subsequent infection in a neonatal intensive care unit in Shanghai, China

L Yin  1 , L He  2 , J Miao  1 , W Yang  1 , X Wang  1 , J Ma  1 , N Wu  1 , Y Cao  3 , C Wang  4
Affiliations

Carbapenem-resistant Enterobacterales colonization and subsequent infection in a neonatal intensive care unit in Shanghai, China

L Yin et al. Infect Prev Pract. .

Abstract

Background: Colonization has been reported to play an important role in carbapenem-resistant Enterobacterales (CRE) infection; however, the extent to which carriers develop clinical CRE infection and related risk factors in neonatal intensive care unit (NICU) patients is unclear.

Aim: To investigate the frequency of CRE colonization and its contribution to infections in NICU patients.

Methods: CRE colonization screening and CRE infection surveillance were performed in the NICU in 2017 and 2018.

Findings: Among 1230 unique NICU patients who were screened for CRE colonization, 144 patients tested positive (11.7%, 144/1230), with 9.2% (110/1197) in the intestinal tract, which was higher than that in the upper respiratory tract (6.6%, 62/945) (P=0.026). Gestational age, low birth weight and prolonged hospitalization were risk factors for CRE colonization (all P<0.001). Diversilab homology monitoring found an overall 17.4% (25/144) risk of infection among patients colonized with CRE. For carbapenem-resistant Klebsiella pneumoniae (CR-KP) and carbapenem-resistant Escherichia coli (CR-ECO), the risks were 19.1% (21/110) and 13.8% (4/29), respectively. The independent risk factors for CR-KP clinical infection among CR-KP carriers were receiving mechanical ventilation (odds ratio (OR), 10.177; 95% confidence interval (CI), 2.667-38.830; P=0.013), a high level of neonatal nutritional risk assessment (OR, 0.251; 95% CI, 0.072-0.881; P=0.031) and a high neonatal acute physiology II (SNAP-II) score (OR, 0.256; 95% CI, 0.882-1.034; P=0.025).

Conclusions: The colonization of CRE may increase the incidence of corresponding CRE infection in NICU patients. Receiving mechanical ventilation, malnutrition and critical conditions with high SNAP-II scores were independent risk factors for subsequent CR-KP clinical infection.

Keywords: CRE; Colonization; NDM-1; NICU; Risk factors for infection; ST17.

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Figures

Figure 1
Figure 1
Diversilab patterns and gene distribution of 46 carbapenem-resistant Klebsiella pneumoniae (CR-KP) colonization and infected isolates. The red line delineates the similarity score of 95% set by the manufacturer.
Figure 2
Figure 2
DiversiLab patterns and Gene distribution of 24 carbapenem-resistant Escherichia coli (CR-ECO) colonization and infected isolates. The red line delineates the similarity score of 95% set by the manufacturer.
See this image and copyright information in PMC

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