BACKGROUND Multidrug resistance (MDR) is a major clinical problem in tertiary hospitals in Tanzania and jeopardizes the life of neonates in critical care units (CCUs). To better understand methods for prevention of MDR infections, this study aimed to determine, among other factors, the role of MDR-Gram-negative bacteria (GNB) contaminating neonatal cots and hands of mothers as possible role in transmission of bacteremia at Bugando Medical Centre (BMC), Mwanza, Tanzania. METHODS This cross-sectional, hospital-based study was conducted among neonates and their mothers in a neonatal intensive care unit and a neonatology unit at BMC from December 2018 to April 2019. Blood specimens (n = 200) were sub-cultured on 5% sheep blood agar (SBA) and MacConkey agar (MCA) plates. Other specimens (200 neonatal rectal swabs, 200 maternal hand swabs and 200 neonatal cot swabs) were directly inoculated on MCA plates supplemented with 2 μg/ml cefotaxime (MCA-C) for screening of GNB resistant to third generation cephalosporins, r-3GCs. Conventional biochemical tests, Kirby-Bauer technique and resistance to cefoxitin 30 μg were used for identification of bacteria, antibiotic susceptibility testing and detection of MDR-GNB and screening of potential Amp-C beta lactamase producing GNB, respectively. RESULTS The prevalence of culture confirmed bacteremia was 34.5% of which 85.5% were GNB. Fifty-five (93.2%) of GNB isolated from neonatal blood specimens were r-3GCs. On the other hand; 43% of neonates were colonized with GNB r-3GCs, 32% of cots were contaminated with GNB r-3GCs and 18.5% of hands of neonates' mothers were contaminated with GNB r-3GCs. The prevalences of MDR-GNB isolated from blood culture and GNB r-3GCs isolated from neonatal colonization, cots and mothers' hands were 96.6, 100, 100 and 94.6%, respectively. Significantly, cyanosis (OR[95%CI]: 3.13[1.51-6.51], p = 0.002), jaundice (OR[95%CI]: 2.10[1.07-4.14], p = 0.031), number of invasive devices (OR[95%CI]: 2.52[1.08-5.85], p = 0.031) and contaminated cot (OR[95%CI]: 2.39[1.26-4.55], p = 0.008) were associated with bacteremia due to GNB. Use of tap water only (OR[95%CI]: 2.12[0.88-5.09], p = 0.040) was protective for bacteremia due to GNB. CONCLUSION High prevalence of MDR-GNB bacteremia and intestinal colonization, and MDR-GNB contaminating cots and mothers' hands was observed. Improved cots decontamination strategies is crucial to limit the spread of MDR-GNB. Further, clinical presentations and water use should be considered in administration of empirical therapy whilst awaiting culture results.

中文翻译：

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坦桑尼亚姆万扎Bugando医疗中心重症监护病房的细菌血症：定殖，受污染的婴儿床和母亲的手在多重耐药性革兰氏阴性细菌的交叉传播中的作用。

背景技术耐多药耐药性（MDR）是坦桑尼亚三级医院的主要临床问题，并危及重症监护病房（CCU）中新生儿的生命。为了更好地了解预防MDR感染的方法，本研究旨在确定Bugando医疗中心除其他因素外，污染MDR-Gram阴性细菌（GNB）污染新生儿婴儿床和母亲的手可能在菌血症传播中的作用（BMC），坦桑尼亚姆万扎。方法这项基于医院的横断面研究于2018年12月至2019年4月在BMC的新生儿重症监护室和新生儿科对新生儿及其母亲进行。血液样本（n = 200）在5％的条件下进行了亚培养。羊血琼脂（SBA）和MacConkey琼脂（MCA）板。其他标本（200例新生儿直肠拭子，将200只产妇拭子和200张新生儿婴儿拭子直接接种在补充有2μg/ ml头孢噻肟（MCA-C）的MCA平板上，以筛选对第三代头孢菌素r-3GC耐药的GNB。常规生化测试，Kirby-Bauer技术和对头孢西丁30μg的耐药性分别用于细菌鉴定，抗生素敏感性测试和MDR-GNB检测，并筛选可能产生Amp-Cβ内酰胺酶的GNB。结果经培养确认的菌血症发生率为34.5％，其中GNB为85.5％。从新生儿血液样本中分离出的GNB中有55（93.2％）个是r-3GC。另一方面; 43％的新生儿被GNB r-3GC所定殖，32％的婴儿床被GNB r-3GC所污染，而新生儿母亲的手的18.5％被GNB r-3GC所污染。从血液培养物中分离的MDR-GNB和从新生儿定植，婴儿床和母亲的手分离的GNB r-3GC的患病率分别为96.6％，100％，100％和94.6％。显着的是，紫（OR [95％CI]：3.13 [1.51-6.51]，p = 0.002），黄疸（OR [95％CI]：2.10 [1.07-4.14]，p = 0.031），侵入性设备数（OR [95％CI]：2.52 [1.08-5.85]，p = 0.031）和受污染的婴儿床（OR [95％CI]：2.39 [1.26-4.55]，p = 0.008）与GNB引起的菌血症相关。仅使用自来水（OR [95％CI]：2.12 [0.88-5.09]，p = 0.040）可以保护由于GNB引起的菌血症。结论MDR-GNB菌血症和肠道菌落普遍存在，MDR-GNB污染了婴儿床和母亲的手。改进的婴儿床去污策略对于限制MDR-GNB的传播至关重要。进一步，