Background

Preterm infants and critically ill neonates are predisposed to nosocomial infections as sepsis. Moreover, these infants acquire commensal bacteria, which might become potentially harmful. On-ward transmission of these bacteria can cause outbreaks.

Aim

To report the findings of a prospective surveillance of bacterial colonization and primary sepsis in preterm infants and neonates.

Methods

The results of the surveillance of bacterial colonization of the gut and the respiratory tract, targeting meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and Gram-negative bacteria from November 2016 to March 2018 were analysed. Bacterial colonization was compared to surveillance of sepsis.

Findings

Six-hundred and seventy-one patients were admitted and 87.0 % (N=584) of the patients were screened; 48.3% (N=282) of the patients screened were colonized with at least one of the bacteria included in the screening; 26.2% of them (N=74) had multi-drug-resistant strains. A total of 534 bacterial isolates were found. The most frequently found species were Escherichia coli, Enterobacter cloacae, Klebsiella oxytoca and Klebsiella pneumoniae. Three MRSA but no VRE were detected. The surveillance detected a K. pneumoniae cluster involving nine patients. There were 23 blood-culture-confirmed sepsis episodes; 60.9% (N=14) were caused by staphylococci. Gram-negative bacteria (one Klebsiella aerogenes and two E. cloacae) caused three sepsis episodes which were preceded by colonization with the respective isolates.

Conclusions

Surveillance of colonization provided a comprehensive overview of species and antibiotic resistance patterns. It allowed early detection of a colonization cluster. Knowledge of colonization and surveillance of sepsis is useful for guiding infection control measures and antibiotic treatment.

中文翻译：

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细菌定植和原发性败血症的前瞻性监测：三级新生儿重症和中级监护病房的发现

背景

早产儿和重症新生儿易患败血症的医院感染。而且，这些婴儿会感染共生细菌，这可能会造成潜在的危害。这些细菌的继续传播会引起疾病暴发。

目的

报告对早产儿和新生儿细菌定植和原发性败血症进行前瞻性监测的结果。

方法

分析了2016年11月至2018年3月针对耐甲氧西林金黄色葡萄球菌（MRSA），耐万古霉素肠球菌（VRE）和革兰氏阴性细菌的肠道和呼吸道细菌定植的监测结果。将细菌定植与败血症监测进行比较。

发现

纳入671例患者，筛查了87.0％（N = 584）的患者。被筛查的患者中有48.3％（N = 282）被定植在筛查中的至少一种细菌中；其中26.2％（N = 74）具有多重耐药菌株。总共发现了534个细菌分离株。最常见的物种是大肠杆菌，阴沟肠杆菌，产氧克雷伯菌和肺炎克雷伯菌。未检测到三个MRSA，但未检测到VRE。监测发现有9名患者感染了肺炎克雷伯菌。有23例经血培养证实的败血症发作；60.9％（N= 14）是由葡萄球菌引起的。革兰氏阴性细菌（一种产气克雷伯氏菌和两种阴沟肠杆菌）引起了三例败血症发作，随后分别定植了相应的分离株。

结论

殖民化监测提供了物种和抗生素耐药性模式的全面概述。它可以及早发现殖民化集群。败血症的定殖和监测知识对于指导感染控制措施和抗生素治疗很有用。