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Simon A, Zemlin M, Geipel M, Gärtner B, Armann J, Meyer S. [Infection prevention in neonatal intensive care units]. DER GYNAKOLOGE 2021; 54:428-434. [PMID: 33967301 PMCID: PMC8094126 DOI: 10.1007/s00129-021-04804-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 12/24/2022]
Abstract
In diesem Beitrag werden einige Besonderheiten der Infektionsprävention bei intensivmedizinisch behandelten Früh und Neugeborenen dargestellt. Ergänzend finden sich Hinweise zum krankenhaushygienischen Management der SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Pandemie und zur Antibiotic Stewardship in der neonatologischen Intensivmedizin.
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Affiliation(s)
- Arne Simon
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 9, Geb. 9, 66421 Homburg/Saar, Deutschland
| | - Michael Zemlin
- Allgemeine Pädiatrie und Neonatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Martina Geipel
- Allgemeine Pädiatrie und Neonatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Barbara Gärtner
- Institut für Medizinische Mikrobiologie und Hygiene (IMMH), Universität und Universitätsklinikums des Saarlandes, Homburg/Saar, Deutschland
| | - Jakob Armann
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Sascha Meyer
- Allgemeine Pädiatrie und Neonatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
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Phan HTT, Stoesser N, Maciuca IE, Toma F, Szekely E, Flonta M, Hubbard ATM, Pankhurst L, Do T, Peto TEA, Walker AS, Crook DW, Timofte D. Illumina short-read and MinION long-read WGS to characterize the molecular epidemiology of an NDM-1 Serratia marcescens outbreak in Romania. J Antimicrob Chemother 2019; 73:672-679. [PMID: 29237003 PMCID: PMC5890751 DOI: 10.1093/jac/dkx456] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives Serratia marcescens is an emerging nosocomial pathogen, and the carbapenemase blaNDM has been reported in several surveys in Romania. We aimed to investigate the molecular epidemiology of S. marcescens in two Romanian hospitals over 2010–15, including a neonatal NDM-1 S. marcescens outbreak. Methods Isolates were sequenced using Illumina technology together with carbapenem-non-susceptible NDM-1-positive and NDM-1-negative Klebsiella pneumoniae and Enterobacter cloacae to provide genomic context. A subset was sequenced with MinION to fully resolve NDM-1 plasmid structures. Resistance genes, plasmid replicons and ISs were identified in silico for all isolates; an annotated phylogeny was reconstructed for S. marcescens. Fully resolved study NDM-1 plasmid sequences were compared with the most closely related publicly available NDM-1 plasmid reference. Results 44/45 isolates were successfully sequenced (S. marcescens, n = 33; K. pneumoniae, n = 7; E. cloacae, n = 4); 10 with MinION. The S. marcescens phylogeny demonstrated several discrete clusters of NDM-1-positive and -negative isolates. All NDM-1-positive isolates across species harboured a pKOX_NDM1-like plasmid; more detailed comparisons of the plasmid structures demonstrated a number of differences, but highlighted the largely conserved plasmid backbones across species and hospital sites. Conclusions The molecular epidemiology is most consistent with the importation of a pKOX_NDM1-like plasmid into Romania and its dissemination amongst K. pneumoniae/E. cloacae and subsequently S. marcescens across hospitals. The data suggested multiple acquisitions of this plasmid by S. marcescens in the two hospitals studied; transmission events within centres, including a large outbreak on the Targu Mures neonatal unit; and sharing of the pKOX_NDM1-like plasmid between species within outbreaks.
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Affiliation(s)
- H T T Phan
- Modernising Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - N Stoesser
- Modernising Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - I E Maciuca
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, UK
| | - F Toma
- Microbiology Department, University of Medicine and Pharmacy, Targu Mures, Romania
| | - E Szekely
- Microbiology Department, University of Medicine and Pharmacy, Targu Mures, Romania
| | - M Flonta
- Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania
| | - A T M Hubbard
- Modernising Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - L Pankhurst
- Modernising Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - T Do
- Modernising Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - T E A Peto
- Modernising Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - A S Walker
- Modernising Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - D W Crook
- Modernising Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - D Timofte
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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Abstract
PURPOSE OF REVIEW Neonates in the neonatal ICU (NICU) are uniquely vulnerable to colonization and infection with pathogens such as multidrug resistant Gram-negative bacteria, which in turn are associated with increased infection-related morbidities and higher case-fatality rates. We reviewed the English, French, and German language literature published between 2015 and 2017, for reports of NICU outbreaks. RECENT FINDINGS A total of 39 outbreaks in NICUs were reported with Gram-negative bacteria (n = 21; 54%) causing most, and extended spectrum beta-lactamase-producing organisms being the most frequent resistance mechanism reported (n = 5). Five viral outbreaks were reported (respiratory syncytial virus = 3). A significant proportion of outbreaks (33%) did not identify a source. Whole genome sequencing was used more (n = 6 reports). The most common described infection prevention and control interventions included staff and parent education on hand hygiene, patient isolation, additional contact precautions, including discontinuation of 'kangaroo care', and cohorting. Reporting and publication bias are likely common. SUMMARY NICUs must be vigilant in identifying outbreaks, conduct comprehensive investigations, and implement targeted infection prevention and control strategies. Molecular epidemiology capacities are an essential element in outbreak investigation. More studies are needed to determine the added value of active colonization screening and their impact on outbreak development.
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