Risk Factors of Nosocomial Infection for Infants in Neonatal Intensive Care Units: A Systematic Review and Meta-Analysis

Neonatal Abstinence Syndrome and Corresponding Pharmacotherapy Approaches from 2 University-affiliated Neonatal Intensive Care Units in Puerto Rico (2018-2020)

OBJECTIVE

Neonatal abstinence syndrome (NAS) is a set of drug withdrawal symptoms suffered by neonates exposed to drugs in utero. Several studies have widely described NAS incidence and treatment approach; however, little is known regarding the incidence and manifestations of this disease in Puerto Rico (PR). The principal aim of this study was to describe NAS incidence in the neonatal units of hospitals affiliated with the University of PR in terms of occurrence, clinical manifestations, and treatment approaches.

METHODS

Our study evaluated the medical records of NAS babies diagnosed from 2018 through 2020 at 2 hospitals affiliated with the University of PR Medical Sciences Campus. Descriptive and inferential statistics were employed to analyze trends.

RESULTS

We identified 12 neonates diagnosed with NAS, 5 with low birthweights (<2500 g); for a NAS incidence of 2 cases per 1000 admitted for the 3 years of recollected data. The urine toxicology results revealed that 9 had experienced intrauterine polydrug exposure. Phenobarbital loading dose were determined on the day of diagnosis (indicated by Finnegan score). The first manifestation of NAS symptoms varied: 8 neonates showed symptoms within 48 hours after birth, whereas 4 had withdrawal symptoms within 72-120 hours of their births. Differences between dosing practices and guidelines were observed, ranging from a 0.69% to a 25% difference during treatment initiation.

CONCLUSION

Further research on the incidence of NAS in PR (national level) is needed for a deeper understanding that we hope will lead to the development of enhanced treatment protocols in PR.

Working Condition and Job Satisfaction of Nurses as Predicting Factors of the Prevalence of Health care-associated Infections among Elderly Inpatients

Background

Health care-Associated Infections (HCAIs) are among the most common adverse events (AEs) that can negatively affect both patients and health systems. The elderly is among patients at high risk for infections. Some controllable risk factors have received less attention in research. Therefore, this study aims to investigate the relationship between prevalence of HCAIs among elderly inpatients, job satisfaction of nurses, and working condition.

Materials and Methods

This cross-sectional study was conducted on 211 nurses working in hospitals affiliated with Iran University of Medical Sciences, Tehran, in 2021. The data were collected from HCAIs reports by the Nosocomial Infection Control Committee, a demographic questionnaire, the Practice Environment Scale of the Nursing Work Index (PES-NWI), and the Minnesota Satisfaction Questionnaire (MSQ). The data were statistically analyzed using Pearson correlation coefficient, ANOVA, t-test, and multiple linear regression (MLR) in SPSS 26.

Results

The results showed that there was a significant relationship between the PES-NWI and MSQ (r = 0.68, p < 0.00). The MLR results indicated that staffing and resource adequacy, nurse participation in hospital affairs, job satisfaction, nursing manager's leadership, and nursing foundations for quality of care are predictive factors that these could explain 78% of the changes in the prevalence of HCAIs and the goodness of fit of the regression model was acceptable [F6.210 = 129.47, p < 0.001].

Conclusions

Since job satisfaction and the work condition could predict HCAIs among the elderly patients, healthcare administers are recommended to consider these two variables in the development of HCAIs prevention and control programs.

Prevalence and risk factors associated with drug resistant bacteria in neonatal and pediatric intensive care units: A retrospective study in Saudi Arabia

Successful empirical antibiotic therapy for infected patients with multi drug resistant bacteria (MDR) can be challenging task in various healthcare settings, including neonatal and pediatric intensive care units (NICU and PICU, respectively), unless an up-to-date comprehensive local antibiogram data is available. Thus, this project aimed to investigate the prevalence of MDR among PICU and NICU patients as well as the identification of risk factors associated with recovered MDR bacteria. This was a retrospective study of PICU and NICU patients admitted with bacterial infection of MDR organisms between October 2020 and May 2021. Frequency distribution, Chi-square test were applied to verify the significance differences among subgroups and to identify risk factor associated with each group. About 36.4% of recruited patients were neonates, while the remaining percentage (63.6%) were pediatric. The most predominant site of infection among these patients were revealed as urinary tract (35%), followed by bloodstream (20.0%), wound/skin (12.9%) and respiratory system (11.4%). Methicillin-resistant Staphylococcus aureus (MRSA) was identified as the most common microbe across these sites of infections (30.7%), followed by Escherichia coli (25.0%), Klebsiella pneumoniae (22.9%) and Serratia (10.0%). High mortality rate was significantly associated with patients who were on mechanical ventilators (28.9%, OR 5.5; 95% CI), followed by patients had invasive operation (27.5%, OR, 8.04; 95% CI) and those who required a total parental nutrition (TPN) since almost one-half of these cases have (46.2%) died. In addition, mortality rate was relatively higher among patients infected with species of Serratia (28.6%) and Enterobacter (20.0%). These data highlighted that MRSA was the main MDR bacteria isolated from PICU and NICU followed by gram-negative bacteria, which were associated with high mortality rate. Therefore, infection control measures and continuous monitoring of emerging MDR bacteria should be applied to limit the bacterial infections in NICU and PICU patients.

Decreased susceptibility to vancomycin and other mechanisms of resistance to antibiotics in Staphylococcus epidermidis as a therapeutic problem in hospital treatment

Multidrug-resistant coagulase-negative staphylococci represent a real therapeutic challenge. The aim of the study was to emphasize the importance of heteroresistance to vancomycin presence in methicillin-resistant strains of S. epidermidis. The research comprised 65 strains of S. epidermidis. Heteroresistance to vancomycin was detected with the use of the agar screening method with Brain Heart Infusion and a population profile analysis (PAP test). In addition, types of cassettes and genes responsible for resistance to antibiotics for 22 multidrug resistant strains were determined. Our investigations showed that 56 of 65 S. epidermidis strains were phenotypically resistant to methicillin. The tested strains were mostly resistant to erythromycin, gentamicin, clindamycin, and ciprofloxacin. Six strains showed decreased susceptibility to vancomycin and their heterogeneous resistance profiles were confirmed with the PAP test. All tested multi-resistant strains exhibited the mecA gene. More than half of them possessed type IV cassettes. ant(4')-Ia and aac(6')/aph(2''), ermC and tetK genes were most commonly found. The described phenomenon of heteroresistance to vancomycin in multidrug resistant bacteria of the Staphylococcus genus effectively inhibits a therapeutic effect of treatment with this antibiotic. That is why it is so important to search for markers that will enable to identify heteroresistance to vancomycin strains under laboratory conditions.

Late-onset neonatal infections and bacterial multidrug resistance

OBJECTIVE

This study aims to describe bacterial and antimicrobial sensibilities in late-onset healthcare-associated infections (HAIs) with laboratory confirmation in a Neonatal Intensive Care Unit (NICU) of a public hospital in Ceará.

METHODS

This was a cross-sectional study conducted from January 2013 to December 2017. The bacterial types involved in late-onset HAIs, their sensitivity to antimicrobials, and their multidrug resistance were evaluated. The latter was classified according to the criteria revised by the Pan-American Health Organization as multidrug resistance (MDR), extended drug resistance (XDR), or pandrug resistance (PDR). The description of the variables was performed through proportions and frequency distribution depicted in tables.

RESULTS

Of the 427 patients with late-onset HAIs, 47 (11.0%) had bacterial infections confirmed by blood cultures, and 7 (14.9%) had infections caused by MDR bacteria. Among the types of bacteria, 26 (55.3%) were Gram-negative bacteria, and 21 (44.7%) were Gram-positive bacteria. Among the Gram-negative bacteria, 92.3% (n=24) showed resistance to more than one antimicrobial, especially to ampicillin (81.2%), cefepime (33.1%), gentamicin (19.4%), and piperacillin/tazobactam (17.2%). Among the MDR ones, three cases had Klebsiella pneumoniae, and three had Pseudomonas aeruginosa, classified as two MDR and one XDR, and three XDR, respectively. Gram-positive resistance to penicillin was the most common one (80.0%), and approximately half of the strains being resistant to oxacillin. Susceptibility was high to vancomycin (97.5%), but one microorganism was resistant to oxacillin and vancomycin.

CONCLUSIONS

The emergence of MDR strains is a reality in NICUs, carrying the risk of therapeutic failure and requiring continuous prevention protocols aimed at minimizing the risks of contamination by bacteria with high morbidity and mortality.

Risk factors for adverse outcomes following surgical repair of esophageal atresia. A retrospective cohort study

Esophageal atresia (EA) is a life-threatening congenital malformation of the esophagus. Despite considerable recent advances in perinatal resuscitation and neonatal care, EA remains an important cause of mortality and morbidity, especially in low-income countries. The aim of this study was to assess risk factors for adverse outcomes following surgical repair of EA at a single center in Tunisia. We performed a retrospective analysis using medical records of neonates with surgical management of EA at our institution from 1 January 2007 to 31 December 2021. In total, 88 neonates were included with a mortality rate of 25%. There were 29 girls and 59 boys. The diagnosis of EA was suspected prenatally in 19 patients. The most common associated anomalies were congenital heart diseases. Prematurity, low birth weight, outborn birth, age at admission >12 hours, congenital heart disease, postoperative sepsis, and anastomotic leak were risk factors for mortality following surgical repair of EA. Anastomotic tension was the only factor associated with short-term complications and the occurrence of short-term complications was predictive of mid-term complications. This study provides physicians and families with contemporary information regarding risk factors for adverse outcomes following surgical repair of EA. Thus, any effort to reduce these risk factors would be critical to improving patient outcomes and reducing cost. Future multi-institutional studies are needed to identify, investigate, and establish best practices and clinical care guidelines for neonates with EA.

Assessment of neonatal intensive care unit nurses' compliance with standard precautions of infection control and identification of enabling factors

Background

Rigorous implementation of infection prevention and control practices by healthcare workers in different healthcare settings is of utmost importance. Neonates, particularly preterm babies in neonatal intensive care units, are a vulnerable population at high risk for developing nosocomial infections. Nurses have the greatest risk of spreading healthcare-associated infections among patients and healthcare workers. This study was conducted to assess the compliance of neonatal intensive care unit nurses with standard precautions of infection control and to identify the potential influencing factors.

Results

This was a cross-sectional study, whereby the compliance of a total of 58 neonatal intensive care unit nurses with standard precautions of infection control was assessed using the Arabic version of the Compliance with Standard Precautions Scale (CSPS-A). Student's t test, ANOVA test, and post hoc test were used for analysis.A suboptimal compliance rate (66.7%) was detected, with the highest for disposal of sharp articles into sharps boxes (86.2%) and the lowest for disposal of sharps box not only when full (27.6%). Significant differences were observed when participants were grouped according to their clinical experience and qualifications, where participants with longer clinical experience displayed higher mean scores for the use of protective devices score (P = 0.024), disposal of sharps score (P = 0.003), and total CSPS score (P = 0.006).

Conclusions

Clinical experience and educational qualifications are key factors that impact nurses' compliance with infection control practices. Nurses should receive up-to-date evidence-based educational and practical sessions that link theory to clinical practice and elucidate the importance of accurate implementation of proper infection prevention and control practices.

Breastfeeding in Neonates Admitted to an NICU: 18-Month Follow-Up

Introduction: The admission of neonates to Neonatal Intensive Care Units (NICUs) has been identified as a primary inhibiting factor in the establishment of breastfeeding. The aims of this study were to (1) estimate the prevalence and duration of breastfeeding in infants/toddlers who had been admitted to an NICU in Greece and (2) to investigate factors, associated with the NICU stay, which affected the establishment and maintenance of breastfeeding in infants/toddlers previously admitted to the NICU. Materials and methods: Data for this cohort study were retrieved from interviews with mothers of infants/toddlers who had been admitted to our NICU as neonates during the period of 2017−2019. Interviews were conducted based on a questionnaire regarding the child’s nutrition from birth to the day of the interview, including previous maternal experience with breastfeeding. Information related to the prenatal period, gestation age, delivery mode, duration of NICU stay, and neonatal feeding strategies during their hospital stay were recorded. Results: The response rate to the telephone interviews was 57%, resulting in 279 mother−infant pairs being included in this study. The results showed that 78.1% of children received maternal milk during their first days of life. Of all infants, 58.1% were exclusively breastfed during their first month, with a gradual decrease to 36.9% and 19.4% by the end of the third and sixth months of life, respectively. The prevalence of breastfed children reached 14.7% and 7.5% at the ages of twelve and eighteen months, respectively. In the multivariate analysis, prematurity emerged as an independent prognostic factor for the duration of exclusive and any breastfeeding (aHR 1.64, 95% CI: 1.03−2.62; and 1.69, 95% CI: 1.05−2.72, respectively; p < 0.05). Additionally, the nationality of the mother, NICU breastfeeding experience, the administration of maternal milk during neonatal hospital stay, and previous breastfeeding experience of the mother were independent prognostic factors for the duration of breastfeeding. Conclusions: Although breastfeeding is a top priority in our NICU, the exclusive-breastfeeding rates at 6 months were quite low for the hospitalized neonates, not reaching World Health Organization (WHO) recommendations. Mothers/families of hospitalized neonates should receive integrated psychological and practical breastfeeding support and guidance.

Preterm vs term delivery in antenatally diagnosed gastroschisis: a systematic review and meta-analysis

OBJECTIVE

To review the evidence regarding gestational age at birth, length of stay, sepsis incidence, days on mechanical ventilation, and mortality between preterm and term deliveries in pregnancies complicated by gastroschisis.

DATA SOURCES

We conducted database searches of PubMed, Cochrane Central Register of Controlled Trials, Embase, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov without language restrictions through August 16, 2021. References of all relevant articles were reviewed.

STUDY ELIGIBILITY CRITERIA

Randomized controlled trials, nonrandomized controlled trials, and observational studies were evaluated comparing length of stay, sepsis, days on mechanical ventilation, and mortality between either elective preterm delivery and expectant management (Group 1) or preterm gestational age and term gestational age (Group 2).

METHODS

Two researchers independently selected studies and evaluated risk of bias with the Risk of Bias 2 tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. Mean differences and odds ratios were calculated using a random-effects model for inclusion and methodological quality. The primary outcome was length of stay. Secondary outcomes were incidence of sepsis, mortality, days on mechanical ventilation, and gestational age.

RESULTS

Thirty studies with a total of 7409 patients were included in the systematic review, of which 25 were included in the analysis. Group 1 studies found no difference in length of stay or mortality and a trend toward fewer days on mechanical ventilation (mean difference, -0.40; 95% confidence interval, -0.89 to -0.10; P=.12; I²=35%). Subgroup analysis excluding premature delivery demonstrated lower sepsis incidence in elective preterm delivery (odds ratio, 0.46; 95% confidence interval, 0.25-0.84; P=.01; I²=0%). Group 2 studies found increased length of stay (mean difference, 15.44; 95% confidence interval, 8.44-21.83; P<.00001; I²=94%), sepsis (odds ratio, 1.69; 95% confidence interval, 1.15-2.50; P=.008; I²=51%), days on mechanical ventilation (mean difference, 1.38; 95% confidence interval, 0.10-2.66; P=.03; I²=66%), and mortality (odds ratio, 2.97; 95% confidence interval, 1.59-5.55; P=.0007; I²=0%). Gestational age was significantly lower in Group 2 studies than in Group 1 studies.

CONCLUSION

Data continue to be conflicting, but subgroup analysis suggested a possible reduction in sepsis incidence and mean days on mechanical ventilation with elective early term delivery.

Nurses in NICUs' views on nosocomial infection prevention

BACKGROUND

Basic infection control measures are required in India's health-care setting in Neonatal Intensive Care Units (NICUs) to lower the prevalence of hospital-associated infections. The aim of the present study was to assess practices followed by nurses of NICUs for nosocomial infection prevention.

MATERIALS AND METHODS

From January to February 2020, a descriptive cross-sectional study was conducted. Participants in the study were chosen by total enumeration sampling technique, i.e., 60 nurses were included in this study who working in tertiary care institutions, India. The study respondents' knowledge and practice for nosocomial infection control strategies were assessed by using a 30-item and 27-item questionnaires, respectively. SPSS (version 23.0) was used to analyze the data collected.

RESULTS

Results showed that all nurses (100%) were females, belongs to the age group of 26-35 years (82%), hold professional qualifications (34%) in GNM as well as post basic BSc nursing, married (72%), had 1-5 years of professional experience (66%), and working in the NICUs for 1-3 years (74%). Most of nurses (55%) had never attended any session on nosocomial infection prevention. Nurses of NICUs (70%) had just a moderate degree of understanding on nosocomial infection prevention. Nurses' practice showed good practise (60%) for nosocomial infection prevention in NICUs.

CONCLUSIONS

The necessity to adopt health-care policy about nosocomial infections and execution of regular training program to upgrade and refresh nurses' knowledge and practices regarding for nosocomial infection control measures is indicated to fill gap among knowledge and practices concerning nosocomial infection control and prevention.

Determinants of late neonatal nosocomial infection: a case-control study in Ceará

OBJECTIVES

To assess the determining factors of late healthcare-associated infections (HAIs) and bacterial multiple drug resistance in neonatal intensive care.

METHODS

This is a case-control study, conducted between January 2013 and December 2017, in a neonatal intensive care unit in the state of Ceará, Brazil. Newborns showing late HAIs were considered cases and those without infection, the control. Variables with p-values ≤ 0.05 in our initial bivariate regressive analysis were included in a non-conditional hierarchical logistic model for multivariate analysis. P-values below 0.01 were considered significant.

RESULTS

Of the 1,132 participants, 427 (37.7%) showed late healthcare-associated infections. Of these, 54 (12.6%), positive blood cultures, of which 14.9% contained multidrug-resistant bacteria. Bivariate analysis showed the protective effect of the feminine phenotype (OR = 0.71; 95%CI: 0.56-0.90) and of gestational ages ≥ 34 weeks (OR = 0.48; 95%CI: 0.30-0.75). In earlier-born preterm infants, late infections were 18 times more likely in those with less than 30 week-gestations (OR = 18.61; 95%CI: 9.84-35.22) and four times higher in those weighing less than 1,500 g (OR = 4.18; 95%CI: 3.12-5.61). Mechanical ventilation increased infection odds by more than seven times (OR = 7.14; 95%CI: 5.26-9.09); as did parenteral nutrition (OR = 5.88; 95%CI: 4.54-7.69); central venous catheters (OR = 10.00; 95%CI: 6.66-16.66); the number of catheters used (OR = 3.93; 95%CI: 3.02-5.12); surgery (OR = 4.00; 95%CI: 2.27-7.14); and hospitalization time (OR = 1.06; 95%CI: 1.05-1.07). The association between preterm infants with less than 30 week-gestations (OR = 5.62; 95%CI: 1.83-17.28); mechanical ventilation (OR = 1.84; 95%CI: 1.26-2.68); central venous catheters (OR = 2.48; 95%CI: 1.40-4.37); and hospitalization time (OR = 1.06; 95%CI: 1.05-1.07) remained significant after adjustment. Among deaths, 41 (55.4%) were associated with late infections.

CONCLUSION

Better practices should be adopted in caring for the premature, as well as in the rational use of procedures, to avoid late healthcare-associated infections, preventable deaths, and risks of bacterial multiple drug resistance and environmental contamination.

Cost Analysis for Patients with Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit

The concept of improving the quality and safety of healthcare is well known. However, a follow-up question is often asked about whether these improvements are cost-effective. The prevalence of nosocomial infections (NIs) in the neonatal intensive care unit (NICU) is approximately 30% in developing countries. Ventilator-associated pneumonia (VAP) is the second most common NI in the NICU. Reducing the incidence of NIs can offer patients better and safer treatment and at the same time can provide cost savings for hospitals and payers. The aim of the study is to assess the direct costs of VAP in the NICU. This is a prospective study, conducted between January 2017 and June 2018 in the NICU of University Hospital “St. George” Plovdiv, Bulgaria. During this period, 107 neonates were ventilated for more than 48 h and included in the study. The costs for the hospital stay are based on the records from the Accounting Database of the setting. The differences directly attributable to VAP are presented both as an absolute value and percentage, based on the difference between the values of the analyzed variables. There are no statistically significant differences between patients with and without VAP in terms of age, sex, APGAR score, time of admission after birth and survival. We confirmed differences between the median birth weight (U = 924, p = 0.045) and average gestational age (t = 2.14, p = 0.035) of the patients in the two study groups. The median length of stay (patient-days) for patients with VAP is 32 days, compared to 18 days for non-VAP patients (U = 1752, p < 0.001). The attributive hospital stay due to VAP is 14 days. The median hospital costs for patients with VAP are estimated at €3675.77, compared to the lower expenses of €2327.78 for non-VAP patients (U = 1791.5, p < 0.001). The median cost for antibiotic therapy for patients with VAP is €432.79, compared to €351.61 for patients without VAP (U = 1556, p = 0.024). Our analysis confirms the results of other studies that the increased length of hospital stays due to VAP results in an increase in hospital costs. VAP is particularly associated with prematurity, low birth weight and prolonged mechanical ventilation.

Inanimate Surfaces and Air Contamination with Multidrug Resistant Species of Staphylococcus in the Neonatal Intensive Care Unit Environment

Background: Contamination of the hospital environment with multi-resistant (MDR) Staphylococcus increases the risk of infection. The aim of this study is to identify the MDR species of Staphylococcus on inanimate surfaces, in air, and in clinical samples, and analyze the risk factors that correlate with the occurrence of infections in a Neonatal Intensive Care Unit. Methods: Samples of inanimate surfaces and air were taken using a premoistened swab (0.9% sodium chloride) and spontaneous air sedimentation, respectively. The clinical isolates were recovered from infected neonates. The isolates (environmental and clinical) were identified by matrix-assisted laser desorption ionization-time of flight and the resistance profile was calculated using the disk diffusion agar technique. Results: In total, 181 isolates were obtained, 93 from (surfaces), 18 from the air, and 70 clinical samples. S. epidermidis was the most frequent species (66.8%), and the failure rate in air cleaning was 100%. More than 60% of the isolates were MDR, and the majority of clinical isolates (60.4%) had a resistance profile identical to that of the environmental isolates. Conclusion: Staphylococcus spp. were found in most of the analyzed samples, with a high frequency of MDR isolates, demonstrating the importance of the hospital environment as a reservoir, and the need for infection control measures, and rational use of antimicrobials.

Differences in the Gut Microbiota Composition and Metabolites Associated With Feeding Intolerance in VLBW Infants With a Gestational Age of ≤ 30 Weeks: A Pilot Study

Objective

To explore the main variations in gut microbiota compositions, short-chain fatty acids (SCFAs) concentrations and autoinducer-2 (AI-2) levels in very-low-birth-weight (VLBW) infants with feeding intolerance (FI).

Methods

Twenty-seven VLBW infants with gestational ages of ≤30 weeks were divided into the FI group (n=14) and feeding tolerance (FT) group (n=13). The gut microbiota composition and SCFAs concentrations and AI-2 levels in feces were detected at 2 and 4 weeks after birth.

Results

There was no difference in alpha diversity between the two groups at 2 and 4 weeks after birth (P>0.05). Although the Chao index decreased (P<0.05), there was no difference in the Shannon index from 2 weeks to 4 weeks in either the FI or FT group (P>0.05). Additionally, there was no difference in beta diversity between the FI and FT groups at 2 weeks (P>0.05), but there was a significant difference in beta diversity between the two groups at 4 weeks (P<0.05) and a large difference from 2 weeks to 4 weeks in both the FI and FT groups (P<0.05). Furthermore, the composition of the microbiota at 4 weeks was significantly different from that at 2 weeks in the FI group (P<0.05). The Veillonella abundance was lower at 4 weeks in the FI group (P<0.05), but there were no differences in the compositions of the other main microbes between the two groups (P>0.05). Proteobacteria and Firmicutes were dominant in both the FI and FT groups. The concentrations of propanoic, valeric and hexanoic acids were lower in the FI group at 2 weeks, and the levels of isobutyric and valeric acids were lower at 4 weeks after birth (P<0.05). The areas under the curves (AUCs) of propanoic, butanoic and valeric acids in predicting FI were 0.878, 0.816 and 0.744, respectively. Compared with that in the FT group, the relative bioluminescence of AI-2 was lower in the FI group at 2 weeks (P<0.05), and the AUC was 0.736.

Conclusions

The main composition of the microbiota was not obviously different in infants with FI. Some SCFAs and AI-2 have moderate value in predicting FI.

Effect of intestinal microecology on postnatal weight gain in very preterm infants in intensive care units

OBJECTIVE

To study the effect of intestinal microecology on postnatal weight gain of very preterm infants in neonatal intensive care unit (NICU).

METHODS

Very preterm infants who met the inclusion criteria were enrolled. The subjects were divided into the extrauterine growth retardation (EUGR) group(defined as a body weight less than the 10th percentile of the corresponding gestational age or a weight loss between birth and a given time of  >  2SD were considered EUGR) and normal growth group, and the growth was evaluated at 2 and 4 weeks after birth. Meanwhile, the stool samples were taken to perform16S ribosomal RNA (rRNA) high -throughput 16S rRNA sequencing of the intestinal microflora was performed on stool samples.

RESULTS

A total of 22 infants were included. There was no significant difference in the alpha diversity indexes indices between the two groups at 2 weeks or 4 weeks after birth. The beta diversity analysis showed that the two groups had similar principal components of the intestinal microflora were similar between the two groups. Linear discriminant analysis (LDA) effect size (LEfSe) showed that 2 weeks after birth, the bacteria with an absolute LDA score (log10) higher than 4 included Streptococcaceae, Streptococcus, Bacteroidetes, Bacteroidales and Stenotrophomonas in the EUGR group and Enterococcaceae and Enterococcus in the control group. At the 4th week after birth, the bacteria with an absolute LDA score (log10) higher than 3 in the EUGR group includedwere Clostriaceae, Eubacteriaceae and Eubacterium. TheBy comparing the composition of the microbial community composition comparison showed, significant differences were found in the principal components of Enterococcus and Streptococcus on the family and genus levels at 2 weeks after birth. No Bifidobacterium was found in either group at 4 weeks after birth.

CONCLUSION

Intestinal microecology is different between infants with EUGR and those with normal growth. The diversity and richness of the intestinal microflora in preterm infants at the NICU are significantly insufficient and change dynamically with time, and the establishment of intestinal homeostasis is obviously delayed.

Evaluation of Biofilm Formation and Prevalence of Multidrug-Resistant Strains of Staphylococcus epidermidis Isolated from Neonates with Sepsis in Southern Poland

Staphylococcus epidermidis strains play an important role in nosocomial infections, especially in the ones associated with biofilm formation on medical devices. The paper was aimed at analyzing the mechanisms of antibiotic resistance and confirming the biofilm-forming ability among S. epidermidis strains isolated from the blood of hospitalized newborns. Genetic analysis of resistance mechanism determinants included multiplex PCR detection of mecA, ermA, ermB, ermC, msrA, and mef genes. Biofilm analysis comprised phenotypic and genotypic methods including Christensen and Freeman methods and PCR detection of the icaADB gene complex. Among the tested S. epidermidis strains, 89% of the isolates were resistant to methicillin, 67%—to erythromycin, 53%—to clindamycin, 63%—to gentamicin, and 23%—to teicoplanin, while all the strains were susceptible to vancomycin and linezolid. The mecA gene was detected in 89% of the isolates, the ermC gene was the most common and present among 56% of the strains, while the msrA gene was observed in 11% isolates. Eighty-five percent of the strains were described as biofilm-positive by phenotypic methods and carried the icaADB gene cluster. Multidrug resistance and the biofilm-forming ability in most of the strains tested may contribute to antimicrobial therapy failure (p < 0.05).

Nosocomial Infection Surveillance in Neonatal Intensive Care Units of Bahrami Children’s Hospital

Background: Nosocomial Infection (NI) is one of the leading causes of short- and long-term morbidity and mortality among neonates, especially in Neonatal Intensive Care Units (NICUs). Objectives: We aimed to evaluate the epidemiology of NIs and associated factors. Methods: From March 2017 to September 2018, all the neonates who were admitted to the NICUs of Bahrami Children’s Hospital were enrolled. Nosocomial infections were identified based on the definition of CDC-NNIS. Demographic, clinical, and laboratory data of the patients were extracted from the medical records. Results: A total of 979 neonates were admitted to the NICU, of whom 60 were diagnosed with NI. The incidence of NI was 6.1 per 100 hospitalized patients. The most prevalent NI was bloodstream infection (30%), followed by pneumonia (21.7%). The most frequent presentations were respiratory distress (31.7%) and poor feeding (26.7%). Major pathogens were Gram-positive bacteria such as Staphylococcus aureus (25.7%) and coagulase-negative staphylococci (25.7%). The mean hospital stay was 25.2 ± 20.89 days. The mortality rate of patients with NI was 16.7%. The factors associated with an increased risk of mortality among patients with NI were a lack of ventilation support, low birth weight, and WBCs with an abnormal range. Conclusions: The results of the present study showed that the incidence of NI was high, and the cultures collected from body fluids had a particular role in the diagnosis and treatment of NI. Standard infection control practices should be applied to reduce the incidence of NI and subsequent morbidity and mortality.