Every month, we ask one NeoIPC Consortium member to review an interesting paper on infection prevention and control in neonatal care.
This month, Julia Bielicki from University Children’s Hospital Basel and St George’s University of London is reviewing:
Härtel C, Faust K, Fortmann I, et al. Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms. Antimicrob Resist Infect Control. 2020;9(1):144. Published 2020 Aug 26.
Why is this important?
Some countries recommend or even mandate regular screening samples among infants on NICUs to establish colonization with multidrug-resistant bacteria. Such surveillance can be used to identify outbreaks and to maximise infection prevention and control measures when warranted. However, regular screening is of course costly and binds resources. Evidence for the utility of such regular screening, particularly of any benefits for infants being managed on NICU, has been lacking.
What was done in this study?
Data collected by the German Neonatal Network on extremely preterm infants born at 22+0 to 28+6 weeks gestational age and managed in 62 German level III NICUs between 2011 and 2018 were analysed. Recommendations for colonization screening were put in place by the German commission for hospital hygiene and infection prevention in 2013. A descriptive analysis of the cohort was provided but also independent risk factors for sepsis mortality were explored using multivariable regression models.
What was observed?
All-cause mortality, the cumulative incidence of clinical sepsis and of culture-proven sepsis were all slightly lower among infants treated after the implementation of colonization screening compared to infants treated before. However, institution of colonization screening was not associated with sepsis-related mortality and multidrug-resistant bacterial culture-proven sepsis cumulative incidence. Alongside implementation of screening, changes in antibiotic use patterns were observed with cefotaxime exposure reduced upon screening introduction, but meropenem exposure increased.
Key take away points
When regular prospective colonization surveillance is introduced in NICUs, this alone can have important implications for infection prevention and control. In the German Neonatal Network introduction of weekly screening was associated with a reduced cumulative incidence of sepsis, but with no concomitant reduction in sepsis-related mortality or cumulative incidence of sepsis caused by the multidrug-resistant bacteria targeted by surveillance. An increasing use of meropenem compensating a reduction in the use of third-generation cephalosporins was observed as a potential unwanted effect of screening.