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Reducing the overall use of broad-spectrum antibiotics in NICU is associated with less prevalence of multi-drug resistant Klebsiella pneumoniae isolation in premature infants
Authors: Meiyan Chu
Abstract
Objectives: The aim of this study was to evaluate the impact of an antibiotic stewardship program on the resistance profiles of Klebsiella pneumoniae (K. pneumoniae) in the neonatal intensive care unit (NICU). This was achieved by examining changes in the antimicrobial resistance patterns of K. pneumoniae isolates collected from preterm infants in a level 3 NICU between 2013 and 2022.
Methods:
We examined antibiotic resistance patterns in all isolated K. pneumoniae strains cultured from preterm infants (gestational age < 37 weeks, postnatal age > 3 days) admitted to our NICU between 2013 and 2022. To assess temporal trends, we divided the study period into three phases (2013–2015, 2016–2018, and 2019–2022) to correlate antibiotic usage trends with resistance dynamics. Multivariable logistic regression was performed to identify risk factors associated with prevalence of multidrug-resistant (MDR) K. pneumoniae colonization or infection in the NICU.
Results:
Antimicrobial use, measured in defined daily doses(DDDs) per 100 patient-days, dropped sharply from 30.8 during 2013–2015 to 12.9 in 2016–2018, then fell further to 6.9 in 2019–2022. The rates of MDR K. pneumoniae isolation among all isolated K. pneumoniae strains decreased significantly from 57.7% in 2013–2015 to 31.8% in 2019–2022 (p = 0.001). The resistance rate to aztreonam declined from 60.8% during 2013–2015 to 41.0% in 2016–2018, then further decreased to 25.0% in 2019–2022. The resistance rate to cefepime decreased from 70.1% to 33.3% and finally to 10.2% across the same periods. The resistance rate to piperacillin-tazobactam declined significantly from 53.6% (2013–2015) to 15.2% (2016–2018) and further to 6.8% (2019–2022). The resistance rate to imipenem also declined from 51.5% (2013–2015) to 4.2% (2016–2018) and ultimately to 1.1% (2019–2022). Multivariable logistic regression analysis reveales that exposure to third-generation or higher cephalosporins (aOR = 2.460, 95%CI: 1.386 to 4.365, p = 0.002) or glycopeptide antibiotics (aOR = 1.887, 95%CI: 1.100 to 3.237, p = 0.021) prior to specimen collection increases the risk of isolating MDR K. pneumonia strains.
Conclusions:
This study demonstrates that reducing broad-spectrum antibiotic use in NICUs may lower the prevalence of MDR K. pneumoniae colonization and infection in premature infants.”
Other specific DSP article suggested by Editorial Board
High efficiency of 70% isopropanol in reducing microbial contamination on healthcare workers’ smartphone surfaces: a pre-post study in Peru
Authors: Torres-Lévano
Abstract
Introduction: Poor cleaning practices for healthcare workers’ mobile phones can promote microbial contamination, posing a latent risk of infections for patients. Despite widespread mobile phone use in healthcare environments, evidence on the effectiveness of disinfection methods in low and middle-income countries remains limited.
Objective: To evaluate the disinfectant capacity of 70% isopropanol on the surface of healthcare workers’ smartphones in a Peruvian hospital in 2023.
Methods: We designed a pre-post study to collect demographic, occupational, and phone usage information, along with microbiological culture analysis results before and after cleaning with 70% isopropanol.
Results: We evaluated 178 mobile phones from healthcare workers, 90.5% (95%CI: 85.1–94.0%) of which showed microbiological contamination. The most frequently isolated microorganism was Staphylococcus aureus (41.0%), followed by Enterococcus sp. (14.9%) and Staphylococcus epidermidis (9.9%). Antibiogram analysis revealed high resistance rates to ampicillin. No factors were associated with microbial contamination on phones. A significant reduction in microbiological contamination was observed (90.4% to 14.0%, p < 0.001) after cleaning with 70% isopropanol. Colony counts significantly decreased from 73.4 ± 31.8 CFU/cm2 to 3.9 ± 11.0 CFU/cm2 (p < 0.001).
Conclusion: The disinfectant capacity of 70% isopropanol on healthcare workers’ smartphone surfaces is highly effective, resulting in an approximately fivefold reduction in contamination rates.
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Association of pre-culture antimicrobial therapy with culture positivity in patients with vertebral osteomyelitis: a 16-year cohort study
Authors: Naganuma, T
Abstract
Background: Microbiological diagnosis is crucial for managing vertebral osteomyelitis (VO), but the impact of pre-culture antimicrobial therapy on culture positivity remains debated. This study aimed to investigate the association between pre-culture antimicrobial administration and the positivity of comprehensive culture tests in patients with VO.
Methods: This single-center cohort study included adult patients who were diagnosed with VO and admitted to a university hospital in Japan between 2006 and 2021. The primary outcome was the proportion of positive culture tests (blood, bone, or abscess). Pre-culture antimicrobial therapy was defined as receiving at least one systemic dose within two days before the first culture specimen collection. To adjust for confounding factors, we used the inverse probability of treatment weighting to estimate average treatment effects (ATEs) and 95% confidence intervals (CIs).
Results: Of the 133 patients, 46 (34.6%) received pre-culture antimicrobials. Overall, 65.4% of patients had at least one positive culture. Pre-culture antimicrobial therapy was significantly associated with a lower proportion of any positive culture (ATE − 0.22; 95% CI, -0.39 to -0.05). When analyzed by specimen type, significant negative associations were found for blood cultures (ATE − 0.30; 95% CI, -0.48 to -0.12) and abscess cultures (ATE − 0.33; 95% CI, -0.51 to -0.14). However, no significant association was observed for bone cultures (ATE − 0.07; 95% CI, -0.33 to 0.20). The duration of antimicrobial therapy before culture collection was not significantly associated with culture positivity.
Conclusion: Pre-culture antimicrobial therapy was associated with a 20% to 30% lower absolute proportion of positive blood and abscess cultures but did not significantly affect the positivity of bone cultures in patients with VO. Bone biopsies may remain a valuable diagnostic tool even if antimicrobial agents have been administered.”
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Efficacy of UV-C devices in Clostridioides difficile environmental decontamination in a hospital setting: a before-after study.
Authors: Fourman, N
Abstract
Background: Clostridioides difficile infection (CDI) is a leading healthcare-associated infection, with significant morbidity, mortality, and healthcare costs. Effective environmental decontamination is critical for infection control, as C. difficile spores persist on surfaces despite standard cleaning protocols. Ultraviolet (UV) light devices have been proposed as adjuncts to standard disinfection methods, yet their real-world effectiveness in reducing environmental contamination remains unclear. This study evaluates the impact of UV devices on environmental contamination in hospital rooms previously occupied by symptomatic CDI patients and asymptomatic C. difficile carriers.
Methods: We conducted a prospective interventional before-after study in a tertiary hospital’s internal medicine wards. Environmental samples were collected from ten high-touch sites in 33 rooms occupied by CDI patients (n = 5) or asymptomatic carriers (n = 28). Following routine daily cleaning with sodium hypochlorite (bleach), UV disinfection was performed, and samples were taken before and after UV application using sponge environmental wipes and cultured to quantify colony-forming units (CFUs). A contamination scale (0–4) was used to assess overall contamination levels, incorporating both CFU counts and the number of affected sites. Statistical analysis included Student’s t-test and chi-square tests.
Results: Before UV disinfection, 27% (9/33) of rooms were classified as heavily contaminated, and 12% (4/33) had medium contamination. After UV application, 21% (7/33) remained heavily contaminated, while 18% (6/33) exhibited medium contamination (p = 0.46). The mean contamination scale score decreased from 1.94 ± 1.56 to 1.58 ± 1.64 (p = 0.08). No significant reductions were observed in CFU couants (29.61±61.07 before vs. 17.97 ± 42.53 after, p = 0.1) or the number of contaminated sites (2.24±2.26 before vs. 1.91 ± 2.19 after, p = 0.07).
Conclusions: Our findings suggest that adding UV disinfection after daily bleach cleaning did not significantly reduce C. difficile contamination. Further evidence is needed to determine the potential added value of UV technology.”