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Utility of Surveillance Cultures for Antimicrobial Resistant Organisms in Infants Transferred to the Neonatal Intensive Care Unit

Macnow, Theodore MD*; O’Toole, Dana BA*; DeLaMora, Patricia MD; Murray, Meghan MPH; Rivera, Kristina BS*; Whittier, Susan PhD§¶; Ross, Barbara BSN; Jenkins, Stephen PhD**††; Saiman, Lisa MD, MPH*‖; Duchon, Jennifer MDCM, MPH*

Pediatric Infectious Disease Journal: December 2013 - Volume 32 - Issue 12 - p e443–e450
doi: 10.1097/INF.0b013e3182a1d77f
Original Studies

Background: Infections with antibiotic resistant organisms (AROs) are an important source of morbidity and mortality among infants hospitalized in the neonatal intensive care unit (NICU). To identify potential reservoirs of AROs in the NICU, active surveillance strategies have been adopted by many NICUs to detect infants colonized with AROs. However, the yield, risks, benefits and costs of different strategies have not been fully evaluated.

Methods: We conducted a retrospective study in 2 level III NICUs from 2004 to 2010 to investigate the yield of surveillance cultures obtained from infants transferred to the NICU from other hospitals. Cultures were processed for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and antibiotic-resistant gram-negative rods. Risk factors, selected outcomes and laboratory costs associated with ARO colonization were assessed.

Results: Among 1751 infants studied, the rate of colonization for methicillin-resistant S. aureus, vancomycin-resistant enterococci and antibiotic-resistant gram-negative rods was 3%, 1.7% and 1%, respectively. Age at transfer was the strongest predictor of ARO colonization; infants transferred at ≥7 days of life had 5.8 increased odds of ARO colonization compared with infants <7 days of age. Transferred infants who were colonized had similar rates of mortality, ARO infection and duration of hospitalization compared with those who were not colonized. The laboratory cost of surveillance cultures during the study period was $58,425.

Conclusions: The rate of colonization with AROs at transfer was low particularly in infants <7 days old. Future studies should examine the safety of targeted surveillance strategies focused on older infants.

From the *Department of Pediatrics, Columbia University Medical Center; Department of Pediatrics, Cornell University; Columbia University School of Nursing; §Department of Pathology, Columbia University Medical Center; Department of Clinical Microbiology, New York-Presbyterian Hospital, Columbia University Medical Center; Department of Infection Prevention and Control, New York-Presbyterian Hospital; **Department of Pathology, Weill Cornell Medical Center; and ††Department of Clinical Microbiology, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.

Accepted for publication June 24, 2013.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Jennifer Duchon, MDCM, MPH, Assistant Professor of Clinical Pediatrics, Division of Neonatology, Columbia University Medical Center, 3959 Broadway, BNH 1201, New York, NY 10032. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.