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Enterobacteriaceae Infections of Very Low Birth Weight Infants in Polish Neonatal Intensive Care Units: Resistance and Cross-transmission

Wójkowska-Mach, Jadwiga MS, PhD*; Chmielarczyk, Agnieszka MS, PhD*; Borszewska-Kornacka, Maria MD, PhD; Domańska, Joanna MS, PhD; Gadzinowski, Janusz MD, PhD§; Gulczyńska, Ewa MD, PhD; Nowiczewski, Marek MD, PhD; Helwich, Ewa MD, PhD; Kordek, Agnieszka MD, PhD**; Pawlik, Dorota MD, PhD††; Jursa-Kulesza, Joanna MD, PhD‡‡; Giedrys-Kalemba, Stefania MD, PhD‡‡; Szczapa, Jerzy MD, PhD§; Heczko, Piotr B. MD, PhD*

The Pediatric Infectious Disease Journal: June 2013 - Volume 32 - Issue 6 - p 594–598
doi: 10.1097/INF.0b013e318287fe2a
Original Studies

Background: The aims of our study were analysis of the occurrence of infections by members of the Enterobacteriaceae family in 6 Polish neonatal intensive care units in 2009, their drug resistance, the epidemiology of extended-spectrum β-lactamase (ESBL)-producing strains and the possibility of using modern tools of microbiology diagnosis in infection control, especially for the reduction of antimicrobial resistance.

Methods: A prospective surveillance covered 910 newborns. Case patients were defined as neonates with very low birth weight who had clinical signs of septicemia, pneumonia or necrotizing enterocolitis. Early-onset infection was defined as infection diagnosed within 3 days after delivery.

Results: The incidence of Enterobacteriaceae infections was 2.6/1000 patient-days. The risk of Enterobacteriaceae pneumonia increased with the length of hospitalization (P = 0.0356). The most common pathogen was Escherichia coli (12.4% of all strains, in early-onset infection 18.5%) and Klebsiella spp. (9.1% of all). The ESBL phenotype was found in 37% of isolates, of which 89.3% were producing CTX-M-type, 70.2% TEM-type and 8.5% SHV-type. Epidemic clones were detected in the 2 studied neonatal intensive care units: 6 of the 9 ESBL-positive Enterobacter cloacae and 16 of the 18 ESBL-positive Klebsiella pneumoniae strains were classified into 1 epidemic clone, which showed resistance to penicillin without inhibitors, amoxycillin/clavulanic acid, cephalosporins, aztreoname, aminoglycosides and trimethoprim/sulfamethoxazole.

Conclusions: Enterobacteriaceae bacilli are a significant problem in neonatal intensive care units, especially in early-onset infection and for long hospitalized very low birth weight infants. The observed high drug resistance was in large part related to the dominance of epidemic strains as a result of horizontal transmission. The best way to reduce drug resistance would be adequate procedures of isolation and hand hygiene.

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From the *Microbiology, Jagiellonian University Medical College, Krakow; Clinic of Neonatology and Intensive Neonatal Care, Warsaw Medical University, Warsaw; Institute of Theoretical and Applied Informatics of the Polish Academy of Sciences, Gliwice; §Department of Neonatology, Poznan University of Medical School, Poznan; Clinic of Neonatology, Polish Mother’s Memorial Hospital-Research Institute, Lodz; Clinic of Neonatology and Intensive Neonatal Care, Institute of Mother and Child, Warsaw; **Department of Neonatal Diseases, Pomeranian Medical University, Szczecin; ††Clinic of Neonatology, Jagiellonian University Medical College, Krakow; and ‡‡Department of Microbiology and Immunology, Pomeranian Medical University, Szczecin, Poland.

Accepted for publication January 15, 2013.

This study was partially supported by a grant from the Ministry of Science and Higher Education (DEC-2011/01/D/N27/00104). The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Jadwiga Wójkowska-Mach, MS, PhD, Chair of Microbiology, Jagiellonian University Medical College, 18 Czysta Street, 31–121 Krakow, Poland. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.