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observational study conducted in a NICU in Sweden, once-a- week surveillance was an effective strategy to reduce transmission by nearly 80% compared to surveillance on demand.30 None- theless, in addition to the consistent use of this weekly active surveillance and contact precautions, our study has demonstrated that private rooms may have further contributed to the observed success in limiting the transmission of ESBL-E. Based on these data, we stopped the active surveillance for the ESBL-E in this unit. For 12 months after the discontinuation of active surveil- lance, ESBL infection rates have remained unchanged, indicating that the existing measures (ie, private rooms, contact precautions, and handwashing) may be far more important contributors to low rates than active surveillance alone. These findings suggest that the change of stopping active surveillance will result in cost savings of ~$70,000 over 10 years. Active surveillance can be optimized by identifying a sub-
cohort of patients with greater likelihood of ESBL-E colonization. However, in our study, comparison of patients with a recent stay of >48 hours in a healthcare facility to those without such exposure did not identify a distinct set of patient characteristics or a threshold associated with the increased likelihood of ESBL-E colonization detection. Our study has several limitations. As a retrospective obser-
vational study, we lacked patient-specific data prior to 2005 and the inability to adjust for other changes in practice that would have occurred during the study period. These changes, includ- ing improved use of antibiotics and other advances in medical care, might have contributed to the decreased ESBL-E trans- mission in our unit. Because the unit had additional active surveillance for VRE and/or MRSA between 2003 and the present, patients could be placed on contact precautions before or after becoming ESBL-E positive, which would further reduce the risk of ESBL-E transmission. Lastly, we did not assess clinical benefits, if any, associated with the early identification of ESBL-E colonization. In summary, we report that ESBL-E transmission and
infection in the CNHS NICU has remained uncommon over a long period. Active surveillance for ESBL-E in this setting might have contributed to the prevention of ESBL-E transmission when used in conjunction with contact precautions and private rooms, but it became increasingly costly when incidence con- tinued to decrease. Thus, we have decided to discontinue the active surveillance, and we continue to emphasize the use of fundamental infection control strategies, including proper hand hygiene, contact precautions, and appropriate antibiotic use, to combat antimicrobial resistance, including that of ESBL-E pathogens, in our NICU.
Acknowledgments. Authors would like to thank Jeffrey Li for proofreading this manuscript and Michelande Ridore for assistance in constructing the U chart.
Financial support. No financial support was provided relevant to this article.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
References
1. Bradford PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001;14:933–951.
Xiaoyan Song et al
2. Ben-Ami R, Schwaber MJ, Navon-Venezia S, et al. Influx of extended- spectrum beta-lactamase-producing enterobacteriaceae into the hospital. Clin Infect Dis 2006;42:925–934.
3. Rodriguez-Bano J, Navarro MD, Romero L, et al. Epidemiology and clinical features of infections caused by extended-spectrum beta- lactamase-producing Escherichia coli in nonhospitalized patients. J Clin Microbiol 2004;42:1089–1094.
4. Fedler KA, Biedenbach DJ, Jones RN. Assessment of pathogen frequency and resistance patterns among pediatric patient isolates: report from the 2004 SENTRY Antimicrobial Surveillance Program on three continents. Diagn Microbiol Infect Dis 2006;56:427–436.
5. Gales AC, Castanheira M, Jones RN, Sader HS. Antimicrobial resistance among gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008– 2010). Diagn Microbiol Infect Dis 2012;73:354–360.
6. Goossens H, Grabein B. Prevalence and antimicrobial susceptibility data for extended-spectrum beta-lactamase– and AmpC-producing Enterobacteriaceae from the MYSTIC program in Europe and the United States (1997–2004). Diagn Microbiol Infect Dis 2005;53:257–264.
7. Badal RE, Bouchillon SK, Lob SH, Hackel MA, Hawser SP, Hoban DJ. Etiology, extended-spectrum beta-lactamase rates and antimicrobial susceptibility of gram-negative bacilli causing intra-abdominal infections in patients in general pediatric and pediatric intensive care units—global data from the Study for Monitoring Antimicrobial Resistance Trends, 2008 to 2010. Pediatr Infect Dis J 2013;32:636–640.
8. Gupta A, Della-Latta P, Todd B, et al. Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Infect Control Hosp Epidemiol 2004;25:210–215.
9. Cotton MF, Wasserman E, Pieper CH, et al. Invasive disease due to extended spectrum beta-lactamase–producing Klebsiella pneumoniae in a neonatal unit: the possible role of cockroaches. J Hosp Infect 2000;44:13–17.
10. Crivaro V, Bagattini M, Salza MF, et al. Risk factors for extended- spectrum beta-lactamase–producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit. J Hosp Infect 2007;67:135–141.
11. Shakil S, Akram M, Ali SM, Khan AU. Acquisition of extended-spectrum beta-lactamase–producing Escherichia coli strains in male and female infants admitted to a neonatal intensive care unit: molecular epidemiology and analysis of risk factors. J Med Microbiol 2010;59:948–954.
12. Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42 Suppl 2: S82–S89.
13. Schwaber MJ, Carmeli Y. Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in Enter- obacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 2007;60:913–920.
14. Schwaber MJ, Navon-Venezia S, Kaye KS, Ben-Ami R, Schwartz D, Carmeli Y. Clinical and economic impact of bacteremia with extended- spectrum-beta-lactamase-producing Enterobacteriaceae. Agents Chemother 2006;50:1257–1262.
Antimicrob
15. Martins IS, MoreiraBM,RileyLW,Santoro-Lopes G. Outbreak of extended- spectrum beta-lactamase-producing Klebsiella pneumoniae infection among renal transplant recipients. J Hosp Infect 2006;64:305–308.
16. Reddy P, Malczynski M, Obias A, et al. Screening for extended-spectrum beta-lactamase–producing Enterobacteriaceae among high-risk patients and rates of subsequent bacteremia. Clin Infect Dis 2007;45:846–852.
17. Wilson AP, Livermore DM, Otter JA, et al. Prevention and control of multi-drug-resistant Gram-negative bacteria: recommendations from a Joint Working Party. J Hosp Infect 2016;92 Suppl 1:S1–S44.
18. Blot S, Depuydt P, Vandijck D, Vandewoude K, Peleman R, Vogelaers D. Predictive value of surveillance cultures and subsequent bacteremia with extended-spectrum beta-lactamase-producing Enterobacteriaceae. Clin Infect Dis 2008;46:481–482; author reply 482.
19. Singh N, Leger MM, Campbell J, Short B, Campos JM. Control of vancomycin-resistant enterococci in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2005;26:646–649.
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