Molecular analysis of stool and rectal swab samples from two hospital neonatal units (NNUs) in Kenya and Nigeria revealed widespread colonization with multidrug-resistant organisms, researchers reported this week in Antimicrobial Resistance and Infection Control.
A total 119 stool and rectal samples were obtained from 42 infants (57% female; 14.3% born extremely preterm) in the two NNUs and tested for extended-spectrum beta-lactamase (ESBL) and carbapenemase genes using a previously validated quantitative polymerase chain reaction (qPCR) assay.
The purpose of the study, conducted by a team of researchers from the United Kingdom, Kenya, and Nigeria, was to explore the frequency and rates of gut colonization with enteric bacteria harboring these multidrug-resistance genes, as colonization with these opportunistic pathogens can cause severe infections and lead to neonatal sepsis—a leading cause of infant mortality in sub-Saharan Africa. Organisms that produce ESBL or carbapenemase enyzmes also spread easily between colonized infants, healthcare workers, and hospital surfaces and are a common cause of outbreaks in NNUs.
Among the infants, 37 (89%) were found to be colonized with ESBL-producing organisms and 26 (62.4%) with carbapenemase producers. Suspected sepsis based on clinical assessment occurred in 30 infants (71.4%). Longitudinal sampling revealed that colonization occurred rapidly and had often occurred by the first sampling point (83.3%).
Median survival time before colonization was 7 days with ESBL organisms and 16 days with carbapenemase producers. The majority of ESBL genes detected belonged to the CTX-M-1 (36/38; 95%), and CTX-M-9 (2/36; 5%) groups, and the most prevalent carbapenemase was blaNDM (27/29, 93%).
Active surveillance of colonization will improve the understanding of AMR in these settings and guide infection control and antibiotic prescribing practice.
The study authors say the high proportions of infants colonized with ESBL- and carbapenemase-producing organisms provide important epidemiologic information to inform infection-control strategies.
"Active surveillance of colonization will improve the understanding of AMR [antimicrobial resistance] in these settings and guide infection control and antibiotic prescribing practice to improve clinical outcomes," they wrote.