Protecting the Next Generation from Superbugs: Is there a Role for Decontamination? Experience from a Major Neonatal Centre in the UK
Background: Increasing antimicrobial resistance is a global problem causing significant morbidity and mortality in neonates.
Objective: We aimed to assess whether increasing antibiotic resistance (AR) was a major issue in our neonatal unit.
Hypotheses:
- Bacteria causing colonization may later cause invasive infection. If so, decontamination of a colonized patient may prevent sepsis.
- Central-line penetration of the skin barrier will increase sepsis particularly with MSSA.
Methods: We analysed all positive blood cultures (BC) 01/01/2011 – 31/12/2015 from our neonatal unit. We eliminated contaminated BC based on inflammatory markers and reference to clinical notes. We collected data on BC species, sensitivities, patient colonization, comorbidities, central-line access and antibiotic treatment.
Results: 496 positive BC were taken between 01/01/2011 – 31/12/2015. We excluded 36 due to normal inflammatory markers and clinical suspicion of contamination.
Positive BC
|
2011 |
2012 |
2013 |
2014 |
2015 |
|
|
Total Species |
13 |
15 |
13 |
14 |
15 |
|
Total Positive BC |
88 |
105 |
114 |
77 |
112 |
Resistant species
|
2013 |
2014 |
2015 |
|
|
Total |
13(11%) |
16(21%) |
24(21%) |
|
Resistance > 1 antibiotic |
6(5%) |
11(14%) |
9(8%) |
|
ESBL |
0 |
1(1%) |
1(1%) |
|
Antibiotic with highest resistance |
Flucloxacillin |
Cephalosporins |
Penicillin |
Patients with positive BC
|
2014 |
2015 |
|
|
<37/40 gestation |
62(80%) |
94(84%)
|
|
Necrotising enterocolitis |
31(40%) |
45(40%)
|
|
Other surgical diagnosis
|
12(16%) |
13(12%) |
|
Central line at time of BC/removed |
50(65%) |
60(54%)
|
|
Previous swab with same bacteria (colonization) |
6(8%) |
24(21%)
|
|
MSSA +BC with MSSA colonization |
0 |
0 |
|
Death related to sepsis |
0 |
5(4%) |
Conclusion: Antibiotic resistance (AR) is a worsening problem affecting 11% of BC in 2013 and 21% in 2014-2015. 16% of sepsis episodes (2014-15) were caused by bacteria which colonized the patient but none caused by MSSA. Therefore, decontamination may be of benefit but this should be weighed against the risk of increasing AR. Consider decontamination when there are additional risks for sepsis e.g. central lines.
Future research should trial decontamination when multiple risk factors for sepsis are present to determine the risk of increased resistance versus sepsis reduction.
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