title: Reduction in colonization and nosocomial infection by multiresistant bacteria in a neonatal unit after institution of educational measures and restriction in the use of cephalosporins.
abstract: BACKGROUND
  Previous administration of third-generation cephalosporins predisposes to colonization and infections by multiresistant Enterobacter sp. The emergence of multiresistant bacteria infections in a neonatal unit during 1995, especially Enterobacter cloacae, stimulated this study.
  
  
  OBJECTIVE
  To evaluate the efficacy of measures to control colonization and nosocomial infection by multiresistant bacteria in a neonatal unit.
  
  
  METHODS
  A tertiary care university hospital.
  
  
  METHODS
  This study was conducted from October 1995 through December 1999 in 4 phases: a cross-sectional study, a longitudinal study with intervention measures, monthly cross-sectional studies, and determination of nosocomial infections caused by multiresistant bacteria (oxacillin-resistant Staphylococcus aureus and gram-negative bacteria resistant to either aminoglycosides or third-generation cephalosporins). Specimens for surveillance culture were obtained through umbilical and rectal swabs, and tracheal aspirates from intubated babies. The intervention measures were as follows: (1) appropriated training of the whole health care team, emphasizing measures to reduce cross-colonization, and the importance of rational usage of antibiotics and (2) suppression of usage of third-generation cephalosporins. Risk factors were analyzed through univariate and multivariate logistic regression.
  
  
  RESULTS
  In the first phase, 32% (10/31) of the patients were colonized by multiresistant bacteria (29% by multiresistant E cloacae ). In the second phase, 342 patients were evaluated; 33% of them were colonized by E cloacae, and a multiresistant strain was isolated in 10.8% (37/342) of the babies. A logistic regression model indicated parenteral nutrition and antibiotic usage as risk factors for colonization by multiresistant E cloacae. In the third phase, for 6 months, only 2 patients were colonized by multiresistant E cloacae. In the fourth phase, the analysis of bacterial resistance profile indicated a reduction of nosocomial infections due to multiresistant bacteria from 18 cases in 1995 to 2 cases per year until 1999.
  
  
  CONCLUSIONS
  These results have shown that the measures adopted were effective.
authors.affiliation: Neonatal Unit of the Pediatric Department, Faculty of Medical Sciences, State University of Campinas, São Paulo, Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Calil
authors.forename: S T
authors.initials: ST
authors.lastname: Marba
authors.forename: A
authors.initials: A
authors.lastname: von Nowakonski
authors.forename: A T
authors.initials: AT
authors.lastname: Tresoldi
mesh_terms: D000704:Analysis of Variance; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D001938:Brazil / Q000453:epidemiology; D002511:Cephalosporins / Q000627:therapeutic use*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D018432:Drug Resistance, Multiple; D016972:Enterobacter cloacae; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000458:organization & administration; D007318:Inservice Training; D007363:Intensive Care Units, Neonatal; D011446:Prospective Studies; D012306:Risk
chemical_list: D002511:Cephalosporins