title: Colonization With Antimicrobial-Resistant Gram-Negative Bacilli at Neonatal Intensive Care Unit Discharge.
abstract: BACKGROUND
  The epidemiology of the colonization of infants with antimicrobial-resistant Gram-negative bacilli (GNB) at discharge from the neonatal intensive care unit (NICU) is not well understood.
  
  
  METHODS
  A multicenter study in which rectal surveillance samples for culture were obtained at NICU discharge from infants hospitalized ≥14 days was performed. Factors associated with colonization with GNB resistant to gentamicin, third/fourth-generation cephalosporin agents, or carbapenem agents were assessed by using a fixed-effects model.
  
  
  RESULTS
  Of these infants, 9% (119 of 1320) were colonized with ≥1 antimicrobial-resistant GNB. Prolonged treatment (≥10 days) with meropenem or third/fourth-generation cephalosporin agents or treatment for ≥5 days with a β-lactam/β-lactamase combination agent were associated with an increased risk of colonization with GNB resistant to gentamicin. Surgery and ≥5 days of treatment with third/fourth-generation cephalosporin agents, a β-lactam/β-lactamase combination agent, or metronidazole were associated with an increased risk of colonization with GNB resistant to third/fourth-generation cephalosporin agents. Female sex and prolonged treatment (≥10 days) with meropenem were associated with colonization with GNB resistant to carbapenem agents.
  
  
  CONCLUSIONS
  Prolonged treatment with broad-spectrum antibiotics was associated with the colonization of infants with antimicrobial-resistant GNB within 7 days of NICU discharge. These findings suggest the potential for dissemination of resistant GNB from colonized infants to other NICUs, the community, or pediatric long-term care facilities. Antimicrobial stewardship efforts aimed at improving appropriate antibiotic use could have a beneficial effect on the emergence of antimicrobial-resistant GNB in the NICU population.
authors.affiliation: Department of Pediatrics.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Clock
authors.affiliation: School of Nursing, Columbia University Medical Center.
authors.forename: Yu-Hui
authors.initials: YH
authors.lastname: Ferng
authors.affiliation: Department of Pediatrics.
authors.forename: Setareh
authors.initials: S
authors.lastname: Tabibi
authors.affiliation: Department of Pediatrics.
authors.forename: Luis
authors.initials: L
authors.lastname: Alba
authors.affiliation: Department of Pediatrics.
authors.forename: Sameer J
authors.initials: SJ
authors.lastname: Patel
authors.affiliation: School of Nursing, Columbia University Medical Center.
authors.forename: Haomiao
authors.initials: H
authors.lastname: Jia
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College, New York, New York.
authors.forename: Patricia
authors.initials: P
authors.lastname: DeLaMora
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College, New York, New York.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Perlman
authors.affiliation: Department of Pediatrics, Section of Neonatology, Christiana Care Health System, Newark, Delaware.
authors.forename: David A
authors.initials: DA
authors.lastname: Paul
authors.affiliation: Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Theoklis
authors.initials: T
authors.lastname: Zaoutis
authors.affiliation: School of Nursing, Columbia University Medical Center.
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Larson
authors.affiliation: Department of Pediatrics.|Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York.
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000382:microbiology; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: antimicrobial resistance; cephalosporin agents; gentamicin; meropenem; risk factors