title: Successful elimination of extended-spectrum beta-lactamase (ESBL)-producing nosocomial bacteria at a neonatal intensive care unit.
abstract: BACKGROUND
  Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are highly dangerous to neonates. At our Neonatal Intensive Care Unit (NICU), the presence of these bacteria became so threatening in 2011 that immediate intervention was required.
  
  
  METHODS
  This study was conducted during a nearly two-year period consisting of three phases: retrospective (9 months), educational (3 months) and prospective (9 months). Based on retrospective data analysis, a complex management plan was devised involving the introduction of the INSURE protocol, changes to the antibiotic regimen, microbiological screening at short intervals, progressive feeding, a safer bathing protocol, staff hand hygiene training and continuous monitoring of the number of newly infected and newly colonized patients. During these intervals, a total of 355 patients were monitored.
  
  
  RESULTS
  Both ESBL-producing Enterobacter cloaceae and Klebsiella pneumoniae were found (in both patients and environmental samples). In the prospective period a significant reduction could be seen in the average number of both colonized (26/167 patients; P=0.029) and infected (3/167 patients; P=0.033) patients compared to data from the retrospective period regarding colonized (72/188 patients) and infected (9/188 patients) patients. There was a decrease in the average number of patient-days (from 343.72 to 292.44 days per months), though this difference is not significant (P=0.058). During the prospective period, indirect hand hygiene compliance showed a significant increase (from the previous 26.02 to 33.6 hand hygiene procedures per patient per hospital day, P<0.001).
  
  
  CONCLUSIONS
  Colonizations and infections were rolled back successfully in a multi-step effort that required an interdisciplinary approach.
authors.affiliation: Infection Control Unit, University of Szeged, Szeged, Hungary. szelbo@gmail.com.
authors.forename: Borbála
authors.initials: B
authors.lastname: Szél
authors.affiliation: Department of Pediatrics, University of Szeged, Szeged, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Reiger
authors.affiliation: Institute of Clinical Microbiology, University of Szeged, Szeged, Hungary.
authors.forename: Edit
authors.initials: E
authors.lastname: Urbán
authors.affiliation: Institute of Clinical Microbiology, University of Szeged, Szeged, Hungary.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lázár
authors.affiliation: Department of Pediatrics, University of Szeged, Szeged, Hungary.
authors.forename: Krisztina
authors.initials: K
authors.lastname: Mader
authors.affiliation: Department of Bacteriology, National Center for Epidemiology, Budapest, Hungary.
authors.forename: Ivelina
authors.initials: I
authors.lastname: Damjanova
authors.affiliation: Infection Control Unit, University of Szeged, Szeged, Hungary.
authors.forename: Kamilla
authors.initials: K
authors.lastname: Nagy
authors.affiliation: Department of Pediatrics, University of Szeged, Szeged, Hungary.
authors.forename: Gyula
authors.initials: G
authors.lastname: Tálosi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control*; D016972:Enterobacter cloacae; D004756:Enterobacteriaceae Infections / Q000517:prevention & control; D005260:Female; D063373:Hand Hygiene; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000458:organization & administration*; D007363:Intensive Care Units, Neonatal; D007710:Klebsiella Infections / Q000517:prevention & control; D007711:Klebsiella pneumoniae; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: INSURE protocol; hand hygiene; interdisciplinary approach; neonates; polyresistance