The Age of Multidrug Resistance: Ten Year Incidence in a Neonatal Intensive Care Unit

Bruno Sanches, Rita Guerreiro, José Diogo, Margarida Cabral, António Gomes

Abstract


Introduction: The emergence of multidrug-resistant bacteria is a medical challenge nowadays. The objective of the present study was to determine the incidence of multidrug-resistant bacteria infections in a neonatal Intensive Care unit.
Material and Methods: Retrospective, descriptive, incidence study of infectious episodes by multidrug-resistant bacteria from 2008 to 2017 in a differentiated perinatal support unit.
Results: Sixty-four infectious episodes included (median gestational age of 28 weeks and birth weight of 885 g). The isolated bacteria were: Enterobacteriaceae (n = 46); Methicillin-resistant Staphylococcus aureus (n = 12); Acinetobacter baumannii (n = 4); Pseudomonas aeruginosa (n = 2). A risk factor was identified in 90.6% of the episodes, with emphasis on central catheter (89%) and previous antibiotic therapy (78%). The lethality rate of these infections was 10.9% (Unit mortality rate: 4.4%). The overall incidence rate was 3.2 infectious episodes/100 hospitalizations, corresponding to 1.7 episodes/1000 days of hospitalization. There were three infectious outbreaks, with an increasing impact of Enterobacteriaceae.
Discussion: The reported incidence rate reflects a risk population, hospitalized in an Intensive Care unit, over a long period of time. The distribution of isolated bacteria, with Enterobacteriaceae predominance, is in accordance with the shift in multidrug resistance reported worldwide. The outbreaks point to the need of understanding risk factors and means of local dissemination. The relevance of these infections is evident in their lethality rate, which is higher compared to that of general hospital infections.
Conclusion: The incidence rate reflects the local dimension of the problem, representing a quality indicator which is relevant for controlling these infections.


Keywords


Drug Resistance, Multiple, Bacterial; Infant, Newborn; Intensive Care Units, Neonatal; Portugal

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