DECOLONIZATION OF MULTIRESISTANT MICROORGANISMS OF INFANTS AFTER HOSPITAL DISCHARGE

Prematurity is a determining factor for the hospitalization of high-risk newborns in the Intensive Care Units. This population is more vulnerable to colonization with multidrug-resistant (MDR) microorganism due to the immature immunological and gastrointestinal systems and skin barriers. Extrinsic factors of health assistance, like exposure to invasive procedures, use of wide-spectrum antimicrobials, and contact with health professionals, also contribute to colonization with these microorganisms in newborns. The knowledge gap in relation to the time of MDR microorganism decolonization in the newborn population is the main objective for this study. It is an exploratory and prospective case study performed in a university hospital’s neonatal unit in southern Brazil from January 2014 to February 2018 with hospitalized babies. Rectal swabs were taken from the babies at hospital discharge and at ambulatory home visits until two consecutive negative culture, when the babies were considered decolonized by MDR microorganisms. Species identification was based on the phenotypic profile generated by disk diffusion and VITEK® 2 Compact. The standard disk diffusion test was performed for ESBL producer detection. During the study period, 604 babies participated in the research: 52.6% were male, 71.0% had caesarian births, 73.5% were underweight, and 76.9% born between 34 and 37 weeks. A total of 125 (86.2%) colonized babies used antibiotics and 90 (62.0%) were submitted to invasive procedures. At the hospital discharge, 145 (24.0%) newborns showed a positive culture for MDR microorganisms and had an average hospitalization time of 35 days. Among colonized newborns, 13.7% were positive for more than one bacterial species. The most prevalent was Klebsiella spp. ESBL producer (30.3%); followed by Serratia spp. ESBL producer (27.3%); Enterobacter spp. ESBL producer (16.4%); Escherichia coli (12.1%); methicillin-resistant Staphylococcus aureus (MRSA, 6.1%); Acinetobacter baumanni CR. (3.0%); Citrobacter spp. ESBL producer (2.4%) and Pseudomonas aeruginosa (1.2%). One isolate each (0.6%) was identified as Enterobacter spp. CR and vancomycin-resistant Enterococcus spp. (VRE). Among all colonized babies, 68 (46.8%) were underwent outpatient care, and 45 were decolonized in an average of 60 days post-discharge, ranging from 30 to 300 days. The study showed that the average time of decolonization did not exceed 3 months after release. Prematurity is a determining factor for the hospitalization of high-risk newborns in the Intensive Care Units. This population is more vulnerable to colonization with multidrug-resistant (MDR) microorganism due to the immature immunological and gastrointestinal systems and skin barriers. Extrinsic factors of health assistance, like exposure to invasive procedures, use of wide-spectrum antimicrobials, and contact with health professionals, also contribute to colonization with these microorganisms in newborns. The knowledge gap in relation to the time of MDR microorganism decolonization in the newborn population is the main objective for this study. It is an exploratory and prospective case study performed in a university hospital’s neonatal unit in southern Brazil from January 2014 to February 2018 with hospitalized babies. Rectal swabs were taken from the babies at hospital discharge and at ambulatory home visits until two consecutive negative culture, when the babies were considered decolonized by MDR microorganisms. Species identification was based on the phenotypic profile generated by disk diffusion and VITEK® 2 Compact. The standard disk diffusion test was performed for ESBL producer detection. During the study period, 604 babies participated in the research: 52.6% were male, 71.0% had caesarian births, 73.5% were underweight, and 76.9% born between 34 and 37 weeks. A total of 125 (86.2%) colonized babies used antibiotics and 90 (62.0%) were submitted to invasive procedures. At the hospital discharge, 145 (24.0%) newborns showed a positive culture for MDR microorganisms and had an average hospitalization time of 35 days. Among colonized newborns, 13.7% were positive for more than one bacterial species. The most prevalent was Klebsiella spp. ESBL producer (30.3%); followed by Serratia spp. ESBL producer (27.3%); Enterobacter spp. ESBL producer (16.4%); Escherichia coli (12.1%); methicillin-resistant Staphylococcus aureus (MRSA, 6.1%); Acinetobacter baumanni CR. (3.0%); Citrobacter spp. ESBL producer (2.4%) and Pseudomonas aeruginosa (1.2%). One isolate each (0.6%) was identified as Enterobacter spp. CR and vancomycin-resistant Enterococcus spp. (VRE). Among all colonized babies, 68 (46.8%) were underwent outpatient care, and 45 were decolonized in an average of 60 days post-discharge, ranging from 30 to 300 days. The study showed that the average time of decolonization did not exceed 3 months after release.