Prevalence of multidrug drug resistant organisms and hand hygiene compliance in surgical NICU in Cairo University Specialized Pediatric Hospital

Abstract

Background: The incidence of neonatal sepsis increased during the recent years, it may be due to frequent use of invasive procedures and the development of resistant organisms. Bacterial resistance to commonly used antibiotics has emerged and complicated the management of NS. Objective: Our study aimed at determining the prevalence and risk factors of MDRO and hand hygiene compliance (HHC) in the SNICU, of Cairo University Specialized Pediatric Hospital (CUSPH) postoperatively. Materials and Methods: A prospective, observational study was carried out from April 2015 to September 2015 in the tertiary-care level SNICU of CUSPH. Fifty- eight neonates who were infection free on admission and were having any surgical pathology were studied. Baseline data collected include Demographic history, evidence of sepsis, Complete examination and investigations including quantitative C-reactive protein (QCRP), WBCs counts, blood culture, and treatment were also included. Hand hygiene was also assessed among the HCWs using the WHO checklist “My Five Moments for Hand Hygiene”. Results: Ninety-five samples were sent to the microbiology laboratory for culture and sensitivity. Some neonates had more than one sample type analyzed. All samples were collected 48 h postoperatively. The most common site of infection was blood stream infection (BSI) representing 39/95 of samples (41%) followed by SSI 16/95 (16.8%), RTI 8/95 (8.4%), and CLABSI 3/95(3.1%), 29/95 (30.5%) samples revealed no growth. Out of 66 isolated microorganisms, Gram-negative bacteria were the most prevalent pathogens of nosocomial infection with 35/66 (53%), while Gram-positive bacteria were 25/66 (37.9%). We found coagulase-negative Staphylococcus aureus (CONS) to be the most common organism 19/66 (28.7%) cultured from blood, followed by Klebsiella 13/66 (19.6%) and Acinetobactor 9/66 (13.6%) of all isolates. Candida was isolated from only one case of SSI 1/66 (1.5%). MRSA were found to be less frequently isolated 3/66 (4.5%). Profile of blood culture and susceptibility patterns provide guidance to start empiric antibiotic treatment which is cornerstone in sepsis management. The most sensitive antibiotic among Gram positive isolates were Teicoplanin and Vancomycin with 100% sensitivity for both antibiotics in MRSA isolates, while they showed sensitivity of 94.7 and 89.5% respectively in CONS isolates, both Ciprofloxicin and Clindamycin showed 33.3% sensitivity to MRSA isolates, while no single MRSA isolate showed sensitivity to Erythromycin nor Amikacin. CONS sensitivity to other antibiotics was as follows; 74% in Amikacin, 79% in ciprofloxacin and 58% in Clindamycin. In Gram negative organisms; Polymexin B and Colistin revealed highest sensitivity (100%) in all Gram negative isolates, followed by Amikacin with 60% sensitivity to E-coli and only 25% sensitivity in both Pseudomonas and Enterobacter, then Meropenem which was 55.6% sensitive to Acenitobacter and 25% sensitivity to both Pseudomonas and Enterobacter. Ciprofloxacin showed 50% sensitivity with Pseutomonas and 25% with Enterobacter, while it was sensitive in 22.2% and 20% of Acenitobacter and E-coli isolates respectively. Gentamicin was 33.3%, 25% and 20% sensitive in Acenitobacter Enterobacter and E-coli isolates respectively. No E-coli isolates showed sensitivity to imipenem, while only 25%, 22.2% and 15.4% of Enterobacter, acenitobacter and klebsiella isolates respectively were sensitive to imipenem. Among 39 blood culture positive cases, 26 isolates were MDRO (66.7%) meanwhile non-MDRO accounted for 13/39 (33.3%) isolates.Overall hand hygiene compliance (HHC) among the HCWs was found to be (30.5%). Conclusion: Prevalence of MDRO among cases of sepsis was found to be (66.7%). Most isolated organisms were resistant to commonly used drugs. Antibiotic stewardship (ASP) program is essentially needed to stop abuse of antibiotics and accordingly development of MDROs. Strict infection control measures mainly HH procedures are needed, to minimize the spread of MDROs. Keywords: Bloodstream Infections (BSI), Surgical Neonatal Intensive Care Unit (NICU), Hand hygiene, MDRO