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Risk factors for enterobacter cloacae colonisation at a neonatal intensive care unit in the Netherlands
© Hopman et al; licensee BioMed Central Ltd. 2015
Published: 16 June 2015
Following an outbreak of Enterobacter cloacae complex ESBL at a neonatal intensive care unit (NICU) in a large tertiary care hospital in the Netherlands, a routine E. cloacae complex screening of all neonates was introduced. Literature on colonisation rates and risk factors for neonatal colonisation with E. cloacae are limited.
To determine the colonisation and risk factors for colonisation with E cloacae complex at the NICU.
Neonates who were admitted at the NICU between March 2013 and April 2014 and who were screened for E. cloacae were included in this study. Microbiological screening data was extracted from the medical microbiology database. Demographical, clinical and admission data and information on birth weight and gestational age were extracted from the electronic patient records. Colonisation rates and risk factors were determined for all neonates and a subgroup of those with gestational age of 30 weeks or below.
Out of 353 neonates who were included in the study, 42 were positive for E. cloacae (11.9%; 95% confidence interval 8.8-15.6%). Risk factors for colonisation were: a lower birth weight, a lower gestational age, lower 1 minute APGAR score and longer duration of admission at the NICU. In neonates who were born ≤30 weeks of gestational age, longer duration of admission and lower gestational age remained independent risk factors for colonisation with E cloacae.
The colonisation rates were highest in the most vulnerable neonates, i.e. those with a lower gestational age, lower birth weight and a longer admission at the NICU. These factors are all interrelated and part of (extreme) prematurity. In situations where screening is performed in response to a suspected outbreak, it is helpful to know the background colonisation rate in order to interpret the colonisation rates. When limited resources are available a cost effective strategy could be to limit screening to neonates born after pregnancy duration <30 weeks.
Disclosure of interest
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.