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Role of environmental surfaces and hands of healthcare workers in perpetuating multi-drug-resistant pathogens in a neonatal intensive care unit

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Abstract

Neonates admitted to neonatal intensive care units are at a risk of developing healthcare-associated infections, leading to increased risk of mortality. This study aimed to identify organisms causing such late-onset infections in neonates and determine whether these isolates were genetically identical to those from the surrounding environmental surfaces and hands of healthcare workers (HCWs). A cross-sectional study was carried out over a period of 4 months in a university neonatal intensive care unit (NICU). Samples were collected from all neonates with symptoms of late-onset infections (n = 180). Fingerprint samples of 21 healthcare workers as well as 330 random environmental samples were also taken from the unit. Isolates from neonates, environment and fingerprints were subjected to protein electrophoresis followed by sequencing to detect genetic similarities. Almost half of neonatal samples were culture positive (91/180, 50.6%), out of which 72% of bacterial isolates (49/68) were multi-drug resistant. Klebsiella pneumoniae (32.6%) and Candida spp. (28.4%) were the commonest neonatal isolates. A cluster of two homologous Klebsiella pneumoniae strains was isolated from a neonate and an examining bed, while another homologous cluster was from a neonatal sample and a portal incubator. A third cluster was isolated from hands and three neonatal samples. This cluster (caused by Klebsiella pneumoniae strain NH54 chromosome) was found to perpetuate over the 4 months of the study. All three clusters were multi-drug-resistant Klebsiella pneumoniae. A homologous pair of each of Candida tropicalis and Candida glabrata was isolated from the blood of two neonates, and one neonatal and a crash cart sample, respectively. Overall, 8.8% (8/91) of neonatal samples were found to be homologous to other neonatal/environmental/hand isolates, denoting perpetuation of pathogens between neonates themselves and also other reservoirs of infections.

Conclusion: The hands of HCWs, crash carts and incubators are reservoirs of pathogens and can lead to nosocomial infections. Clusters of multi-drug-resistant Klebsiella pneumoniae and Candida spp. were the predominant neonatal pathogens in this NICU.

What is Known:

• The role of hands and the environment in transmission of infections to neonates is a subject of debate.

• Genetic sequencing provides solid evidence for detecting homologous strains.

What is New:

• K. pneumoniae was the most frequently isolated pathogen, and concomitant isolation was found in two cases from the neonatal surroundings (bed/incubator) and hands.

• Candida spp. with homology were also found in different neonates and environmental samples suggesting risk of transmission.

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Availability of data and material

All data will be provided by the researcher upon request.

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Change history

  • 22 September 2021

    The Reference 13 journal abbreviation has been updated.

Abbreviations

C. glabrata:

Candida glabrata

C. tropicalis:

Candida tropicalis

CSF:

Cerebrospinal fluid

HCAIs:

Healthcare-associated infections

HCWs:

Healthcare workers

K. pneumoniae:

Klebsiella pneumoniae

MRSA:

Methicillin-resistant Staphylococcus aureus

MDR:

Multi-drug resistant

NICU:

Neonatal intensive care unit

References

  1. Kumar S et al (2018) Healthcare associated infections in neonatal intensive care unit and its correlation with environmental surveillance. J Infect and Pub Health 11(2):275–279

    Article  Google Scholar 

  2. Srivastava S, Shetty N (2007) Healthcare-associated infections in neonatal units: lessons from contrasting worlds. J Hosp Infect 65(4):292–306

    Article  CAS  Google Scholar 

  3. Mahapatra A et al (2002) Enterobacter cloacae: a predominant pathogen in neonatal septicaemia. Indian J Med Microbiol 20(2):110

    CAS  PubMed  Google Scholar 

  4. Denniston S, Riordan FAI (2006) Staphylococcus aureus bacteraemia in children and neonates: a 10 year retrospective review. J Infect 53(6):387–393

    Article  Google Scholar 

  5. Medhat H, Khashana A (2017) Incidence of neonatal infection in South Sinai, Egypt. Int J Infect 4(1): e36615

  6. Moore KL et al (2005) Neonatal sepsis in Egypt associated with bacterial contamination of glucose-containing intravenous fluids. The Pedia Infect Dis J24(7):590–594

    Article  Google Scholar 

  7. Gill CJ et al (2011) Effect of training 273 traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study. British Med J 342: d346

  8. Forbes BA, Sahm DF, Weissfeld AS (2007) Bailey and Scott’s diagnostic microbiology, in Back to cited text, F.L. Fort Lauderdale, Editor. Mosby Elsevier, China

  9. Radpour R et al (2009) Simultaneous isolation of DNA, RNA, and proteins for genetic, epigenetic, transcriptomic, and proteomic analysis. J Proteome Res 8(11):5264–5274

    Article  CAS  Google Scholar 

  10. El-khodary GM et al (2020) Phylogenetic identification and assessment of the nutritional value of different diets for a copepod species isolated from Eastern Harbor coastal region. The Egypt J Aqua Res 46(2):173–180

    Article  Google Scholar 

  11. Chandel DS et al (2011) Extended-spectrum β-lactamase-producing Gram-negative bacteria causing neonatal sepsis in India in rural and urban settings. J Med Microbiol 60(Pt 4):500–507

    Article  Google Scholar 

  12. Mohaddesi H et al (2014) Investigating the effects of the neonatal factors and therapeutic modalities on neonatal mortality in neonatal intensive care unit of Shahid Motahhari Hospital, Urmia. Iran J Nurs Midwifery Res 19(5):485

    PubMed  PubMed Central  Google Scholar 

  13. Omran EA, Eisa FF, Bakr WMK (2020) Microbial contamination of neonatal injectable lipid emulsions at 12 and 24 hours’ infusion time with evaluation of infection control measures. J Pediatr Pharmacol Ther 25(1):53–60

    PubMed  PubMed Central  Google Scholar 

  14. Gadallah MAH et al (2014) Surveillance of 295 health care–associated infections in a tertiary hospital neonatal intensive care unit in Egypt: 1-year follow-up. Am J Infect Control 42(11):1207–1211

    Article  Google Scholar 

  15. El-Din SE et al (2015) Epidemiology of neonatal sepsis and implicated pathogens: a study from Egypt. Biomed Res Int 2015:11

    Google Scholar 

  16. Peterside O, Pondei K, Akinbami FO (2015) Bacteriological profile and antibiotic susceptibility pattern of neonatal sepsis at a teaching hospital in Bayelsa state. Nigeria Tropical Med and health 43(3):183–190

    Article  Google Scholar 

  17. Zhou B et al (2016) Clinical and microbiological profile of babies born with risk of neonatal sepsis. Exp Ther Med 12(6):3621–3625

    Article  Google Scholar 

  18. Sepehri G et al (2009) Bacterial contamination and resistance to commonly used antimicrobials of healthcare workers’ mobile phones in teaching hospitals, Kerman. Iran Am J Appl Sci 6(5):806

    Article  Google Scholar 

  19. Tarabay J (2018) What’s growing in your water? Identification of a pseudomonas outbreak in a NICU. Am J Infect Control 46(6):S106

    Article  Google Scholar 

  20. Gray J, Omar N (2013) Nosocomial infections in neonatal intensive care units in developed and developing countries: how can we narrow the gap? J Hosp Infect 83(3):193–195

    Article  CAS  Google Scholar 

  21. Malik A et al (2003) Nosocomial Klebsiella infection in neonates in a tertiary care hospital: protein profile by SDS-page and klebocin typing as epidemiological markers. Indian J Med Microbiol 21(2):82

    Article  CAS  Google Scholar 

  22. Gramatniece A et al (2019) Control of Acinetobacter baumannii outbreak in the neonatal intensive care unit in Latvia: whole-genome sequencing powered investigation and closure of the ward. Antimicrob Resist Infect Control 8(1):84

    Article  CAS  Google Scholar 

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Funding

This study was self-funded by the researchers with no external funding or grants.

Author information

Authors and Affiliations

  1. Department of Microbiology, High Institute of Public Health, Alexandria University, El-Ibrahimia, 165 El-Horreya Avenue, Alexandria, Egypt

    Marwa A. Elkady, Wafaa M. K. Bakr & Eman A. Omran

  2. Department of Paediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Hesham Ghazal

Authors
  1. Marwa A. Elkady
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  2. Wafaa M. K. Bakr
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  3. Hesham Ghazal
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  4. Eman A. Omran
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Contributions

Marwa Elkady was responsible for sample collection, microbiological processing and manuscript preparation. Wafaa Bakr and Eman Omran were responsible for manuscript preparation and data analysis. Hesham Ghazal was responsible for sample collection from neonates and facilitating work at the NICU with other HCWs.

Corresponding author

Correspondence to Eman A. Omran.

Ethics declarations

Ethics approval

Approval from the Ethical Committee of the High Institute of Public Health, Alexandria University, was taken prior to the commencement of this study. The ethical consideration adheres to the Declaration of Helsinki.

Conflict of interest

The authors declare no competing interests.

Consent to participate

Written informed consent from the parents/guardians of each neonate was taken prior to sample and data collection. Verbal consent was taken from each HCW prior to participation and fingertip sampling.

Consent for publication

Informed consent from the parents/guardians of each neonate was taken regarding the publication of this data.

Additional information

Communicated by Nicole Ritz

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Elkady, M.A., Bakr, W.M.K., Ghazal, H. et al. Role of environmental surfaces and hands of healthcare workers in perpetuating multi-drug-resistant pathogens in a neonatal intensive care unit. Eur J Pediatr 181, 619–628 (2022). https://doi.org/10.1007/s00431-021-04241-6

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  • DOI: https://doi.org/10.1007/s00431-021-04241-6

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