Environmental Contamination with Multi-drug Resistant Organisms in a Nigerian Neonatal Intensive Care Unit. Impactful Infection Source

Abstract

Background: Neonates admitted into neonatal intensive care unit (NICU) are at high risk of acquiring infections due to the immaturity of their immune systems and the barrage of intensive medical care. Multiple drug resistant organisms are mostly implicated in causing these infections, usually acquired through contaminated environment. This research was designed to assess the environmental contamination with multi-drug resistant organisms in neonatal intensive care unit. Methods: Environmental samples were collected from all the equipment in each of the 3 rooms in neonatal intensive care unit and cultured on 5% sheep blood agar, chocolate agar and MacConkey agar plates. The isolates were identified with standard biochemical tests. Antibiotic susceptibility profile was done using modified Kirby Bauer disc diffusion method and interpreted according to the guidelines by Clinical and Laboratory Standard Institute. Methicillin resistant Staphylococcus aureus was detected using cefoxitin disc while extended spectrum beta-lactamase (ESBL) producers were confirmed with ESBL chromogenic agar. Results: Out of 36 samples collected from different sites in the 3 rooms, 19(53%) yielded bacterial growth. A total of 28 (78%) bacterial isolates were detected, with majority 25(89%) isolated from room 1. Staphylococcus aureus 15(42%) was the predominant isolate followed by Klebsiella pneumoniae 5(14%) and non-Candida albicans spp 3(8%). Most of Staphylococcus aureus isolates were from samples collected from incubators. Out of 15 Staphylococcus aureus isolated, 11 (73%) were MRSA. Among the Gram negatives, all 5(100%) Klebsiella pneumonioae and 3(60) Acinetobacter species were positive for extended spectrum beta-lactamase production. All the isolates were resistant to 3 or more classes of antibiotics. Imipenem and linezolid were the most sensitive antibiotics to the isolated organisms. Conclusion: High degree of contamination of the environment in NICU with multi drug resistant bacteria is worrisome because of the serious threat it poses. This calls for immediate holistic interventional measures. Strict Compliance with infection prevention and control measures. Additionally, there should be regular antimicrobial resistance surveillance in NICU.