Reduction in Colonization and Nosocomial Infection by Multiresistant Bacteria in a Neonatal Unit After Institution of Educational Measures and Restriction in the Use of Cephalosporins

Am J Infect Control. 2001 Jun;29(3):133-8. doi: 10.1067/mic.2001.114223.


Introduction: Previous administration of third-generation cephalosporins predisposes to colonization and infections by multiresistant Enterobacter sp. The emergence of multiresistant bacteria infections in a neonatal unit during 1995, especially Enterobacter cloacae, stimulated this study.

Objective: To evaluate the efficacy of measures to control colonization and nosocomial infection by multiresistant bacteria in a neonatal unit.

Setting: A tertiary care university hospital.

Patients and methods: This study was conducted from October 1995 through December 1999 in 4 phases: a cross-sectional study, a longitudinal study with intervention measures, monthly cross-sectional studies, and determination of nosocomial infections caused by multiresistant bacteria (oxacillin-resistant Staphylococcus aureus and gram-negative bacteria resistant to either aminoglycosides or third-generation cephalosporins). Specimens for surveillance culture were obtained through umbilical and rectal swabs, and tracheal aspirates from intubated babies. The intervention measures were as follows: (1) appropriated training of the whole health care team, emphasizing measures to reduce cross-colonization, and the importance of rational usage of antibiotics and (2) suppression of usage of third-generation cephalosporins. Risk factors were analyzed through univariate and multivariate logistic regression.

Results: In the first phase, 32% (10/31) of the patients were colonized by multiresistant bacteria (29% by multiresistant E cloacae ). In the second phase, 342 patients were evaluated; 33% of them were colonized by E cloacae, and a multiresistant strain was isolated in 10.8% (37/342) of the babies. A logistic regression model indicated parenteral nutrition and antibiotic usage as risk factors for colonization by multiresistant E cloacae. In the third phase, for 6 months, only 2 patients were colonized by multiresistant E cloacae. In the fourth phase, the analysis of bacterial resistance profile indicated a reduction of nosocomial infections due to multiresistant bacteria from 18 cases in 1995 to 2 cases per year until 1999.

Conclusion: These results have shown that the measures adopted were effective.

MeSH terms

  • Analysis of Variance
  • Bacterial Infections / epidemiology
  • Bacterial Infections / microbiology
  • Bacterial Infections / prevention & control*
  • Brazil / epidemiology
  • Cephalosporins / therapeutic use*
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Cross Infection / prevention & control*
  • Cross-Sectional Studies
  • Drug Resistance, Multiple*
  • Enterobacter cloacae
  • Enterobacteriaceae Infections / epidemiology
  • Enterobacteriaceae Infections / prevention & control
  • Humans
  • Infant, Newborn
  • Infection Control / organization & administration
  • Inservice Training*
  • Intensive Care Units, Neonatal*
  • Prospective Studies
  • Risk


  • Cephalosporins