National surveillance study of extended spectrum β lactamase (ESBL) producing organism infection in neonatal units of england and wales
Aims Extended spectrum β lactamase (ESBL) are regarded as new β lactamases. They are able to hydrolyse the oxyimino group, conferring resistance to most β lactam antibiotics. There is no child or neonate specific data for ESBL infection are published for the UK. Although ESBL infection in the neonatal population can cause significant mortality and morbidity, there is lack of consensus regarding its management and the efficacy of routine ESBL screening for all infants in neonatal units. We conducted a national survey to characterise the prevalence of neonatal ESBL infection and it's management strategy in different units.
Methods A cross-sectional survey was performed across the neonatal units of England and Wales requesting data from 198 neonatal units during two rounds in January 2010 and July 2010. We asked questions regarding the occurrence of ESBL infection or colonisation and unit specific management, including screening.
Results Questionnaires were returned by 133 units (67%). 35 units reported ESBL positive results within the 2 years prior to the survey, giving a prevalence of 26%. ESBL producing E Coli and Klebsiella were isolated from most units with positive results. Of these, 16 units reported positive surface swabs or faeces and 19 units had invasive ESBL infections (positive results from blood, urine or respiratory secretions). Of the 35 units with positive results, 15 units were level 3 units, 15 were level 2 units and 5 units were level 1 unit. There were 10 units (four level 2 and six level 3 units) which declared ESBL outbreaks, with 11% of units (who returned the questionnaire) routinely screening all babies in their units for ESBL organisms in faeces or surface swabs. Interestingly, nine units (26%) do not isolate babies with positive ESBL results. Most units use meropenem (with or without an aminoglycoside), although two units use cefotaxime for treatment.
Conclusion ESBL infection in the neonatal population is high in England and Wales. Close monitoring of the spread of resistance in these organisms and a consensus guideline regarding management may help to reduce the prevalence of these infections.