Trending and modeling multi-drug resistant organisms in the Neonatal Intensive Care Unit
Jennifer Duchon, MD, MPH
BACKGROUND: Safe and effective antimicrobial therapy for neonates infected with multidrug resistant organisms (MDROs) is limited so both active and passive surveillance for MDROs are important interventions to prevent transmission and infection with MDROs in neonates hospitalized in the Neonatal Intensive Care Unit (NICU). Surveillance data analyzed from infants transferred to the 2 NICUs affiliated with New York Presbyterian (NYP) demonstrated low rates of MDRO colonization in the first week of life. Thus, we changed our surveillance policy to only culture infants 7 days of age and older, providing us with a unique opportunity to assess these different surveillance strategies and monitor the safety of this change
GAP: Optimal strategies, risks, costs, and benefits of surveillance in the NICU population have not been fully evaluated
1) Colonization of transferred infants >7 days old with MDROs will be similar before and after surveillance policy change.
2) Infections with MDROs among all infants will be similar before and after surveillance policy change.
3) Predictive models can estimate colonization of all infants in the NICU and further refine targeted MDRO surveillance by predicting potential outbreak conditions.
METHODS: Eligible subjects are all infants hospitalized in the NICUs of NYPfrom July 2006-June 2016.The rates of MDRO colonization and infection from July 2006-June 2013 when all transferred infants had surveillance cultures performed with rates from July 2013-July 2016, when only infants >7 days old had surveillance cultures performed will be assessed, and predictive models of MDRO colonization and transmission will be hypothesized using Bayesian algorithms.
IMPACT: From this project we will create evidence based surveillance guidelines for the NICU population; future research can test the generalizability of these guidelines beyond our NICUs, with an ultimate goal of providing a means to prevent transmission and infection with MDROs in the NICU.