128 - Invasive Extended-spectrum β-lactamase producing Enterobacteriaceae infections among infants following vertical colonization at the Neonatal Intensive Care Unit

Poster Number: 128
Publication Number: 128.1913

Background: Extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) became prevalent in communities that 15% of healthy adults were colonized at intestinal tract in Japan. Although vertical transmission of ESBL-E from mothers to neonates during delivery could predispose a risk of developing infection, prevalence of neonatal ESBL-E colonization and subsequent invasive ESBL-E infection among colonizers were not known.

Objective: Our aim of the study was to describe incidence of ESBL-E colonization among neonates admitted to the NICU and incidence of subsequent invasive ESBL-E infections.

Design/Methods: Neonates were enrolled at the NICU of Tokyo Metropolitan Children’s Medical Center between April 2011 and March 2023. On admission, neonates were routinely screened for ESBL-E with pharyngeal, rectal swabs. Neonates colonized with ESBL-E was investigated for developing invasive ESBL-E infection during NICU hospitalization. Demographic data and type of invasive ESBL-E infections were collected from electrical medical charts.

Results: Among 8,247 neonates admitted to the NICU, ESBL-E was isolated in 105 (1.3%). The fiscal annual rates of ESBL-E colonization ranged from 0.29 to 3.1% had no specific trend. Median gestational age and birthweight were 38w5d (IQR 37w1d-39w4d) and 2,876 (IQR 2,325-3,182) gram. Among them, twelve (0.15%) colonizers developed invasive ESBL-E infections at median age of 11 (IQR 5.75-19) days old. Median gestational age and birthweight were 37w5d (IQR 25w0d-39w3d) and 2,535 (IQR 665-3,052) gram. Bacteremia was observed in four patients. Common infections included 4 ventilator associated pneumonia, 4 urinary tract infection and 2 peritonitis due to intestinal perforation. Four patients (32%) had empirical treatment without ESBL-E coverage. There was no mortality at day 28 from infection onset.

Conclusion(s): Although ESBL-E colonization occurred in 1.3% of neonates admitted to the NICU, subsequent invasive ESBL-E infection was rare in our patients cohort.