scholarly journals Optical DNA Mapping Combined with Cas9-Targeted Resistance Gene Identification for Rapid Tracking of Resistance Plasmids in a Neonatal Intensive Care Unit Outbreak

mBio ◽  
2019 ◽  
Vol 10 (4) ◽  
Author(s):  
Santosh K. Bikkarolla ◽  
Viveka Nordberg ◽  
Fredrika Rajer ◽  
Vilhelm Müller ◽  
Muhammad Humaun Kabir ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Resistant Bacteria ◽  
Content Type ◽  
Dna Mapping ◽  
Global Spread ◽  
Resistance Plasmids

ABSTRACTThe global spread of antibiotic resistance amongEnterobacteriaceaeis largely due to multidrug resistance plasmids that can transfer between different bacterial strains and species. Horizontal gene transfer of resistance plasmids can complicate hospital outbreaks and cause problems in epidemiological tracing, since tracing is usually based on bacterial clonality. We have developed a method, based on optical DNA mapping combined with Cas9-assisted identification of resistance genes, which is used here to characterize plasmids during an extended-spectrum β-lactamase (ESBL)-producingEnterobacteriaceaeoutbreak at a Swedish neonatal intensive care unit. The outbreak included 17 neonates initially colonized with ESBL-producingKlebsiella pneumoniae(ESBL-KP), some of which were found to carry additional ESBL-producingEscherichia coli(ESBL-EC) in follow-up samples. We demonstrate that all ESBL-KP isolates contained two plasmids with theblaCTX-M-15gene located on the smaller one (~80 kbp). The same ESBL-KP clone was present in follow-up samples for up to 2 years in some patients, and the plasmid carrying theblaCTX-M-15gene was stable throughout this time period. However, extensive genetic rearrangements within the second plasmid were observed in the optical DNA maps for several of the ESBL-KP isolates. Optical mapping also demonstrated that even though other bacterial clones and species carryingblaCTX-Mgroup 1 genes were found in some neonates, no transfer of resistance plasmids had occurred. The data instead pointed toward unrelated acquisition of ESBL-producingEnterobacteriaceae(EPE). In addition to revealing important information about the specific outbreak, the method presented is a promising tool for surveillance and infection control in clinical settings.IMPORTANCEThis study presents how a novel method, based on visualizing single plasmids using sequence-specific fluorescent labeling, could be used to analyze the genetic dynamics of an outbreak of resistant bacteria in a neonatal intensive care unit at a Swedish hospital. Plasmids are a central reason for the rapid global spread of bacterial resistance to antibiotics. In a single experimental procedure, this method replaces many traditional plasmid analysis techniques that together provide limited details and are slow to perform. The method is much faster than long-read whole-genome sequencing and offers direct genetic comparison of patient samples. We could conclude that no transfer of resistance plasmids had occurred between different bacteria during the outbreak and that secondary cases of ESBL-producingEnterobacteriaceaecarriage were instead likely due to influx of new strains. We believe that the method offers potential in improving surveillance and infection control of resistant bacteria in hospitals.

scholarly journals Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management

2020 ◽  
Vol 68 (1) ◽  
Author(s):  
Reem M. Soliman ◽  
Fatma Alzahraah Mostafa ◽  
Antoine Abdelmassih ◽  
Elham Sultan ◽  
Dalia Mosallam
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Side Effects ◽  
Patent Ductus Arteriosus ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Patent Ductus

Abstract Background Patent ductus arteriosus poses diagnostic and therapeutic dilemma for clinicians, diagnosis of persistent PDA, and determination of its clinical and hemodynamic significance are challenging. The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU, to report cardiac and respiratory complications of PDA, and to study the management strategies and their subsequent outcomes. Result Echocardiography was done for 152 preterm babies admitted to neonatal intensive care unit (NICU) on day 3 of life. Eighty-seven (57.2%) preterms had PDA; 54 (62.1%) non-hemodynamically significant PDA (non-hsPDA), and 33 (37.9%) hemodynamically significant PDA. Hemodynamically significant PDA received medical treatment (paracetamol 15 mg/kg/6 h IV for 3 days). Follow-up echocadiography was done on day 7 of life. Four babies died before echo was done on day 7. Twenty babies (68.9%) achieved closure after 1st paracetamol course. Nine babies received 2nd course paracetamol. Follow-up echo done on day 11 of life showed 4 (13.7%) babies achieved successful medical closure after 2nd paracetamol course; 5 babies failed closure and were assigned for surgical ligation. The group of non-hsPDA showed spontaneous closure after conservative treatment. Pulmonary hemorrhage was significantly higher in hsPDA group. Mortality was higher in hsPDA group than non-hsPDA group. Conclusion Echocardiographic evaluation should be done for all preterms suspected clinically of having PDA. We should not expose vulnerable population of preterm infants to medication with known side effects unnecessarily; we should limit medical closure of PDA to hsPDA. Paracetamol offers several important therapeutic advantages options being well tolerated and having more favorable side effects profile.

scholarly journals Maternal experiences with specificities of prematurity that hinder breastfeeding

2015 ◽  
Vol 24 (1) ◽  
pp. 55-63 ◽  
Author(s):  
Luciana Barbosa Pereira ◽  
Ana Cristina Freitas de Vilhena Abrão ◽  
Conceição Vieira da Silva Ohara ◽  
Circéa Amália Ribeiro
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Study ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Clinical Instability ◽  
Mothers Of Preterm Infants ◽  
Late Start

A qualitative study which has Symbolic Interactionism as theoretical framework and Interpretative Interactionism as its methodological one, aiming to unveil motherly experiences against prematurity peculiarities that hinder breastfeeding during infant's hospitalization at the Neonatal Intensive Care Unit. Were interviewed 13 mothers of preterm infants assisted at an Outpatient Follow-up Clinic of Montes Claros MG, Brazil. Results show that as trying to breastfeed a premature infant, the mother interacts with situations signified by her as obstacles to breastfeeding: the "torment" of their child's hospitalization and clinical instability, the fear of baby's death, its difficulty to suck, the late start of breastfeeding interpreted a something difficult, as a risk to weight. We consider that although breastfeeding a preterm infant is a challenge, appropriate professional conducts and hospital procedures might facilitate it and therefore should be implemented, aiming at promoting, protecting and supporting breastfeeding.

Congenital Tuberculosis and Management of Exposures in a Neonatal Intensive Care Unit

2002 ◽  
Vol 23 (10) ◽  
pp. 573-579 ◽  
Author(s):  
Brent W. Laartz ◽  
Hugo J. Narvarte ◽  
Douglas Holt ◽  
Julie A. Larkin ◽  
William F. Pomputius
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Chest Radiographs ◽  
Skin Tests ◽  
Base Line ◽  
Urban Hospital ◽  
Congenital Tuberculosis

Objective:We report a case of congenital tuberculosis in a neonatal intensive care unit (NICU) and the management of exposure to other neonates in the hospital. We review the literature regarding congenital tuberculosis and management of exposures in the NICU.Design:Case report and a survey of exposures with a 3-month follow-up.Setting:Urban hospital.Patients:Neonates exposed to a case of congenital tuberculosis.Interventions:Exposure to tuberculosis was treated with isoniazid. Purified protein derivative tests were placed at base-line and 3 to 4 months after exposure. Chest radiographs were performed if clinically indicated.Results:Congenital tuberculosis was diagnosed in our patient at 21 days of age during a prolonged hospital course. After initiation of anti-tuberculous medications, the patient gradually recovered from his illness. While he was treated in the NICU, there were 37 potentially exposed infants. Of these, 36 were administered tuberculin skin tests (average age, 1.7 months), all of which were read as 0 mm of induration. Of those 37, 35 began prophylaxis with isoniazid, and 30 were able to complete treatment with a minimum of 3 months of isoniazid therapy. Of those 30, two infants received 6 months of therapy. Additionally, 29 of the 37 infants had chest radiographs, none of which showed suspicious infiltrates or adenopathy. Finally, 30 of the 36 infants had repeat tuberculin skin tests at 3 months, all of which were read as 0 mm of induration (average age, 3.7 months).Conclusion:Congenital tuberculosis is an uncommon disease that requires early diagnosis for successful therapy and vigilant follow-up of potential exposures in the NICU. (Infect Control Hosp Epidemiol 2002;23:573-579).

149 Follow-up of adverse events in a neonatal intensive care unit

2010 ◽  
Vol 19 (Suppl 1) ◽  
pp. A92-A93
Author(s):  
L. F. Stephanie ◽  
R. Hasinirina ◽  
S. Betty ◽  
B. Martine
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care
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