Risk factors for colonization/infection by resistant microorganisms in outbreaks in neonatal unit—a systematic review and meta-analysis

Abstract

Objective

This study aims to evaluate risk factors for infection/colonization by resistant bacteria among patients in Neonatal Intensive Care Units (NICU).

Methods

This systematic review is reported according to PRISMA. The search occurred by consulting the PubMed, Embase, Cochrane, SciELO, and Scopus databases. Inclusion criteria considered studies with Neonatal population admitted to the Neonatal Intensive Care Unit (P); Risk factors for resistant bacterial infection (E); No risk factors for resistant bacterial infection (C); Isolation of resistant bacteria in an outbreak (O), Observational studies (S). For Meta-Analysis, data were transformed to a logarithmic scale to directly calculate the standard error from the confidence intervals. The quality of studies was assessed Critical Appraisal Tools recommended by JBI.

Results

A total of 21 articles were eligible and presented a sample size ranging from 10 to 263 newborns (a total of 1979 neonates). Six (28.6 %) studies evaluated infection, five (23.8) evaluated colonization, and 10 (47.6 %) evaluated colonization and infection, covering Gram-positive (n = 8; 38 %) and Gram-negative (n = 13; 62 %) bacteria. In the meta-analysis, the use of venous access (OR: 1.58; 95 %CI 1.14–2.20), mechanical ventilation (OR: 7.55 95 %CI 4.27–13.36), and parenteral nutrition (OR: 4.79; 95 %CI 2.23–10.29) increased the chance of colonization/infection by multiresistant microorganisms. The included studies were considered as having adequate quality.

Conclusion

The main risk factors in outbreaks of infection/colonization by resistant microorganisms in Neonatal Units are the use of invasive devices and parenteral nutrition, which leads to the identification of newborns at risk, targeting the development of preventive measures.