World Journal of Pediatrics

, Volume 13, Issue 3, pp 210–216 | Cite as

Successful elimination of extended-spectrum beta-lactamase (ESBL)-producing nosocomial bacteria at a neonatal intensive care unit

  • Borbála Szél
  • Zsolt Reiger
  • Edit Urbán
  • Andrea Lázár
  • Krisztina Mader
  • Ivelina Damjanova
  • Kamilla Nagy
  • Gyula Tálosi
Original Article



Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are highly dangerous to neonates. At our Neonatal Intensive Care Unit (NICU), the presence of these bacteria became so threatening in 2011 that immediate intervention was required.


This study was conducted during a nearly two-year period consisting of three phases: retrospective (9 months), educational (3 months) and prospective (9 months). Based on retrospective data analysis, a complex management plan was devised involving the introduction of the INSURE protocol, changes to the antibiotic regimen, microbiological screening at short intervals, progressive feeding, a safer bathing protocol, staff hand hygiene training and continuous monitoring of the number of newly infected and newly colonized patients. During these intervals, a total of 355 patients were monitored.


Both ESBL-producing Enterobacter cloaceae and Klebsiella pneumoniae were found (in both patients and environmental samples). In the prospective period a significant reduction could be seen in the average number of both colonized (26/167 patients; P=0.029) and infected (3/167 patients; P=0.033) patients compared to data from the retrospective period regarding colonized (72/188 patients) and infected (9/188 patients) patients. There was a decrease in the average number of patient-days (from 343.72 to 292.44 days per months), though this difference is not significant (P=0.058). During the prospective period, indirect hand hygiene compliance showed a significant increase (from the previous 26.02 to 33.6 hand hygiene procedures per patient per hospital day, P<0.001).


Colonizations and infections were rolled back successfully in a multi-step effort that required an interdisciplinary approach.

Key words

hand hygiene INSURE protocol interdisciplinary approach neonates polyresistance 


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Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Borbála Szél
    • 1
  • Zsolt Reiger
    • 2
  • Edit Urbán
    • 3
  • Andrea Lázár
    • 3
  • Krisztina Mader
    • 2
  • Ivelina Damjanova
    • 4
  • Kamilla Nagy
    • 1
  • Gyula Tálosi
    • 2
  1. 1.Infection Control UnitUniversity of SzegedSzegedHungary
  2. 2.Department of PediatricsUniversity of SzegedSzegedHungary
  3. 3.Institute of Clinical MicrobiologyUniversity of SzegedSzegedHungary
  4. 4.Department of BacteriologyNational Center for EpidemiologyBudapestHungary

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