Neonatal Unit Colonization Pressure and Acquisition of Extended-Spectrum β-Lactamase Gut Colonization

Importance Understanding how neonatal unit colonization pressure, the proportion of infants carrying resistant bacteria on a unit, is associated with antibiotic-resistant bacterial acquisition risk can inform the design and implementation of effective infection prevention and control (IPC) interventions. Objectives To describe resistant bacterial gene prevalence in European neonatal units and to assess the association between unit-level extended-spectrum β-lactamase (ESBL) colonization pressure and infant-level ESBL acquisition. Design, Setting, and Participants Multicenter study in 24 tertiary neonatal units in 8 European countries (Estonia, Greece, Germany, Italy, Poland, Spain, Switzerland, and the United Kingdom) using repeated cross-sectional surveys collecting stool samples from infants over 4 surveys with 4-, 7-, and 14-day intervals, analyzed using real-time quantitative polymerase chain reaction (PCR) between January 2022 and June 2024 as part of the NeoIPC project. All infants present on the neonatal unit at 8:00 am on the day of the survey were eligible; infants could contribute to multiple surveys. Exposure ESBL colonization pressure at previous survey. Main Outcome and Measure Incident infant gut colonization with ESBL-harboring bacteria (ESBL-colonized). Bayesian hierarchical logistic regression modeling was used to assess the association between colonization pressure and infant-level acquisition risk on the neonatal unit. Results Overall, 943 infants (547 of 943 male [58.0%]; median [IQR] gestational age, 34 [30-38] weeks, and median [IQR] birth weight, 2130 [1254-3084] g) contributed to 1847 infant-survey observations. Stool samples were collected and PCR results obtained in 1448 of 1847 infant surveys (78.4%). The most common genes detected were those encoding ESBLs (205 of 1448 samples [14.2%]), with high unit-level variation. In the colonization acquisition analysis, we included 829 samples from 533 infants hospitalized since birth who were either newly admitted since or not colonized at the previous survey time point; 90 of 533 infants (16.9%) became ESBL-colonized. Their median (IQR) gestational age was 34 (30-37) weeks, and median (IQR) length of stay at survey was 14 (5-32) days. Colonization pressure was associated with increased odds of becoming ESBL-colonized for all survey intervals (4-day interval: mean odds ratio [OR], 1.89; 95% credible interval [CrI], 1.22-2.94; 7-day interval: OR, 1.76; 95% CrI, 1.26-2.63; 14-day interval: OR, 1.73; 95% CrI, 1.15-2.52 per 10% increase of colonization pressure). Conclusions and Relevance In this cross-sectional study, ESBL colonization pressure was associated with individual risk of acquiring ESBL on the neonatal unit. Unit-level interventions targeting colonization rather than infection may have important direct and indirect benefits in units with high colonization pressure.

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Journal
JAMA Network Open
Published
2026-09-15
DOI
https://doi.org/10.1001/jamanetworkopen.2026.32644
Primary Topic
Neonatal and Maternal Infections
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article
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article

Neonatal Unit Colonization Pressure and Acquisition of Extended-Spectrum β-Lactamase Gut Colonization

Elena Priante, Jennifer Martin, A Cook, Éric Giannoni et al.
JAMA Network Open
Neonatal and Maternal Infections
article

Neonatal Unit Colonization Pressure and Acquisition of Extended-Spectrum β-Lactamase Gut Colonization

Elena Priante, Jennifer Martin, A Cook, Éric Giannoni, Εlias Iosifidis, Martin Stocker, Mari‐Liis Ilmoja, Dimitra Gialamprinou, Dariusz Gruszfeld, Maria Simitsopoulou, Eleni Papachatzi, Liesbet Van Heirstraeten, Anna Badura, Veronica Notarbartolo, Elske Sieswerda, Surbhi Malhotra‐Kumar, Eugenio Baraldi, Elena Bergón Sendín, Evangelia Koemtzidou, Chiara Minotti, Matilda Berkell, Concepción de Alba Romero, José R. Zubizarreta, Helgi Padari, Julia Bielicki, Kristin Tanney, Varvara Dimopoulou, Georgıos Mitsiakos, Eva Garcia-Canto, Mario Giuffrè, Tuuli Metsvaht, Kassandra Tataropoulou, Begoña Loureiro-Gonzalez, Aleksandra Pietrzyk, Filip Djukic, Jasmine Myhill, Charles C. Roehr, Chiara Messina, Paul Clarke, C. Henri van Werkhoven, Eleftheria Hatzidaki, Donna Tolentino, Sven Wellmann, Vassiliki Papaevangelou, David R. M. Smith, Nicolina-Hilda Anagnostatou, Fernando Cabañas, Despoina Gkentzi, Nicola Booth, Amy Reid, NeoIPC Feasibility Group, Yolanda Campos-Franco, Maria Livieratou, Argyro Ftergioti, Alexandra Périsset, Angeliki Kontou, Emmanuel Roilides, Caridad Tapia-Collados, Kosmas Sarafidis, Grete Haube, Javier Perez-Lopez, Paula Brock
article en

Abstract

Importance Understanding how neonatal unit colonization pressure, the proportion of infants carrying resistant bacteria on a unit, is associated with antibiotic-resistant bacterial acquisition risk can inform the design and implementation of effective infection prevention and control (IPC) interventions. Objectives To describe resistant bacterial gene prevalence in European neonatal units and to assess the association between unit-level extended-spectrum β-lactamase (ESBL) colonization pressure and infant-level ESBL acquisition. Design, Setting, and Participants Multicenter study in 24 tertiary neonatal units in 8 European countries (Estonia, Greece, Germany, Italy, Poland, Spain, Switzerland, and the United Kingdom) using repeated cross-sectional surveys collecting stool samples from infants over 4 surveys with 4-, 7-, and 14-day intervals, analyzed using real-time quantitative polymerase chain reaction (PCR) between January 2022 and June 2024 as part of the NeoIPC project. All infants present on the neonatal unit at 8:00 am on the day of the survey were eligible; infants could contribute to multiple surveys. Exposure ESBL colonization pressure at previous survey. Main Outcome and Measure Incident infant gut colonization with ESBL-harboring bacteria (ESBL-colonized). Bayesian hierarchical logistic regression modeling was used to assess the association between colonization pressure and infant-level acquisition risk on the neonatal unit. Results Overall, 943 infants (547 of 943 male [58.0%]; median [IQR] gestational age, 34 [30-38] weeks, and median [IQR] birth weight, 2130 [1254-3084] g) contributed to 1847 infant-survey observations. Stool samples were collected and PCR results obtained in 1448 of 1847 infant surveys (78.4%). The most common genes detected were those encoding ESBLs (205 of 1448 samples [14.2%]), with high unit-level variation. In the colonization acquisition analysis, we included 829 samples from 533 infants hospitalized since birth who were either newly admitted since or not colonized at the previous survey time point; 90 of 533 infants (16.9%) became ESBL-colonized. Their median (IQR) gestational age was 34 (30-37) weeks, and median (IQR) length of stay at survey was 14 (5-32) days. Colonization pressure was associated with increased odds of becoming ESBL-colonized for all survey intervals (4-day interval: mean odds ratio [OR], 1.89; 95% credible interval [CrI], 1.22-2.94; 7-day interval: OR, 1.76; 95% CrI, 1.26-2.63; 14-day interval: OR, 1.73; 95% CrI, 1.15-2.52 per 10% increase of colonization pressure). Conclusions and Relevance In this cross-sectional study, ESBL colonization pressure was associated with individual risk of acquiring ESBL on the neonatal unit. Unit-level interventions targeting colonization rather than infection may have important direct and indirect benefits in units with high colonization pressure.

JAMA Network OpenVol. 9(9)
University of East Anglia (GB), North Bristol NHS Trust (GB), University of Padua (IT), University of Antwerp (BE), Inserm (FR), Institut Pasteur (FR), St George's, University of London (GB), University of Patras (GR), University of Basel (CH), Utrecht University (NL), Université de Versailles Saint-Quentin-en-Yvelines (FR), National and Kapodistrian University of Athens (GR), Université Paris Cité (FR), Aristotle University of Thessaloniki (GR), Université Paris-Saclay (FR), Norfolk and Norwich University Hospitals NHS Foundation Trust (GB), St George’s University Hospitals NHS Foundation Trust (GB), Instituto de Salud Carlos III (ES), Tartu University Hospital (EE), University Medical Center Utrecht (NL), University Hospital Regensburg (DE), University of Bristol (GB), University of Oxford (GB), Research Institute Hospital 12 de Octubre (ES), BioCruces Health research Institute (ES), PENTA Foundation (IT), East Tallinn Central Hospital (EE), Hospital Universitario 12 De Octubre (ES), Centre de recherche en Epidémiologie et Santé des Populations (FR), Papageorgiou General Hospital (GR), St Mary's Hospital (GB), Hospital Universitario Quirónsalud Madrid (ES), Department of Health (ES), Tallinn Health Care College (EE), Hospital Quirónsalud Barcelona (ES), Children's Memorial Health Institute (PL), Ippokrateio General Hospital of Thessaloniki (GR), Luzerner Kantonsspital (CH), University Children’s Hospital Basel (CH), Hospital de Cruces (ES), Hospital General Universitario de Alicante Doctor Balmis (ES), University Hospital of Heraklion (GR), University General Hospital Attikon (GR), Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo (IT), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES), Panagiotis & Aglaia Kyriakou Children's Hospital (GR), Kantonsspital Aarau (CH), Città della Speranza Foundation (IT), Hippocration General Hospital (GR), City St George's, University of London (GB), University of Tartu (EE), University of Palermo (IT), University of Lausanne (CH)
Good health and well-being
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Neonatal and Maternal Infections
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