Neonatal Unit Colonization Pressure and Acquisition of Extended-Spectrum β-Lactamase Gut Colonization
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.
Related
- Nosocomial Outbreak of Extended-Spectrum β-Lactamase SHV-5-Producing Isolates of Pseudomonas aeruginosa in Athens, Greece.
- Prevalence, acquisition, and risk factors of carbapenem-resistant enterobacterales colonization in long-term care hospitals: A prospective active surveillance study
- Prevalence and risk factors for persistent faecal carriage of extended spectrum beta-lactamase producing Escherichia coli in a paediatric community population
- A mouse-adapted Staphylococcus aureus strain enables lifelong neonatal colonization and elicits a Th17-dominated immune response
- Distribution of blaCTX-M, blaTEM and blaSHV encoding-genes among extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli isolates at the different hospitals in Tabuk, Kingdom of Saudi Arabia
BibTeX
@article{cook2026neonatal,
title = {{Neonatal Unit Colonization Pressure and Acquisition of Extended-Spectrum β-Lactamase Gut Colonization}},
author = {Aislinn Cook and Matilda Berkell and C. Henri van Werkhoven and Elske Sieswerda and David Smith and Chiara Minotti and Liesbet van Heirstraeten and Elias Iosifidis and Emmanuel Roilides and Tuuli Metsvaht and Jose Ignacio Pijoan Zubizarreta and Begoña Loureiro-Gonzalez and Eric Giannoni and Chiara Messina and Surbhi Malhotra-Kumar and Julia Anna Bielicki and Jennifer Martin and Filip Djukic and Caridad Tapia-Collados and Eva García-Cantó and Despoina Gkentzi and Eleni Papachatzi and Varvara Dimopoulou and Charles Roehr and Paula Brock and Eleftheria Hatzidaki and Nicolina-Hilda Anagnostatou and Eugenio Baraldi and Elena Priante and Kosmas Sarafidis and Angeliki Kontou and Georgios Mitsiakos and Dimitra Gialamprinou and Vassiliki Papaevangelou and Maria Livieratou and Kristin Tanney and Nicola Booth and Donna Tolentino and Amy Reid and Argyro Ftergioti and Maria Simitsopoulou and Kassandra Tataropoulou and Evangelia Koemtzidou and Concepción de Alba Romero and Elena Bergon Sendin and Javier Perez-Lopez and Yolanda Campos-Franco and Aleksandra Pietrzyk and Grete Haube and Mari-Liis Ilmoja and Helgi Padari and Martin Stocker and Alexandra Périsset and Dariusz Gruszfeld and Paul Clarke and Jasmine Myhill and Fernando Cabañas and Mario Giuffrè and Veronica Notarbartolo and Sven Wellmann},
journal = {JAMA Network Open},
year = {2026},
month = sep,
doi = {10.1001/jamanetworkopen.2026.32644},
url = {https://hal.science/hal-05784692v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Neonatal Unit Colonization Pressure and Acquisition of Extended-Spectrum β-Lactamase Gut Colonization
AU - Aislinn Cook
AU - Matilda Berkell
AU - C. Henri van Werkhoven
AU - Elske Sieswerda
AU - David Smith
AU - Chiara Minotti
AU - Liesbet van Heirstraeten
AU - Elias Iosifidis
AU - Emmanuel Roilides
AU - Tuuli Metsvaht
AU - Jose Ignacio Pijoan Zubizarreta
AU - Begoña Loureiro-Gonzalez
AU - Eric Giannoni
AU - Chiara Messina
AU - Surbhi Malhotra-Kumar
AU - Julia Anna Bielicki
AU - Jennifer Martin
AU - Filip Djukic
AU - Caridad Tapia-Collados
AU - Eva García-Cantó
AU - Despoina Gkentzi
AU - Eleni Papachatzi
AU - Varvara Dimopoulou
AU - Charles Roehr
AU - Paula Brock
AU - Eleftheria Hatzidaki
AU - Nicolina-Hilda Anagnostatou
AU - Eugenio Baraldi
AU - Elena Priante
AU - Kosmas Sarafidis
AU - Angeliki Kontou
AU - Georgios Mitsiakos
AU - Dimitra Gialamprinou
AU - Vassiliki Papaevangelou
AU - Maria Livieratou
AU - Kristin Tanney
AU - Nicola Booth
AU - Donna Tolentino
AU - Amy Reid
AU - Argyro Ftergioti
AU - Maria Simitsopoulou
AU - Kassandra Tataropoulou
AU - Evangelia Koemtzidou
AU - Concepción de Alba Romero
AU - Elena Bergon Sendin
AU - Javier Perez-Lopez
AU - Yolanda Campos-Franco
AU - Aleksandra Pietrzyk
AU - Grete Haube
AU - Mari-Liis Ilmoja
AU - Helgi Padari
AU - Martin Stocker
AU - Alexandra Périsset
AU - Dariusz Gruszfeld
AU - Paul Clarke
AU - Jasmine Myhill
AU - Fernando Cabañas
AU - Mario Giuffrè
AU - Veronica Notarbartolo
AU - Sven Wellmann
PY - 2026
DA - 2026/09/15
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.32644
UR - https://hal.science/hal-05784692v1
AB - 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.
SN - 2574-3805
ER -