Neonates at a risk of hospital-acquired ESKAPEE infection despite implementation of infection prevention protocols

Background: Healthcare associated infections are frequently reported to be antimicrobial resistant. This resistance contributes to poorer patient outcomes, increases the spread of infection and an increase the financial burden on healthcare systems. Aim: In an effort to assess whether ESKAPEE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species and Escherichia coli) and other bacteria posed an infection risk during the COVID-19 pandemic, 420 surface swabs and handwash samples were collected from a neonatal intensive care unit (NICU) at a public hospital in Gauteng, South Africa, from July to November 2020. Methods: Sterile cotton swabs and sterile, sealable sampling bags were used to collect samples, surface swabs and handwash samples. Bacteria isolated (N = 238) from 127 (32.2%) of the total 420 samples via culture-based methods were then identified using the VITEK 2® compact system. Identifications were confirmed by species- or genus-specific polymerase chain reaction. Findings: bacterial isolates were also subjected to antimicrobial susceptibility testing using the VITEK 2® compact system and then categorized as multi-drug-resistant (MDR) or extensively drug resistant (XDR). Almost all (35/38, 92.1%) of the Gram-positive cocci analysed were categorized as MDR. Two-thirds (22/33, 66.7%) of the Gram-negative bacilli analysed were categorized as MDR, and one was XDR. ESKAPEE pathogens (N = 28), including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species, comprised a subset of isolated bacteria. Over 85% (24/28) of the ESKAPEE pathogens were identified as MDR. Conclusion: The presence of these MDR bacteria in the NICU poses an important infection risk, and as such, existing infection prevention and control measures in this and other South African hospitals should be strengthened and their implementation and staff adherence to these measures should be regularly monitored and/or assessed.