Colonization With Antimicrobial-Resistant Gram-Negative Bacilli at Neonatal Intensive Care Unit Discharge.

Background. The epidemiology of the colonization of infants with antimicrobial-resistant Gram-negative bacilli (GNB) at discharge from the neonatal intensive care unit (NICU) is not well understood. Methods. A multicenter study in which rectal surveillance samples for culture were obtained at NICU discharge from infants hospitalized >= 14 days was performed. Factors associated with colonization with GNB resistant to gentamicin, third/fourth-generation cephalosporin agents, or carbapenem agents were assessed by using a fixed-effects model. Results. Of these infants, 9% (119 of 1320) were colonized with >= 1 antimicrobial-resistant GNB. Prolonged treatment (>= 10 days) with meropenem or third/fourth-generation cephalosporin agents or treatment for >= 5 days with a beta-lactam/beta-lactamase combination agent were associated with an increased risk of colonization with GNB resistant to gentamicin. Surgery and >= 5 days of treatment with third/fourth-generation cephalosporin agents, a beta-lactam/beta-lactamase combination agent, or metronidazole were associated with an increased risk of colonization with GNB resistant to third/fourth-generation cephalosporin agents. Female sex and prolonged treatment (>= 10 days) with meropenem were associated with colonization with GNB resistant to carbapenem agents. Conclusions. Prolonged treatment with broad-spectrum antibiotics was associated with the colonization of infants with antimicrobial-resistant GNB within 7 days of NICU discharge. These findings suggest the potential for dissemination of resistant GNB from colonized infants to other NICUs, the community, or pediatric long-term care facilities. Antimicrobial stewardship efforts aimed at improving appropriate antibiotic use could have a beneficial effect on the emergence of antimicrobial-resistant GNB in the NICU population.