Major Article Predictors for gut colonization of carbapenem-resistant Enterobacteriaceae in neonates in a neonatal intensive care unit Narendra Pal Singh MD a , Debapriya Das Choudhury MD a , Kavita Gupta MD a, *, Sumit Rai MD b , Prerna Batra MD c , Vikas Manchanda MD d , Rituparna Saha MD a , I.R. Kaur MD a a Department of Microbiology, UCMS & GTB Hospital, New Delhi, India b Department of Microbiology, VMMC & Safdarjang Hospital, New Delhi, India c Department of Paediatrics, UCMS & GTB Hospital, New Delhi, India d Maulana Azad Medical College, New Delhi, India Key Words: Carbapenem-resistant Enterobacteriaceae neonatal intensive care unit risk factors colonization Background: With the emergence of carbapenem-resistant isolates, the therapeutic alternatives have become limited. Various factors are responsible for carbapenem-resistant Enterobacteriaceae (CRE) gut colonization. This study was conducted to determine predictors for CRE gut colonization in neonates who were hospital delivered and admitted in a neonatal intensive care unit (NICU). Methods: Three rectal swabs were collected from 300 hospital-delivered and NICU-admitted neonates (likely to stay for >3 days). The data collected for the possible risk factors for CRE gut colonization were namely mode of delivery, prolonged rupture of membrane >18 hours, period of gestation, birth weight, meconium-stained liquor, ventilation, intravenous catheter, nasogastric (NG) tube, NG feeding, breastfeeding, katori spoon feeding, top feeding, expressed breastmilk, antibiotics administration, and duration of hos- pitalization. P < .05 was considered as statistically significant. Results: A total of 26 cases of CRE were isolated from 300 neonates. Statistically significant risk factors were found to be NG tube, breastfeeding, NG feeding, top feeding, expressed breastmilk, ventilation, an- tibiotic administration, and duration of hospitalization. Top feeding and antibiotics administration were identified as 2 independent risk factors by multiple logistic regression. Conclusions: Active surveillance of cultures from hospitalized patients and implementation of preven- tive efforts can reduce the risk of CRE. © 2018 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc. Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a major cause of nosocomial infection in several regions around the world, including India. Enterobacteriaceae strains resistant to ≥3 classes of antibiotics are endemic in many hospitals and account for a significant proportion of hospital-acquired bloodstream infections. 1 Carbapenems are usually used as a last resort of treat- ment for severe infections caused by the multidrug-resistant gram- negative bacteria. However, the emergence of carbapenem-resistant isolates and their progressive geographic dissemination has limited therapeutic alternatives with potential threat of CRE outbreaks. Out- breaks of infection have been described for many different groups of patients; among them, infants are associated with worse out- comes with the suboptimal empirical antibiotic treatment. 2-4 Persistent colonization with CRE strains in neonates has potential implications not only for themselves but also for their contacts. 5 This colonization may be associated with diseases in the neonatal period such as late-onset sepsis, necrotizing enterocolitis, and postneo- natal diseases (eg, atopy, inflammatory bowel disease, irritable bowel syndrome). 5,6 It increases the likelihood of appearance of CRE in- fections and eventually evolution of carbapenemase genes in the community. Colonization of the gastrointestinal tract by CRE may be asymptomatic, and this constitutes a reservoir for transmission that may remain unidentified in hospitals that do not implement active surveillance testing. Fecal carriage of CRE strains is particu- larly problematic because Enterobacteriaceae are common causes of both health care– and community-acquired infections, raising the possibility of spread of CRE into the community. 6 These issues, * Address correspondence to Kavita Gupta, MD, Dept of Microbiology, UCMS & GTB Hospital, H-204, DDA Flats, Pocket-C, Molarband, Mohan Estate, New Delhi 110044, India. E-mail address: drkavitagupta2010@gmail.com (K. Gupta). Conflicts of interest: None to report. 0196-6553/© 2018 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc. https://doi.org/10.1016/j.ajic.2018.01.007 American Journal of Infection Control 46 (2018) e31-e35 Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control