{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:57:49Z","timestamp":1792803469955,"version":"4.5.0"},"reference-count":36,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deutsche Forschungsgemeinschaft","id":[{"id":"https:\/\/ror.org\/018mejw64","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Frie-drich-Alexander-University of Erlangen-Nuernberg within the funding programs \u201cOpen Access Publication Funding\u201d"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>(1) Background: Since 2013, weekly screening for multidrug-resistant Gram-negative (MDRGN) bacteria has been performed in German neonatal intensive care units (NICU). National guidelines recommend considering these colonization analyses for antibiotic treatment regimens. Our retrospective single center study provides insight into the clinical dichotomy of bacterial colonization and infection rates in neonates. (2) Methods: We analyzed microbiological data of neonates admitted to our tertiary level NICU over nine years. Colonization with MDRGN\/Serratia marcescens (SERMA) was compared to microbiological findings in sepsis and pneumonia. (3) Results: We analyzed 917 blood and 1799 tracheal aspirate samples. After applying criteria from the Nosocomial Infection Surveillance for Neonates (NEO-KISS), we included 52 and 55 cases of sepsis and pneumonia, respectively; 19.2% of sepsis patients and 34.5% of pneumonia patients had a prior colonization with MDRGN bacteria or SERMA. In these patients, sepsis was not attributable to MDRGN bacteria yet one SERMA, while in pneumonias, ten MDRGN bacteria and one SERMA were identified. We identified late-onset pneumonia and cesarean section as risk factors for MDRGN\/SERMA acquisition. (4) Conclusions: Colonization screening is a useful tool for hygiene surveillance. However, our data suggest that consideration of colonization with MDRGN\/SERMA might promote extensive use of last resort antibiotics in neonates.<\/jats:p>","DOI":"10.3390\/antibiotics12020189","type":"journal-article","created":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T05:36:55Z","timestamp":1673933815000},"page":"189","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Evaluating the Use of Neonatal Colonization Screening for Empiric Antibiotic Therapy of Sepsis and Pneumonia"],"prefix":"10.3390","volume":"12","author":[{"given":"Alisa","family":"B\u00e4r","sequence":"first","affiliation":[{"name":"Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuernberg, Loschgestra\u00dfe 15, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Schmitt-Groh\u00e9","sequence":"additional","affiliation":[{"name":"Division of Allergology, Pulmonology and Mucoviscidosis, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University of Erlangen-Nuernberg, Loschgestra\u00dfe 15, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1130-9727","authenticated-orcid":false,"given":"J\u00fcrgen","family":"Held","sequence":"additional","affiliation":[{"name":"Institute of Clinical Microbiology, Immunology and Hygiene, University Clinic Erlangen, Wasserturmstra\u00dfe 3\/5, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Lubig","sequence":"additional","affiliation":[{"name":"Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuernberg, Loschgestra\u00dfe 15, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Hanslik","sequence":"additional","affiliation":[{"name":"Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuernberg, Loschgestra\u00dfe 15, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian B.","family":"Fahlbusch","sequence":"additional","affiliation":[{"name":"Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuernberg, Loschgestra\u00dfe 15, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3591-5265","authenticated-orcid":false,"given":"Heiko","family":"Reutter","sequence":"additional","affiliation":[{"name":"Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuernberg, Loschgestra\u00dfe 15, 91054 Erlangen, Germany"},{"name":"Institute of Human Genetics University Clinic Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9132-6174","authenticated-orcid":false,"given":"Joachim","family":"Woelfle","sequence":"additional","affiliation":[{"name":"Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuernberg, Loschgestra\u00dfe 15, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"van der Donk","sequence":"additional","affiliation":[{"name":"Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuernberg, Loschgestra\u00dfe 15, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Schleier","sequence":"additional","affiliation":[{"name":"Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuernberg, Loschgestra\u00dfe 15, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Hepp","sequence":"additional","affiliation":[{"name":"Institute for Medical Informatics, Biometry and Epidemiology (IMBE), Friedrich-Alexander-University Erlangen-Nuernberg, Waldstr. 6, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4699-6427","authenticated-orcid":false,"given":"Patrick","family":"Morhart","sequence":"additional","affiliation":[{"name":"Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuernberg, Loschgestra\u00dfe 15, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1093\/infdis\/144.5.449","article-title":"Nosocomial infections in a neonatal intensive care unit","volume":"144","author":"Goldmann","year":"1981","journal-title":"J. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Friese, K., Mylonas, I., and Schulze, A. (2013). Infektionserkrankungen der Schwangeren und des Neugeborenen, Springer.","DOI":"10.1007\/978-3-540-78325-1"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1053\/jhin.2002.1341","article-title":"Risk factors for nosocomial infections in a neonatal intensive-care unit","volume":"53","author":"Auriti","year":"2003","journal-title":"J. Hosp. Infect."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Maier, R.F., and Obladen, M. (2017). Neugeborenenintensivmedizin, Springer.","DOI":"10.1007\/978-3-662-53576-9"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.ajic.2006.04.210","article-title":"Surveillance of multidrug-resistant gram-negative bacilli in a neonatal intensive care unit: Prominent role of cross transmission","volume":"35","author":"Mammina","year":"2007","journal-title":"Am. J. Infect. Control"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1053\/j.semperi.2007.01.004","article-title":"Antibiotic-resistant organisms in the neonatal intensive care unit","volume":"31","author":"Bizzarro","year":"2007","journal-title":"Semin. Perinatol."},{"key":"ref_7","unstructured":"Robert-Koch-Institut (2012). Mitteilung der Kommission f\u00fcr Krankenhaushygiene und Infektionspr\u00e4vention: Erg\u00e4nzende Empfehlung (2011) zur \u201ePr\u00e4vention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1.500 g\u201c (2007). Epidemiol. Bull., 2, 13\u201318."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1001\/archpedi.155.10.1098","article-title":"Improving survival of vulnerable infants increases neonatal intensive care unit nosocomial infection rate","volume":"155","author":"Zafar","year":"2001","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_9","unstructured":"Robert-Koch-Institut (2013). Mitteilung der Kommission f\u00fcr Krankenhaushygiene und Infek tions pr\u00e4vention (KRINKO): Praktische Umsetzung sowie krankenhaushygienische und infektionspr\u00e4ventive Konsequenzen des mikrobiellen Kolonisationsscreenings bei intensivmedizinisch behandelten Fr\u00fch- und Neugeborenen. Epidemiol. Bull., 42, 421\u2013436."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.cmi.2017.08.008","article-title":"The relationship between Gram-negative colonization and bloodstream infections in neonates: A systematic review and meta-analysis","volume":"24","author":"Folgori","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.jhin.2018.03.017","article-title":"Routine screening for colonization by Gram-negative bacteria in neonates at intensive care units for the prediction of sepsis: Systematic review and meta-analysis","volume":"99","author":"Seidel","year":"2018","journal-title":"J. Hosp. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/INF.0b013e3182875227","article-title":"Surveillance of multidrug-resistant Gram-negative pathogens in high-risk neonates\u2014Does it make a difference?","volume":"32","author":"Simon","year":"2013","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_13","first-page":"227","article-title":"Gram-Negative Bacilli in Infants Hospitalized in The Neonatal Intensive Care Unit","volume":"6","author":"Patel","year":"2017","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1097\/INF.0b013e3181e7884f","article-title":"Concordance of Gastrointestinal Tract Colonization and Subsequent Bloodstream Infections With Gram-negative Bacilli in Very Low Birth Weight Infants in the Neonatal Intensive Care Unit","volume":"29","author":"Smith","year":"2010","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1017\/ice.2016.95","article-title":"Media Stories on NICU Outbreaks Lead to an Increased Prescription Rate of Third-Line Antibiotics in the Community of Neonatal Care","volume":"37","author":"Hartz","year":"2016","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.jhin.2018.09.017","article-title":"Evaluation of microbiological screening in a neonatal intensive care unit to optimize empiric antibiotic use","volume":"101","author":"Schmeh","year":"2019","journal-title":"J. Hosp. Infect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1099\/00222615-46-11-903","article-title":"Serratia marcescens","volume":"46","author":"Hejazi","year":"1997","journal-title":"J. Med. Microbiol."},{"key":"ref_18","unstructured":"Nationales Referenzzentrum (NRZ) f\u00fcr Surveillance von Nosokomialen Infektionen am Institut f\u00fcr Hygiene und Umweltmedizin Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin (2020, June 01). Protokoll Surveillance von Nosokomialen Infektionen, Multiresistenten Erregern und Antibiotika-Anwendungen bei Fr\u00fchgeborenen mit Einem Geburtsgewicht unter 1.500g 2020. [Online]. Available online: https:\/\/www.nrz-hygiene.de\/files\/Protokolle\/NEO%20Protokolle\/NEOKISS_Protokoll_Jun_2020.pdf."},{"key":"ref_19","first-page":"130","article-title":"Bakterielle Infektionen bei Neugeborenen","volume":"223","author":"Zemlin","year":"2021","journal-title":"Arb. Der Wiss. Med. Fachgesellschaften E. V."},{"key":"ref_20","first-page":"8","article-title":"Colonization and infection due to multi-resistant bacteria in neonates: A single center analysis","volume":"226","author":"Haase","year":"2014","journal-title":"Klin. Padiatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.jhin.2019.01.021","article-title":"Prospective surveillance of bacterial colonization and primary sepsis: Findings of a tertiary neonatal intensive and intermediate care unit","volume":"102","author":"Baier","year":"2019","journal-title":"J. Hosp. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e322","DOI":"10.1542\/peds.2013-1248","article-title":"Risk factors and outcomes for multidrug-resistant Gram-negative bacteremia in the NICU","volume":"133","author":"Tsai","year":"2014","journal-title":"Pediatrics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jgar.2020.08.017","article-title":"Rectal screening displays high negative predictive value for bloodstream infection with (ESBL-producing) Gram-negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit","volume":"23","author":"Lenglet","year":"2020","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s13756-020-00804-8","article-title":"Sepsis related mortality of extremely low gestational age newborns after the introduction of colonization screening for multi-drug resistant organisms","volume":"9","author":"Faust","year":"2020","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Wang, H.-C., Liao, C.-C., Chu, S.-M., Lai, M.-Y., Huang, H.-R., Chiang, M.-C., Fu, R.-H., Hsu, J.-F., and Tsai, M.-H. (2020). Impacts of Multidrug-Resistant Pathogens and Inappropriate Initial Antibiotic Therapy on the Outcomes of Neonates with Ventilator-Associated Pneumonia. Antibiotics, 9.","DOI":"10.3390\/antibiotics9110760"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.jhin.2017.03.015","article-title":"Multi-drug-resistant Enterobacteriaceae in a Portuguese neonatal intensive care unit","volume":"96","author":"Pragosa","year":"2017","journal-title":"J. Hosp. Infect."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1097\/00006454-200211000-00010","article-title":"Risk of resistant infections with Enterobacteriaceae in hospitalized neonates","volume":"21","author":"Singh","year":"2002","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"756209","DOI":"10.1155\/2013\/756209","article-title":"Frequency and characteristics of infections caused by extended-spectrum beta-lactamase-producing organisms in neonates: A prospective cohort study","volume":"2013","author":"Vijayakanthi","year":"2013","journal-title":"BioMed Res. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"11971","DOI":"10.1073\/pnas.1002601107","article-title":"Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns","volume":"107","author":"Costello","year":"2010","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.earlhumdev.2004.10.017","article-title":"The influence of the mode of delivery on circulating cytokine concentrations in the perinatal period","volume":"81","author":"Protonotariou","year":"2005","journal-title":"Early Hum. Dev."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Rutayisire, E., Huang, K., Liu, Y., and Tao, F. (2016). The mode of delivery affects the diversity and colonization pattern of the gut microbiota during the first year of infants\u2019 life: A systematic review. BMC Gastroenterol., 16.","DOI":"10.1186\/s12876-016-0498-0"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"765","DOI":"10.3855\/jidc.12091","article-title":"Colonization by multidrug-resistant microorganisms of hospitalized newborns and their mothers in the neonatal unit context","volume":"14","author":"Sakai","year":"2020","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1086\/668425","article-title":"Device-associated infections among neonatal intensive care unit patients: Incidence and associated pathogens reported to the National Healthcare Safety Network, 2006\u20132008","volume":"33","author":"Hocevar","year":"2012","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1016\/j.ajic.2014.05.007","article-title":"Epidemiology of pathogens and drug resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units: A meta-analysis","volume":"42","author":"Tan","year":"2014","journal-title":"Am. J. Infect. Control"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1159\/000355539","article-title":"Ventilator-associated pneumonia in neonatal patients: An update","volume":"105","author":"Cernada","year":"2014","journal-title":"Neonatology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1136\/thx.2008.110239","article-title":"Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia","volume":"64","author":"Morris","year":"2009","journal-title":"Thorax"}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/2\/189\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:08:09Z","timestamp":1760119689000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/2\/189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,17]]},"references-count":36,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["antibiotics12020189"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics12020189","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,17]]}}}