{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T02:22:51Z","timestamp":1791080571938,"version":"4.1.0"},"reference-count":47,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T00:00:00Z","timestamp":1674086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Serial perirectal swabs are used to identify colonization of multidrug-resistant bacteria and prevent spread. The purpose of this study was to determine colonization with carbapenem-resistant Enterobacterales (CRE) and vancomycin-resistant Enterococci (VRE). An additional purpose was to establish whether sepsis and epidemic associated with these factors were present in the neonatal intensive care unit (NICU), to which infants with hospital stays exceeding 48 h in an external healthcare center NICU were admitted. Perirectal swab samples were collected in the first 24 h by a trained infection nurse using sterile cotton swabs moistened with 0.9% NaCl from patients admitted to our unit after hospitalization exceeding 48 h in an external center. The primary outcome was positivity in perirectal swab cultures, and the secondary outcomes were whether this caused invasive infection and significant NICU outbreaks. A total of 125 newborns meeting the study criteria referred from external healthcare centers between January 2018 and January 2022 were enrolled. Analysis revealed that CRE constituted 27.2% of perirectal swab positivity and VRE 4.8%, and that one in every 4.4 infants included in the study exhibited perirectal swab positivity. The detection of colonization by these microorganisms, and including them within the scope of surveillance, is an important factor in the prevention of NICU epidemics.<\/jats:p>","DOI":"10.3390\/children10020187","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T04:19:40Z","timestamp":1674101980000},"page":"187","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Should Perirectal Swab Culture Be Performed in Cases Admitted to the Neonatal Intensive Care Unit? Lessons Learned from the Neonatal Intensive Care Unit"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1783-0185","authenticated-orcid":false,"given":"Aysen","family":"Orman","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Mersin University School of Medicine, Mersin 33110, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalcin","family":"Celik","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Mersin University School of Medicine, Mersin 33110, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guliz","family":"Evik","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology and Infectious Diseases, Mersin University School of Medicine, Mersin 33110, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulden","family":"Ers\u00f6z","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology and Infectious Diseases, Mersin University School of Medicine, Mersin 33110, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6721-4105","authenticated-orcid":false,"given":"Necdet","family":"Kuyucu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Infectious Disease, Mersin University School of Medicine, Mersin 33110, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berfin Ozgokce","family":"Ozmen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Infectious Disease, Mersin University School of Medicine, Mersin 33110, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s11908-015-0510-9","article-title":"Carbapenem-Resistant Enterobacteriaceae Infections in Children","volume":"18","author":"Chiotos","year":"2016","journal-title":"Curr. Infect. Dis. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"F72","DOI":"10.1136\/archdischild-2015-308707","article-title":"Outbreaks of extended spectrum beta-lactamase-producing Enterobacteriaceae in neonatal intensive care units: A systematic review","volume":"101","author":"Stapleton","year":"2016","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/S0140-6736(15)00474-2","article-title":"Access to effective antimicrobials: A worldwide challenge","volume":"387","author":"Laxminarayan","year":"2016","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"548","DOI":"10.4103\/0377-4929.191802","article-title":"Vancomycin-resistant enterococci in neonatal stool as a cause of septicemia: Challenges for infection control practices","volume":"59","author":"Kaushal","year":"2016","journal-title":"Indian J. Pathol. Microbiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1097\/CM9.0000000000000935","article-title":"Neonatal sepsis: Within and beyond China","volume":"133","author":"Dong","year":"2020","journal-title":"Chin. Med. J. (Engl.)"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1038\/s41390-021-01745-7","article-title":"Neonatal multidrug-resistant gram-negative infection: Epidemiology, mechanisms of resistance, and management","volume":"91","author":"Flannery","year":"2022","journal-title":"Pediatr. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13756-021-00902-1","article-title":"Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program","volume":"10","author":"Saporito","year":"2021","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_8","first-page":"535","article-title":"Adjuvant therapy in septic neonates with immunoglobulin preparations containing Ig isotypes in addition to IgG: A critical review of current literature","volume":"21","author":"Capasso","year":"2017","journal-title":"Curr. Pediatr. Res."},{"key":"ref_9","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_10","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1097\/01.inf.0000069766.86901.91","article-title":"Factors associated with hand hygiene practices in two neonatal intensive care units","volume":"22","author":"Cohen","year":"2003","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_11","unstructured":"World Health Organization (2017). Guidelines for the Prevention Control of Carbapenem\u2014Resistant Enterobactericea. Acinetobacter baumannii and Pseudomonas Aeruginosa in Healt Care Facilities, WHO Guidelines Approved by the Guidelines Review Committee."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"L643","DOI":"10.1152\/ajplung.00327.2022","article-title":"Confronting antimicrobial resistance together","volume":"323","author":"Chambers","year":"2022","journal-title":"Am. J. Physiol. Lung Cell Mol. Physiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jhin.2021.11.020","article-title":"Impact of discontinuing contact precautions and enforcement of basic hygiene measures on nosocomial vancomycin- resistant Enterococcus faecium transmission","volume":"121","author":"Eichel","year":"2022","journal-title":"J. Hosp. Infect."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/j.idc.2016.07.009","article-title":"Vancomycin-Resistant Enterococci: Epidemiology, Infection Prevention, and Control","volume":"30","author":"Reyes","year":"2016","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_15","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_16","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1016\/j.ajic.2015.11.008","article-title":"Is it worth screening for vancomycin-resistant Enterococcus faecium colonization?: Financial burden of screening in a developing country","volume":"44","author":"Altun","year":"2016","journal-title":"Am. J. Infect. Control"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.jpeds.2018.05.048","article-title":"Neonatal Sepsis of Early Onset, and Hospital-Acquired and Community-Acquired Late Onset: A Prospective Population-Based Cohort Study","volume":"201","author":"Giannoni","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1186\/s13756-021-01033-3","article-title":"Clonal spread of carbapenem-resistant Klebsiella pneumoniae among patients at admission and discharge at a Vietnamese neonatal intensive care unit","volume":"10","author":"Berglund","year":"2021","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_19","first-page":"3907","article-title":"Investigation of Extended-Spectrum \u03b2-Lactamase and Carbapenemase Producing Gram-Negative Bacilli in Rectal Swabs Collected from Neonates and Their Associated Factors in Neonatal Intensive Care Units of Southern Ethiopia","volume":"14","author":"Zakir","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.jgar.2016.11.004","article-title":"Rectal carriage of extended-spectrum \u03b2-lactamase- and carbapenemase-producing Enterobacteriaceae among hospitalised neonates in a neonatal intensive care unit in Fez, Morocco","volume":"8","author":"Arhoune","year":"2017","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.ajic.2018.07.009","article-title":"Carbapenemase-producing Enterobacteriaceae among pregnant women and newborns in Algeria: Prevalence, molecular characterization, maternal-neonatal transmission, and risk factors for carriage","volume":"47","author":"Mairi","year":"2019","journal-title":"Am. J. Infect. Control"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"411","DOI":"10.3390\/idr13020039","article-title":"Carbapenemase-Producing Enterobacteriaceae (CPE) Newborn Colonization in a Portuguese Neonatal Intensive Care Unit (NICU): Epidemiology and Infection Prevention and Control Measures","volume":"13","author":"Almeida","year":"2021","journal-title":"Infect. Dis. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.1016\/S0378-3782(14)70018-0","article-title":"Management of outbreaks in neonatal intensive care units","volume":"90","author":"Decembrino","year":"2014","journal-title":"Early Hum. Dev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"778","DOI":"10.24953\/turkjped.2020.05.009","article-title":"Carbapenem and colistin resistance in children with Enterobacteriaceae infections","volume":"62","author":"Alabaz","year":"2020","journal-title":"Turk. J. Pediatr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jhin.2007.07.026","article-title":"Risk factors for extended-spectrum beta-lactamase-producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit","volume":"67","author":"Crivaro","year":"2007","journal-title":"J. Hosp. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1093\/jpids\/piw014","article-title":"Colonization with Antimicrobial-Resistant Gram-Negative Bacilli at Neonatal Intensive Care Unit Discharge","volume":"6","author":"Clock","year":"2017","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e01440-17","DOI":"10.1128\/AAC.01440-17","article-title":"Multicenter Study of the Risk Factors for Colonization or Infection with Carbapenem-Resistant Enterobacteriaceae in Children","volume":"61","author":"Chiotos","year":"2017","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Seesahai, J., Church, P.T., Asztalos, E., Eng-Chong, M., Arbus, J., and Banihani, R. (2021). Neonates with Maternal Colonization of Carbapenemase-Producing, Carbapenem-Resistant Enterobacteriaceae: A Mini-Review and a Suggested Guide for Preventing Neonatal Infection. Children, 8.","DOI":"10.3390\/children8050399"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.jhin.2018.09.010","article-title":"Vagino-rectal colonization and maternal\u2013neonatal transmission of Enterobacteriaceae producing extended-spectrum \u03b2-lactamases or carbapenemases: A cross-sectional study","volume":"101","author":"Serrano","year":"2019","journal-title":"J. Hosp. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1017\/ice.2016.174","article-title":"Antimicrobial-Resistant Pathogens Associated with Healthcare-Associated Infections: Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011\u20132014","volume":"37","author":"Weiner","year":"2016","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1086\/502595","article-title":"Control of vancomycin-resistant enterococci in the neonatal intensive care unit","volume":"26","author":"Singh","year":"2005","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1111\/jcpt.13383","article-title":"Prevalence of vancomycin-resistant enterococci in Asia-A systematic review and meta-analysis","volume":"46","author":"Shrestha","year":"2021","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_33","first-page":"3478","article-title":"Vancomycin-resistant enterococci colonization in a neonatal intensive care unit: Who will be infected?","volume":"29","author":"Akturk","year":"2016","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.jgar.2022.05.019","article-title":"Prevalence, risk factors and molecular analysis of vancomycin-resistant Enterococci colonization in a referral neonatal intensive care unit: A prospective study in northern Iran","volume":"30","author":"Farhadi","year":"2022","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.ajic.2013.02.005","article-title":"Vancomycin-resistant Enterococcus outbreak in a neonatal intensive care unit: Epidemiology, molecular analysis and risk factors","volume":"41","author":"Iosifidis","year":"2013","journal-title":"Am. J. Infect. Control"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1017\/ice.2019.202","article-title":"A nonclonal outbreak of vancomycin-sensitive Enterococcus faecalis bacteremia in a neonatal intensive care unit","volume":"40","author":"Kotsanas","year":"2019","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hufnagel, M., Liese, C., Loescher, C., Kunze, M., Proempeler, H., Berner, R., and Krueger, M. (2007). Enterococcal colonization of infants in a neonatal intensive care unit: Associated predictors, risk factors and seasonal patterns. BMC Infect. Dis., 7.","DOI":"10.1186\/1471-2334-7-107"},{"key":"ref_38","first-page":"682","article-title":"Vancomycin-resistant enterococcus colonization in neonatal intensive care unit: Prevention and eradication experience","volume":"46","author":"Benzer","year":"2012","journal-title":"Mikrobiyol. Bul."},{"key":"ref_39","first-page":"367","article-title":"Neonatal infectious diseases: Evaluation of neonatal sepsis","volume":"60","author":"Spearman","year":"2013","journal-title":"Pediatr. Clin."},{"key":"ref_40","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_41","doi-asserted-by":"crossref","first-page":"e014986","DOI":"10.1136\/bmjopen-2016-014986","article-title":"Predicting late-onset sepsis by routine neonatal screening for colonisation by gram-negative bacteria in neonates at intensive care units: A protocol for a systematic review","volume":"7","author":"Harder","year":"2017","journal-title":"BMJ Open"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1007\/s00431-020-03788-0","article-title":"Do isolates from pharyngeal and rectal swabs match blood culture bacterial pathogens in septic VLBW infants? A pilot, cross-sectional study","volume":"180","author":"Capasso","year":"2021","journal-title":"Eur. J. Pediatr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s13756-020-00755-0","article-title":"A silent outbreak of vancomycin-resistant Enterococcus faecium in a neonatal intensive care unit","volume":"9","author":"Marom","year":"2020","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_44","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_45","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1099\/jmm.0.033803-0","article-title":"Colonization of the gut with Gram-negative bacilli, its association with neonatal sepsis and its clinical relevance in a developing country","volume":"60","author":"Das","year":"2011","journal-title":"J. Med. Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1017\/ice.2021.189","article-title":"The impact of vancomycin-resistant Enterococcus (VRE) screening policy change on the incidence of healthcare-associated VRE bacteremia","volume":"43","author":"Cho","year":"2022","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Wang, J., Lv, Y., Yang, W., Zhao, P., and Yin, C. (2022). Epidemiology and clinical characteristics of infection\/colonization due to carbapenemase-producing Enterobacterales in neonatal patients. BMC Microbiol., 22.","DOI":"10.1186\/s12866-022-02585-z"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/2\/187\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:10:14Z","timestamp":1760119814000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/2\/187"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,19]]},"references-count":47,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["children10020187"],"URL":"https:\/\/doi.org\/10.3390\/children10020187","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,19]]}}}