{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:00:23Z","timestamp":1760234423333,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T00:00:00Z","timestamp":1621036800000},"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>Carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE) are highly drug-resistant Gram-negative bacteria. They include New Delhi metallo-\u00df-lactamase (NDM)-producing carbapenemase (50.4% of all species in Ontario). Antibiotic challenges for resistant bacteria in neonates pose challenges of unknown dosing and side effects. We report two antenatally diagnosed CP-CRE colonization scenarios with the NDM 1 gene. The case involves extreme preterm twins who had worsening respiratory distress at birth requiring ventilator support, with the first twin also having cardiovascular instability. They were screened for CP-CRE, and a polymyxin antibiotic commenced. In the delivery room, neonatal intensive care unit (NICU) and the follow-up clinic, in collaboration with the interdisciplinary group, contact precautions and isolation procedures were instituted. None of the infants exhibited infection with CP-CRE. Consolidating knowledge with regard to CP-CRE and modifying human behavior associated with its spread can mitigate potential negative consequences. This relates to now and later, when travel and prolific human to human contact resumes, from endemic countries, after the current COVID-19 pandemic. Standardized efforts to curb the acquisition of this infection would be judicious given the challenges of treatment and continued emerging antibiotic resistance. Simple infection control measures involving contact precautions, staff education and parental cohorting can be useful and cost-effective in preventing transmission. Attention to NICU specific measures, including screening of at-risk mothers (invitro fertilization conception) and their probands, careful handling of breastmilk, judicious antibiotic choice and duration of treatment, is warranted. What does this study add? CP-CRE is a nosocomial infection with increasing incidence globally, and a serious threat to public health, making it likely that these cases will present with greater frequency to the NICU team. Only a few similar cases have been reported in the neonatal literature. Current published guidelines provide a framework for general hospital management. Still, they are not specific to the NICU experience and the need to manage the parents\u2019 exposure and the infants. This article provides a holistic framework for managing confirmed or suspected cases of CP-CRE from the antenatal care through the NICU and into the follow-up clinic targeted at preventing or containing the spread of CP-CRE.<\/jats:p>","DOI":"10.3390\/children8050399","type":"journal-article","created":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T23:17:16Z","timestamp":1621207036000},"page":"399","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Neonates with Maternal Colonization of Carbapenemase-Producing, Carbapenem-Resistant Enterobacteriaceae: A Mini-Review and a Suggested Guide for Preventing Neonatal Infection"],"prefix":"10.3390","volume":"8","author":[{"given":"Judy","family":"Seesahai","sequence":"first","affiliation":[{"name":"Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paige Terrien","family":"Church","sequence":"additional","affiliation":[{"name":"Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Asztalos","sequence":"additional","affiliation":[{"name":"Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanee","family":"Eng-Chong","sequence":"additional","affiliation":[{"name":"Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo","family":"Arbus","sequence":"additional","affiliation":[{"name":"Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"},{"name":"Neonatal Intensive Care Unit Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3865-3045","authenticated-orcid":false,"given":"Rudaina","family":"Banihani","sequence":"additional","affiliation":[{"name":"Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"F547","DOI":"10.1136\/archdischild-2017-313203","article-title":"Epidemiology of UK neonatal infections: The neonIN infection surveillance network","volume":"103","author":"Cailes","year":"2018","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.drup.2016.09.002","article-title":"The rapid spread of carbapenem-resistant Enterobacteriaceae","volume":"29","author":"Potter","year":"2016","journal-title":"Drug Resist. Updat."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/S1473-3099(13)70318-9","article-title":"Antibiotic resistance\u2014the need for global solutions","volume":"13","author":"Laxminarayan","year":"2013","journal-title":"Lancet Infect Dis."},{"key":"ref_4","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_5","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1086\/522287","article-title":"A Step Closer to Extreme Drug Resistance (XDR) in Gram-Negative Bacilli","volume":"45","author":"Paterson","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","unstructured":"(2021, January 17). Guidance for Control of Infections with Carbapenem-Resistant or Car-Bapenemase-Producing Enterobacteriaceae in Acute Care Facilities, Available online: https:\/\/www-cdc-gov.myaccess.library.utoronto.ca\/mmwr\/preview\/mmwrhtml\/mm5810a4.htm."},{"key":"ref_7","first-page":"668","article-title":"Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: Systematic review and meta-analysis","volume":"72","author":"Righi","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.cmi.2019.04.013","article-title":"Management of carbapenem-resistant Enterobacteriaceae infections","volume":"25","author":"Andini","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_9","unstructured":"Public Health Ontario (2021, March 06). Ontario Agency for Health Protection and Promotion. Available online: https:\/\/www.publichealthontario.ca\/en\/health-topics\/infection-prevention-control\/routine-practices-additional-precautions."},{"key":"ref_10","unstructured":"(2021, April 29). Carbapenemases in Enterobacteriaceae: Detection and Antimicrobial Therapy. Available online: https:\/\/www.frontiersin.org\/article\/10.3389\/fmicb.2019.01823."},{"key":"ref_11","unstructured":"Infection Control (2021, February 28). CDC Reports that CRE Are a Nightmare Bacteria  in Healthcare Environments. Dow Jones Factiva, Life Science Weekly. Available online: https:\/\/global-factiva-com.myaccess.library.utoronto.ca\/redir\/default.aspx?P=sa&NS=16&AID=9UNI011000&an=LFSW000020130322e93q0011t&cat=a&ep=ASI."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"6787","DOI":"10.1128\/AAC.01359-16","article-title":"Results from the Canadian Nosocomial Infection Surveillance Program on Carbapenemase-ProducingEnterobacteriaceae, 2010 to 2014","volume":"60","author":"Mataseje","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_13","unstructured":"Public Health Ontario (2021, January 17). Carbapenemase-Producing Enterobacteriaceae Frequently Asked Questions, Available online: https:\/\/www.publichealthontario.ca\/-\/media\/documents\/F\/2019\/faq-cpe.pdf?la=en."},{"key":"ref_14","unstructured":"(2021, April 29). Surveillance Report: CPE in Ontario, 1 May 2018\u201330 April 2019. Available online: https:\/\/www.publichealthontario.ca\/-\/media\/documents\/surveillance-reports\/cpe\/surveillance-report-cpe-2019.pdf?la=en."},{"key":"ref_15","first-page":"1","article-title":"The sink as a potential source of transmission of carbapenemase-producing Enterobacteriaceae in the intensive care unit","volume":"6","author":"Blommaert","year":"2017","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1016\/j.ajic.2020.06.132","article-title":"Sink and Drain Monitoring and Decontamination Protocol for Carbapenemase-producing Enterobacteriaceae (CPE)","volume":"48","author":"Tang","year":"2020","journal-title":"Am. J. Infect. Control."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.3201\/eid2409.180164","article-title":"Emergence of Carbapenemase-Producing Enterobacteriaceae, South-Central Ontario, Canada1","volume":"24","author":"Kohler","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_18","unstructured":"(2021, March 06). Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Divi-sion of Healthcare Quality Promotion (DHQP) [Internet], Available online: https:\/\/www-cdc-gov.myaccess.library.utoronto.ca\/infectioncontrol\/basics\/transmission-based-precautions.html."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1086\/497831","article-title":"Dissemination of the Metallo\u2014Lactamase Gene blaIMP-4 among Gram-Negative Pathogens in a Clinical Setting in Australia","volume":"41","author":"Peleg","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12941-016-0124-6","article-title":"Outbreak of plasmid-mediated NDM-1-producing Klebsiella pneumoniae ST105 among neonatal patients in Yunnan, China","volume":"15","author":"Zheng","year":"2016","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"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":"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_23","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_24","unstructured":"Mougkou, K., Michos, A., Spyridopoulou, K., Daikos, G.L., Siahanidou, T., Spyridis, N., Kapetanakis, J., Korkas, A., Anagnostakou, C., and Papagaroufalis, G. (2012, January 8\u201312). Colonization of neonates with carbapenemase-producing Enterobacteriaceae (CPE). Proceedings of the 30th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2012), Thessalonike, Greece."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1016\/j.ajic.2018.01.007","article-title":"Predictors for gut colonization of carbapenem-resistant Enterobacteriaceae in neonates in a neonatal intensive care unit","volume":"46","author":"Singh","year":"2018","journal-title":"Am. J. Infect. Control."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12887-019-1709-y","article-title":"A review of -multidrug-resistant Enterobacteriaceae in a neonatal unit in Johannesburg, South Africa","volume":"19","author":"Ballot","year":"2019","journal-title":"BMC Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s13756-017-0259-z","article-title":"Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: Guidance from the European Centre for Disease Prevention and Control","volume":"6","author":"Magiorakos","year":"2017","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-019-4492-4","article-title":"Implementing a toolkit for the prevention, management and control of carbapenemase-producing Enterobacteriaceae in English acute hospitals trusts: A qualitative evaluation","volume":"19","author":"Schneider","year":"2019","journal-title":"BMC Health Serv. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"20802","DOI":"10.2807\/1560-7917.ES2014.19.19.20802","article-title":"Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: A nine-year experience, France, 2004 to 2012","volume":"19","author":"Fournier","year":"2014","journal-title":"Eurosurveillance"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.idh.2017.09.001","article-title":"Recommendations for the control of carbapenemase-producing Enterobacteriaceae (CPE): A guide for acute care health facilities","volume":"22","author":"Chair","year":"2017","journal-title":"Infect. Dis. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1017\/ice.2019.173","article-title":"Infection prevention and control practices related to carbapenemase-producing Enterobacteriaceae (CPE) in acute-care hospitals in Ontario, Canada","volume":"40","author":"Jamal","year":"2019","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jiph.2018.11.003","article-title":"Epidemiology of carbapenemase-producing Enterobacteriaceae in a pediatric hospital in a country with high endemicity","volume":"12","author":"Castagnola","year":"2019","journal-title":"J. Infect. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s13756-018-0375-4","article-title":"Collateral damage of using Colistin in hos-pitalized patients on emergence of colistin-resistant Escherichia coli and Klebsiella pneumoniae colonization and infection","volume":"7","author":"Wangchinda","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1097\/INF.0b013e3182064bfe","article-title":"Intravenous Colistin Administration in Neonates","volume":"30","author":"Jajoo","year":"2011","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"548","DOI":"10.12659\/MSM.898213","article-title":"Use of Colistin in a Neonatal Intensive Care Unit: A Cohort Study of 65 Patients","volume":"23","author":"Asker","year":"2017","journal-title":"Med Sci. Monit."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Kimberlin, D.W. (2018). Red Book: 2018\u20132021 Report of The Committee on Infectious Diseases, American Academy of Pediatrics.","DOI":"10.1542\/9781610025225"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.ajic.2011.05.022","article-title":"Risk factors for developing clinical infection with carbapenem-resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-resistant K pneumoniae","volume":"40","author":"Borer","year":"2012","journal-title":"Am. J. Infect. Control."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1111\/j.1469-0691.2012.03888.x","article-title":"Asymptomatic rectal carriage of blaKPC producing carbapenem-resistant Enterobacteriaceae: Who is prone to become clinically infected?","volume":"19","author":"Schechner","year":"2013","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_39","unstructured":"Virox Technologies Incorporated (2021, April 03). RescueTM Ready to Use One Step Disinfectant Cleaner & Deodorizer. [Internet]. Available online: https:\/\/rescuedisinfectants.com\/wp-content\/uploads\/2017\/07\/REF067_Rescue-RTU-Ref-Sheet_17-069-2.pdf."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/5\/399\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:01:51Z","timestamp":1760162511000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/5\/399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,15]]},"references-count":39,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["children8050399"],"URL":"https:\/\/doi.org\/10.3390\/children8050399","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2021,5,15]]}}}