To investigate the high-risk factors and prevention strategies of multiple drug-resistant organisms (MDRO) infection in neonatal intensive care unit (NICU).

Clinical data of the neonates with positive pathogen cultures who were hospitalized in the NICU of the Seventh Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2020 were collected. The 25 neonates with positive MDRO culture results were assigned as MDRO group, while 45 neonates with non-MDRO culture results were assigned as non-MDRO group. The composition ratio, strain, detected sites and drug resistance of MDRO were analyzed, retrospectively, and the disease and outcome of both neonatal groups were compared. The high-risk factors for MDRO infection were analyzed by Univariate analysis and multivariate Logistic regression analysis.

Total of 70 strains of pathogens were isolated from 714 samples, among which, 25 strains (35.7%) were MDRO. 15 strains (60.0%) of MDRO were Gram-positive cocci, among which, 12 strains (48.0%) were coagulase-negative Staphylococci and 3 strains (12.0%) were methicillin-resistant Staphylococcus aureus. 10 strains were Gram-negative bacilli (40%), among which, 6 strains (24.0%) were Escherichia coli producing extended-spectrum beta-lactamase. Univariate analysis showed that chorioamnionitis [16 (64.0%) vs. 17 (37.7%): χ² = 4.435, P = 0.035], combined usage of more than two antibiotics [10 (40.0%) vs. 8 (17.7%): χ² = 4.155, P = 0.042] and administration of parenteral nutrition for longer than 2 weeks [15 (60.0%) vs.15 (33.3%): χ² = 4.667, P = 0.031] of the two groups were with significant differences. Logistic regression analysis showed that chorioamnionitis was an independent risk factor for neonatal with MDRO infection in NICU [OR = 2.899, 95%CI: 1.007-8.350), χ² = 3.889, P = 0.049]. The main infectious diseases of neonates in MDRO group were sepsis (6/25, 24.0%) and pneumonia (6/25, 24.0%), while those in non-MDRO group were purulent meningitis (2/45, 4.4%) and pneumonia (2/45, 4.4%). The infection rate of neonates in MDRO group was significantly higher than that of non-MDRO group [14 (56.0%) vs. 5 (11.1%): χ² = 16.376, P < 0.001]. There was no significant difference between the two groups for prognosis [24 (96.0%) vs. 43 (95.5%): χ² = 0.000, P = 1.000], hospital duration [21.0 (7.5, 37.0) days vs. 8.0 (4.0, 35.5) days, Z =-1.793, P = 0.073] and cost [￥35 880 (10 395, 87 050) vs. ￥13 713 (7 287, 76 127): Z =-1.189, P = 0.234].

The infection rate of neonates with MDRO was higher than that of neonates with non-MDRO. Chorioamnionitis was an independent risk factor for MDRO infection in NICU neonates. The management of MDRO infection in NICU neonates should be conducted by active handling of maternal amnionitis, rational use of perinatal antibiotics, and strengthening infection control.