Evidence map›Paper›PMID 42742944›Full record

ArticleJAMA network open2026

Neonatal Unit Colonization Pressure and Acquisition of Extended-Spectrum β-Lactamase Gut Colonization.

Aislinn Cook, Matilda Berkell, C Henri van Werkhoven, Elske Sieswerda, David R M Smith, Chiara Minotti, Liesbet van Heirstraeten, Elias Iosifidis, Emmanuel Roilides, Tuuli Metsvaht and 52 more

Abstract readMulticenter Study
In one paragraph

Article in JAMA network open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

62 authors.

Aislinn CookCentre for Neonatal and Paediatric Infection, City St George's, University of London, London, United Kingdom.
Matilda BerkellLaboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Universiteit Antwerpen, Antwerp, Belgium.
C Henri van WerkhovenJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Elske SieswerdaJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
David R M SmithEpidemiology and Modelling of Antibiotic Evasion Unit, Institut Pasteur, Université Paris Cité, Paris, France.
Chiara MinottiPaediatric Research Centre, University Children's Hospital Basel, Basel, Switzerland.
Liesbet van HeirstraetenLaboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Universiteit Antwerpen, Antwerp, Belgium.
Elias Iosifidis3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece.
Emmanuel Roilides3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece.
Tuuli MetsvahtDepartment of Microbiology, Institute of Translational Medicine, University of Tartu, Tartu, Estonia.
Jose Ignacio Pijoan ZubizarretaBiobizkaia Health Research Institute, Barakaldo, Spain.
Begoña Loureiro-GonzalezBiobizkaia Health Research Institute, Barakaldo, Spain.
Eric GiannoniClinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Switzerland.
Chiara MessinaFondazione Penta ETS, Padova, Italy.
Surbhi Malhotra-KumarLaboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Universiteit Antwerpen, Antwerp, Belgium.
Julia Anna BielickiCentre for Neonatal and Paediatric Infection, City St George's, University of London, London, United Kingdom.
NeoIPC Feasibility Group
Jennifer MartinCentre for Neonatal and Paediatric Infection, City St George's, University of London, London, United Kingdom.
Filip DjukicCentre for Neonatal and Paediatric Infection, City St George's, University of London, London, United Kingdom.
Caridad Tapia-ColladosNeonatology Section, Dr Balmis University General Hospital, ISABIAL, Alicante, Spain.
Eva García-CantóNeonatology Section, Dr Balmis University General Hospital, ISABIAL, Alicante, Spain.
Despoina GkentziDepartment of Paediatrics, Medical School, University of Patras, Greece.
Eleni PapachatziDepartment of Paediatrics, Medical School, University of Patras, Greece.
Varvara DimopoulouClinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Switzerland.
Charles C RoehrFaculty of Health and Life Sciences, University of Bristol, Bristol, United Kingdom.
Paula BrockNewborn Care, Women's and Children Division, North Bristol NHS Trust, Bristol, United Kingdom.
Eleftheria HatzidakiDepartment of Neonatology/Neonatal Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete; Heraklion, Crete, Greece.
Nicolina-Hilda AnagnostatouDepartment of Neonatology/Neonatal Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete; Heraklion, Crete, Greece.
Eugenio BaraldiDepartment of Women' and Children's Health, University of Padua, Padua, Italy.
Elena PrianteDepartment of Women' and Children's Health, University of Padua, Padua, Italy.
Kosmas SarafidisFirst Department of Neonatology and Neonatal Intensive Care, Aristotle University of Thessaloniki, Ippokrateion General Hospital, Thessaloniki, Greece.
Angeliki KontouFirst Department of Neonatology and Neonatal Intensive Care, Aristotle University of Thessaloniki, Ippokrateion General Hospital, Thessaloniki, Greece.
Georgios Mitsiakos2nd Neonatal Department and NICU, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece.
Dimitra Gialamprinou2nd Neonatal Department and NICU, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece.
Vassiliki PapaevangelouThird Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece.
Maria LivieratouNICU, Attikon University Hospital, Athens, Greece.
Kristin TanneyNICU, St Mary's Hospital, Manchester University NHS Foundation Trust, United Kingdom.
Nicola BoothNICU, St Mary's Hospital, Manchester University NHS Foundation Trust, United Kingdom.
Donna TolentinoNeonatal Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
Amy ReidNeonatal Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
Argyro Ftergioti3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece.
Maria Simitsopoulou3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece.
Kassandra TataropoulouNICU-2nd Department of Pediatrics, NKUA, Children's Hospital of Athens P. and A. Kyriakou, Athens, Greece.
Evangelia KoemtzidouNICU-2nd Department of Pediatrics, NKUA, Children's Hospital of Athens P. and A. Kyriakou, Athens, Greece.
Concepción de Alba RomeroHospital 12 Octubre, Madrid, Sprain.
Elena Bergon SendinHospital 12 Octubre, Madrid, Sprain.
Javier Perez-LopezBiobizkaia Health Research Institute, Barakaldo, Spain.
Yolanda Campos-FrancoBiobizkaia Health Research Institute, Barakaldo, Spain.
Aleksandra PietrzykDepartment of Neonatology and Neonatal Intensive Care, Children's Memorial Health Institute, Warsaw, Poland.
Grete HaubeClinic of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia.
Mari-Liis IlmojaClinic of Anaesthesiology and Intensive Care, East Tallinn Central Hospital, Tallinn, Estonia.
Helgi PadariClinic of Anaesthesiology and Intensive Care, Tallinn Children's Hospital, Tallinn, Estonia.
Martin StockerLuzerner Kantonsspittal, Luzerne, Switzerland.
Alexandra PérissetKantonsspital Aarau, Aarau, Switzerland.
Dariusz GruszfeldDepartment of Neonatology and Neonatal Intensive Care, Children's Memorial Health Institute, Warsaw, Poland.
Paul ClarkeNorwich Medical School, University of East Anglia, Norwich, United Kingdom.
Jasmine MyhillNeonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom.
Fernando CabañasDepartment of Pediatrics and Neonatology, Quironsalud Madrid University Hospital and Quironsalud San José Hospital, Madrid, Spain.
Mario GiuffrèHead of Neonatology, Nursery and Neonatal Intensive Care Unit, University Hospital Policlinic Paolo Giaccone of Palermo, Palermo, Italy.
Veronica NotarbartoloNeonatology, Nursery and Neonatal Intensive Care Unit, University Hospital Policlinic Paolo Giaccone of Palermo, Palermo, Italy.
Sven WellmannDepartment of Neonatology, University Children's Hospital Regensburg (KUNO), Hospital St Hedwig of the Order of St John of God, University of Regensburg, Regensburg, Germany.
Anna BaduraDepartment of Neonatology, University Children's Hospital Regensburg (KUNO), Hospital St Hedwig of the Order of St John of God, University of Regensburg, Regensburg, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Understanding how neonatal unit colonization pressure, the proportion of infants carrying resistant bacteria on a unit, is associated with antibiotic-resistant bacterial acquisition risk can inform the design and implementation of effective infection prevention and control (IPC) interventions. Objectives: To describe resistant bacterial gene prevalence in European neonatal units and to assess the association between unit-level extended-spectrum β-lactamase (ESBL) colonization pressure and infant-level ESBL acquisition. Design, Setting, and Participants: Multicenter study in 24 tertiary neonatal units in 8 European countries (Estonia, Greece, Germany, Italy, Poland, Spain, Switzerland, and the United Kingdom) using repeated cross-sectional surveys collecting stool samples from infants over 4 surveys with 4-, 7-, and 14-day intervals, analyzed using real-time quantitative polymerase chain reaction (PCR) between January 2022 and June 2024 as part of the NeoIPC project. All infants present on the neonatal unit at 8:00 am on the day of the survey were eligible; infants could contribute to multiple surveys. Exposure: ESBL colonization pressure at previous survey. Main Outcome and Measure: Incident infant gut colonization with ESBL-harboring bacteria (ESBL-colonized). Bayesian hierarchical logistic regression modeling was used to assess the association between colonization pressure and infant-level acquisition risk on the neonatal unit. Results: Overall, 943 infants (547 of 943 male [58.0%]; median [IQR] gestational age, 34 [30-38] weeks, and median [IQR] birth weight, 2130 [1254-3084] g) contributed to 1847 infant-survey observations. Stool samples were collected and PCR results obtained in 1448 of 1847 infant surveys (78.4%). The most common genes detected were those encoding ESBLs (205 of 1448 samples [14.2%]), with high unit-level variation. In the colonization acquisition analysis, we included 829 samples from 533 infants hospitalized since birth who were either newly admitted since or not colonized at the previous survey time point; 90 of 533 infants (16.9%) became ESBL-colonized. Their median (IQR) gestational age was 34 (30-37) weeks, and median (IQR) length of stay at survey was 14 (5-32) days. Colonization pressure was associated with increased odds of becoming ESBL-colonized for all survey intervals (4-day interval: mean odds ratio [OR], 1.89; 95% credible interval [CrI], 1.22-2.94; 7-day interval: OR, 1.76; 95% CrI, 1.26-2.63; 14-day interval: OR, 1.73; 95% CrI, 1.15-2.52 per 10% increase of colonization pressure). Conclusions and Relevance: In this cross-sectional study, ESBL colonization pressure was associated with individual risk of acquiring ESBL on the neonatal unit. Unit-level interventions targeting colonization rather than infection may have important direct and indirect benefits in units with high colonization pressure.

Indexed as

beta-LactamasesCross InfectionGastrointestinal MicrobiomeIntensive Care Units, NeonatalCross-Sectional StudiesEuropeFecesFemaleHumansInfant, NewbornMalebeta-Lactamases

Identifiers

PMID42742944
PMCPMC13579436

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.