Healthcare-associated infections in neonates

PURPOSE OF REVIEW: To identify important findings in the recent literature related to healthcare-associated infections in neonatal care. RECENT FINDINGS: Bloodstream infection remains the leading healthcare-associated infection in the neonatal unit, but multimodal interventions have been shown to successfully reduce this life-threatening complication. Emerging pathogens such as methicillin-resistant Staphylococcus aureus, extended-spectrum-beta-lactamase-producing Gram-negative organisms and pan-resistant Acinetobacter baumannii or Serratia marcescens complicate the use of standard antibiotic treatment and are a particular concern in this setting because of the limitation in antibiotic classes among neonates. Community-acquired methicillin-resistant S. aureus infections are increasing in frequency and are particularly worrisome. Fluconazole prophylaxis offers a simple solution for the prevention of invasive Candida infection and has been already widely adopted. Although there is evidence for its efficacy, there is still some debate about the pros and cons of azole prophylaxis in the prevention of invasive Candida infections. Furthermore, its use in low-prevalence settings remains highly questionable. The introduction of restrictive guidelines limiting the use of antibiotics in early-onset neonatal infections has proved to be safe and efficient and may also reduce the incidence of late-onset infection. Outbreaks remain an ongoing concern in neonatal care and are increasingly complicated by emerging multiresistant pathogens. SUMMARY: Healthcare-associated infections remain a permanent challenge among neonates.