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Han KH, Oh MS, Ahn J, Lee J, Kim YW, Yoon YM, Kim YJ, Kang HS, Kang KS, Greenbaum LA, Choi JH. Piperacillin-Tazobactam versus Cefotaxime as Empiric Treatment for Febrile Urinary Tract Infection in Hospitalized Children. Infect Chemother 2024; 56:266-275. [PMID: 38960740 PMCID: PMC11224032 DOI: 10.3947/ic.2024.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/15/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND According to international pediatric urinary tract infection (UTI) guidelines, selecting ampicillin/sulbactam or amoxicillin/clavulanate is recommended as the first-line treatment for pediatric UTI. In Korea, elevated resistance to ampicillin and ampicillin/sulbactam has resulted in the widespread use of third-generation cephalosporins for treating pediatric UTIs. This study aims to compare the efficacy of piperacillin-tazobactam (TZP) and cefotaxime (CTX) as first-line treatments in hospitalized children with UTIs. MATERIALS AND METHODS The study, conducted at Jeju National University Hospital, retrospectively analyzed medical records of children hospitalized for febrile UTIs between 2014 and 2017. UTI diagnosis included unexplained fever, abnormal urinalysis, and the presence of significant uropathogens. Treatment responses, recurrence, and antimicrobial susceptibility were assessed. RESULTS Out of 323 patients, 220 met the inclusion criteria. Demographics and clinical characteristics were similar between TZP and CTX groups. For children aged ≥3 months, no significant differences were found in treatment responses and recurrence. Extended-spectrum beta-lactamase (ESBL)-positive strains were associated with recurrence in those <3 months. CONCLUSION In Korea, escalating resistance to empirical antibiotics has led to the adoption of broad-spectrum empirical treatment. TZP emerged as a viable alternative to CTX for hospitalized children aged ≥3 months with UTIs. Consideration of ESBL-positive strains and individualized approaches for those <3 months are crucial.
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Affiliation(s)
- Kyoung Hee Han
- Department of Pediatrics, Jeju National University College of Medicine and Jeju National University Hospital, Jeju, Korea
| | - Min-Su Oh
- Department of Pediatrics, Jeju National University College of Medicine and Jeju National University Hospital, Jeju, Korea
| | - Jungmin Ahn
- Department of Pediatrics, Jeju National University College of Medicine and Jeju National University Hospital, Jeju, Korea
| | - Juyeon Lee
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Youn Woo Kim
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
| | - Young Mi Yoon
- Department of Pediatrics, Jeju National University College of Medicine and Jeju National University Hospital, Jeju, Korea
| | - Yoon-Joo Kim
- Department of Pediatrics, Jeju National University College of Medicine and Jeju National University Hospital, Jeju, Korea
| | - Hyun Sik Kang
- Department of Pediatrics, Jeju National University College of Medicine and Jeju National University Hospital, Jeju, Korea
| | - Ki-Soo Kang
- Department of Pediatrics, Jeju National University College of Medicine and Jeju National University Hospital, Jeju, Korea
| | - Larry A Greenbaum
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Jae Hong Choi
- Department of Pediatrics, Jeju National University College of Medicine and Jeju National University Hospital, Jeju, Korea.
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Nurjadi D, Eichel VM, Pöschl J, Gille C, Kranig S, Heeg K, Boutin S. Monocentric observational cohort study to investigate the transmission of third-generation cephalosporin-resistant Enterobacterales in a neonatal intensive care unit in Heidelberg, Germany. Microbiol Spectr 2023; 11:e0203823. [PMID: 37737640 PMCID: PMC10581168 DOI: 10.1128/spectrum.02038-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/04/2023] [Indexed: 09/23/2023] Open
Abstract
Third-generation cephalosporin-resistant Enterobacterales is a major threat for newborns in neonatal intensive care units (NICUs). The route of acquisition in a non-outbreak setting should be investigated to implement adequate infection prevention measures. To identify risk factors for colonization with and to investigate the transmission pattern of third-generation cephalosporin-resistant Enterobacterales in a NICU setting. This monocentric observational cohort study in a tertiary NICU in Heidelberg, Germany, enrolled all hospitalized neonates screened for cephalosporin-resistant Enterobacterales. Data were collected from 1 January 2018 to 31 December 2021. Weekly screening by rectal swabs for colonization with third-generation cephalosporin-resistant Enterobacterales was performed for all newborns until discharge. Whole-genome sequencing was performed for molecular characterization and transmission analysis. In total, 1,287 newborns were enrolled. The median length of stay was 20 (range 1-250) days. Eighy-eight infants (6.8%) were colonized with third-generation cephalosporin-resistant Enterobacterales. Low birth weight [<1500 g (adjusted odds ratio, 5.1; 95% CI 2.2-11.5; P < 0.001)] and longer hospitalization [per 30 days (adjusted odds ratio, 1.7; 95% CI 1.5-2.0; P < 0.001)] were associated with colonization or infection with drug-resistant Enterobacterales in a multivariate analysis. Enterobacter cloacae complex was the most prevalent third-generation cephalosporin-resistant Enterobacterales detected, 64.8% (59 of 91). Whole-genome sequencing, performed for the available 85 of 91 isolates, indicated 12 transmission clusters involving 37 patients. This cohort study suggests that transmissions of third-generation cephalosporin-resistant Enterobacterales in newborns occur frequently in a non-outbreak NICU setting, highlighting the importance of surveillance and preventive measures in this vulnerable patient group. IMPORTANCE Preterm newborns are prone to infections. Therefore, infection prevention should be prioritized in this vulnerable patient group. However, outbreaks involving drug-resistant bacteria, such as third-generation resistant Enterobacterales, are often reported. Our study aims to investigate transmission and risk factors for acquiring third-generation cephalosporin-resistant Enterobacterales in a non-outbreak NICU setting. Our data indicated that premature birth and low birth weight are significant risk factors for colonization/infection with third-generation cephalosporin-resistant Enterobacterales. Furthermore, we could identify putative transmission clusters by whole-genome sequencing, highlighting the importance of preemptive measures to prevent infections in this patient collective.
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Affiliation(s)
- Dennis Nurjadi
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
- Department of Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
| | - Vanessa M. Eichel
- Department of Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Pöschl
- Department of Neonatology, Heidelberg University Hospital, Heidelberg University Children’s Hospital, Heidelberg, Germany
| | - Christian Gille
- Department of Neonatology, Heidelberg University Hospital, Heidelberg University Children’s Hospital, Heidelberg, Germany
| | - Simon Kranig
- Department of Neonatology, Heidelberg University Hospital, Heidelberg University Children’s Hospital, Heidelberg, Germany
| | - Klaus Heeg
- Department of Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Sébastien Boutin
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
- Department of Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
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Poggi C, Dani C. New Antimicrobials for the Treatment of Neonatal Sepsis Caused by Multi-Drug-Resistant Bacteria: A Systematic Review. Antibiotics (Basel) 2023; 12:956. [PMID: 37370275 DOI: 10.3390/antibiotics12060956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Infections by multi-drug-resistant (MDR) organisms are sharply increasing in newborns worldwide. In low and middle-income countries, a disproportionate amount of neonatal sepsis caused by MDR Gram negatives was recently reported. Newborns with infections by MDR organisms with limited treatment options may benefit from novel antimicrobials. METHODS We performed a literature search investigating the use in newborns, infants and children of novel antimicrobials for the treatment of MDR Gram negatives, namely ceftazidime/avibactam, ceftolozane/tazobactam, cefiderocol, meropenem/vaborbactam, imipenem/relebactam, and Gram positives with resistance of concern, namely ceftaroline and dalbavancin. PubMed, EMBASE, and Web of Science were searched. RESULTS A total of 50 records fulfilled the inclusion criteria. Most articles were case reports or case series, and ceftazidime/avibactam was the most studied agent. All studies showed favorable efficacy and safety profile in newborns and across different age cohorts. CONCLUSIONS novel antibiotics may be considered in newborns for the treatment of MDR Gram negatives with limited treatment options and for Gram positives with resistance concerns. Further studies are needed to address their effectiveness and safety in newborns.
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Affiliation(s)
- Chiara Poggi
- Neonatal Intensive Care Unit, Department of Mother and Child Care, Careggi University Hospital, 50141 Florence, Italy
| | - Carlo Dani
- Neonatal Intensive Care Unit, Department of Mother and Child Care, Careggi University Hospital, 50141 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50141 Florence, Italy
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Al Dabbagh M, Alghounaim M, Almaghrabi RH, Dbaibo G, Ghatasheh G, Ibrahim HM, Aziz MA, Hassanien A, Mohamed N. A Narrative Review of Healthcare-Associated Gram-Negative Infections Among Pediatric Patients in Middle Eastern Countries. Infect Dis Ther 2023; 12:1217-1235. [PMID: 37071349 DOI: 10.1007/s40121-023-00799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Gram-negative bacteria (GNB) have become prominent across healthcare and community settings due to factors including lack of effective infection control and prevention (ICP) and antimicrobial stewardship programs (ASPs), GNB developing antimicrobial resistance (AMR), and difficulty treating infections. This review summarizes available literature on healthcare-associated infections (HAIs) in Middle Eastern pediatric patients. METHODS Literature searches were performed with PubMed and Embase databases. Articles not reporting data on GNB, HAIs, pediatric patients, and countries of interest were excluded. RESULTS The searches resulted in 220 publications, of which 49 met the inclusion criteria and 1 additional study was identified manually. Among 19 studies across Egypt reporting GNB prevalence among pediatric patients, Klebsiella species/K. pneumoniae and Escherichia coli were typically the most common GNB infections; among studies reporting carbapenem resistance and multidrug resistance (MDR), rates reached 86% and 100%, respectively. Similarly, in Saudi Arabia, Klebsiella spp./K. pneumoniae and E. coli were the GNB most consistently associated with infections, and carbapenem resistance (up to 100%) and MDR (up to 75%) were frequently observed. In other Gulf Cooperation Council countries, including Kuwait, Oman, and Qatar, carbapenem resistance and MDR were also commonly reported. In Jordan and Lebanon, E. coli and Klebsiella spp./K. pneumoniae were the most common GNB isolates, and AMR rates reached 100%. DISCUSSION This review indicated the prevalence of GNB-causing HAIs among pediatric patients in Middle Eastern countries, with studies varying in reporting GNB and AMR. Most publications reported antimicrobial susceptibility of isolated GNB strains, with high prevalence of extended-spectrum beta-lactamase-producing K. pneumoniae and E. coli isolates. A review of ASPs highlighted the lack of data available in the region. CONCLUSIONS Enhanced implementation of ICP, ASPs, and AMR surveillance is necessary to better understand the widespread burden of antimicrobial-resistant GNB and to better manage GNB-associated HAIs across Middle Eastern countries.
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Affiliation(s)
- Mona Al Dabbagh
- King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | | | | | - Ghassan Dbaibo
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon.
| | | | - Hanan M Ibrahim
- Pediatric Department, Children's Hospital, Ain Shams University Hospital, Cairo, Egypt
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Siddique MH, Hayat S, Muzammil S, Ashraf A, Khan AM, Ijaz MU, Khurshid M, Afzal M. Ecofriendly phytosynthesized zirconium oxide nanoparticles as antibiofilm and quorum quenching agents against Acinetobacter baumannii. Drug Dev Ind Pharm 2022; 48:502-509. [PMID: 36191015 DOI: 10.1080/03639045.2022.2132260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The worldwide increase of multi-drug resistance has directed the researchers to focus on ecofriendly ways of nanoparticles synthesis with effective antivirulence properties. Here, we report the antibiofilm and quorum quenching potential of zirconium oxide nanoparticles (ZrO2 NPs) synthesized from aqueous ginger extract against multi drug resistant (MDR) Acinetobacter baumannii. The results indicated that ZrO2 NPs were of tetragonal shape with average diameter of 16 nm. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values for A. baumannii were 15.6 µg/ml and 62.5 µg/ml respectively as revealed by broth microdilution assay. Exposure of bacterial cells to ZrO2 NPs resulted in reactive oxygen species (ROS) generation which in turn led to cellular membrane disruption as observed by an increase in leakage of cellular contents such as proteins, sugars and DNA. The antibiofilm activity was evaluated by microtiter plate assay and the results revealed that the percentage inhibition of biofilm was found to be 14.3-80.6%. ZrO2 NPs also obstructed the chemical composition of biofilms matrix by reducing the proteins and carbohydrate contents. Molecular docking studies of ZrO2 NPs with four proteins (2NAZ, 4HKG, 5D6H and 5HM6) involved in biofilm formation of A. baumannii revealed the interaction of zirconium with target proteins. These findings suggested the in vitro efficacy of phytosynthesized ZrO2 NPs as antibiofilm and quorum quenching agents that can be exploited in the development of alternative therapeutic options against MDR A. baumannii.
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Affiliation(s)
| | - Sumreen Hayat
- Department of Microbiology, Government College University, Faisalabad
| | - Saima Muzammil
- Department of Microbiology, Government College University, Faisalabad
| | - Asma Ashraf
- Department of Zoology, Government College University, Faisalabad
| | | | - Muhammad Umar Ijaz
- Department of Zoology, Wildlife and Fisheries, University of Agriculture, Faisalabad, Pakistan
| | - Mohsin Khurshid
- Department of Microbiology, Government College University, Faisalabad
| | - Muhammad Afzal
- Department of Bioinformatics and Biotechnology, Govt. College University, Faisalabad
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Kucova P, Kantor L, Fiserova K, Lasak J, Röderova M, Kolar M. Bacterial Pathogens and Evaluation of a Cut-Off for Defining Early and Late Neonatal Infection. Antibiotics (Basel) 2021; 10:278. [PMID: 33803288 PMCID: PMC7998728 DOI: 10.3390/antibiotics10030278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 12/02/2022] Open
Abstract
Bacterial infections are an important cause of mortality and morbidity in newborns. The main risk factors include low birth weight and prematurity. The study identified the most common bacterial pathogens causing neonatal infections including their resistance to antibiotics in the Neonatal Department of the University Hospital Olomouc. Additionally, the cut-off for distinguishing early- from late-onset neonatal infections was assessed. The results of this study show that a cut-off value of 72 h after birth is more suitable. Only in case of early-onset infections arising within 72 h of birth, initial antibiotic therapy based on gentamicin with ampicillin or amoxicillin/clavulanic acid may be recommended. It has been established that with the 72-h cut-off, late-onset infections caused by bacteria more resistant to antibiotics may be detected more frequently, a finding that is absolutely crucial for antibiotic treatment strategy.
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Affiliation(s)
- Pavla Kucova
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic; (P.K.); (K.F.); (M.R.); (M.K.)
| | - Lumir Kantor
- Neonatal Department, University Hospital Olomouc, 779 00 Olomouc, Czech Republic;
| | - Katerina Fiserova
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic; (P.K.); (K.F.); (M.R.); (M.K.)
| | - Jakub Lasak
- Neonatal Department, University Hospital Olomouc, 779 00 Olomouc, Czech Republic;
| | - Magdalena Röderova
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic; (P.K.); (K.F.); (M.R.); (M.K.)
| | - Milan Kolar
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic; (P.K.); (K.F.); (M.R.); (M.K.)
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Muzammil S, Khurshid M, Nawaz I, Siddique MH, Zubair M, Nisar MA, Imran M, Hayat S. Aluminium oxide nanoparticles inhibit EPS production, adhesion and biofilm formation by multidrug resistant Acinetobacter baumannii. BIOFOULING 2020; 36:492-504. [PMID: 32529892 DOI: 10.1080/08927014.2020.1776856] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/28/2020] [Indexed: 06/11/2023]
Abstract
Acinetobacter baumannii is a biofilm forming multidrug resistant (MDR) pathogen responsible for respiratory tract infections. In this study, aluminium oxide nanoparticles (Al2O3 NPs) were synthesized and characterized by TEM and EDX and shown to be spherical shaped nanoparticles with a diameter < 10 nm. The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) for the Al2O3 NPs ranged between 125 and 1,000 µg ml-1. Exposure to NPs caused cellular membrane disruption, indicated by an increase in cellular leakage of the contents. Biofilm inhibition was 11.64 to 70.2%, whereas attachment of bacteria to polystyrene surfaces was reduced to 48.8 to 51.9% in the presence of NPs. Nanoparticles also reduced extracellular polymeric substance production and the biomass of established biofilms. The data revealed the non-toxic nature of Al2O3 NPs up to a concentrations of 120 µg ml-1 in HeLa cell lines. These results demonstrate an effective and safer use of Al2O3 NPs against the MDR A. baumannii by targeting biofilm formation, adhesion and EPS production.
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Affiliation(s)
- Saima Muzammil
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | - Mohsin Khurshid
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | - Iqra Nawaz
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | | | - Muhammad Zubair
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | - Muhammad Atif Nisar
- Department of Microbiology, Government College University, Faisalabad, Pakistan
- College of Science and Engineering, Flinders University, Adelaide, South Australia
| | - Muhammad Imran
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari, Pakistan
| | - Sumreen Hayat
- Department of Microbiology, Government College University, Faisalabad, Pakistan
- Department of Biotechnology, University of Sargodha, Sargodha, Pakistan
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Nobre FX, Bastos IS, Dos Santos Fontenelle RO, Júnior EAA, Takeno ML, Manzato L, de Matos JME, Orlandi PP, de Fátima Souza Mendes J, Brito WR, da Costa Couceiro PR. Antimicrobial properties of α-Ag 2WO 4 rod-like microcrystals synthesized by sonochemistry and sonochemistry followed by hydrothermal conventional method. ULTRASONICS SONOCHEMISTRY 2019; 58:104620. [PMID: 31450327 DOI: 10.1016/j.ultsonch.2019.104620] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 05/29/2023]
Abstract
In this study we report the synthesis of silver tungstate microcrystals (α-Ag2WO4) by sonochemistry method (SC) at 65 °C and sonochemistry followed by conventional hydrothermal (SC + HC) for 1, 6 and 12 h, at 140 °C. The structural characterization by XRD confirms the alpha phase of the orthorhombic structure and the space group Pn2n, for all synthesized microcrystals. All the actives modes identified at the Raman spectroscopy were characteristic of alpha phase. The optical band gap by UV-Vis spectroscopy using the diffuse reflectance were 2.98, 3.0, 2.99 and 2.96 eV, for the microcrystals SC, SC + HC-1 h, SC + HC-6 h and SC + HC-12 h, respectively. FE-SEM images show the rod-like microcrystals, however, exhibiting the plane surface (1 0 1) only for the synthesized microcrystals with the assistance of the hydrothermal method (SC + HC-1 h, SC + HC- 6 h and SC + HC-12 h). The antimicrobial potential was confirmed for all α-Ag2WO4 microcrystals synthesized. However, the SC + HC-12 h microcrystals were more susceptible in the bacterial and fungal inhibition, with MIC values for microorganisms C. albicans, T. rubrum, MRSA e EHEC, 0.2-0.5, 4-9, 250 and 31.25 μg mL-1, respectively.
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Affiliation(s)
| | | | | | - Edgar Alves Araújo Júnior
- Laboratório Interdisciplinar de Materiais Avançados, Universidade Federal do Piauí, Teresina 64049-550, Amazonas, Brazil
| | - Mitsuo Lopes Takeno
- Instituto Federal do Amazonas, Campus Manaus Distrito Industrial, 69075-000 Amazonas, Brazil
| | - Lizandro Manzato
- Instituto Federal do Amazonas, Campus Manaus Distrito Industrial, 69075-000 Amazonas, Brazil
| | - José Milton Elias de Matos
- Laboratório Interdisciplinar de Materiais Avançados, Universidade Federal do Piauí, Teresina 64049-550, Amazonas, Brazil
| | | | | | - Walter Ricardo Brito
- Laboratório de Fisico-Química, Universidade Federal do Amazonas, Manaus 69077-000, Amazonas, Brazil
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Ren Z, Zheng X, Yang H, Zhang Q, Liu X, Zhang X, Yang S, Xu F, Yang J. Human umbilical-cord mesenchymal stem cells inhibit bacterial growth and alleviate antibiotic resistance in neonatal imipenem-resistant Pseudomonas aeruginosa infection. Innate Immun 2019; 26:215-221. [PMID: 31623477 PMCID: PMC7144031 DOI: 10.1177/1753425919883932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Human umbilical-cord mesenchymal stem cells (hUCMSCs) are a safe and convenient source of MSCs and have shown beneficial effects in neonatal infection and sepsis animal models. However, the factors leading to improved outcomes are still unclear. The aim of this study was to investigate the antibacterial effect and regulation of antimicrobial resistance of hUCMSCs. We separated imipenem-resistant Pseudomonas aeruginosa (PA) from neonates and incubated it with hUCMSCs as well as their culture medium. Assessment of direct inhibition of bacterial growth was done by counting CFUs. The concentration of antibacterial peptides in the culture medium of hUCMSCs was measured. Standard PA was inoculated with a sub-inhibitory concentration of imipenem with and without hUCMSC conditioned medium and antimicrobial peptides. The sensitivity to imipenem was detected until PA showed resistance to imipenem. Outer membrane protein (OprD2) mRNA expression in PA before and after the induction of imipenem resistance was analysed. We found that HUCMSCs possessed direct antimicrobial properties against bacteria and could alleviate antibiotic resistance via reserving OprD2 expression in PA.
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Affiliation(s)
- Zhuxiao Ren
- Department of Neonatology, Guangdong Women and Children Hospital, PR China
| | - Xuaner Zheng
- Department of Neonatology, Guangdong Women and Children Hospital, PR China
| | - Haoming Yang
- Department of Neonatology, Guangdong Women and Children Hospital, PR China
| | - Qi Zhang
- Department of Clinical Genetic Center, Guangdong Women and Children Hospital, PR China
| | - Xiaohong Liu
- Department of Neonatology, The People's Hospital of Zhuhai, PR China
| | - Xiaoling Zhang
- Department of Neonatology, Guangdong Women and Children Hospital, PR China
| | - Shumei Yang
- Department of Neonatology, Guangdong Women and Children Hospital, PR China
| | - Fang Xu
- Department of Neonatology, Guangdong Women and Children Hospital, PR China
| | - Jie Yang
- Department of Neonatology, Guangdong Women and Children Hospital, PR China
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Screening and Serial Neutrophil Counts Do Not Contribute to the Recognition or Diagnosis of Late-Onset Neonatal Sepsis. J Pediatr 2019; 205:105-111.e2. [PMID: 30318373 DOI: 10.1016/j.jpeds.2018.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/15/2018] [Accepted: 09/10/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the validity of screening and serial neutrophil counts in predicting the absence/presence of late-onset sepsis (LOS) in infants with central venous catheters. STUDY DESIGN Retrospective study of infants admitted to the neonatal intensive care unit (2009-2013) at Parkland Hospital with a central venous catheter and ≥1 LOS evaluations. Infants were categorized as proven or suspect LOS or uninfected based on results of blood cultures, clinical illness, and duration of antibiotics. Receiver operating curves (ROCs) were constructed to predict the absence or presence of LOS using Manroe reference ranges for total and immature neutrophils and the immature to total neutrophil ratio at 0, 12, and 24 hours after blood culture and the neutrophil value score, which assesses serial values. RESULTS Of the 497 infants with a central venous catheter, 179 underwent ≥1 LOS evaluations, and 140 of 179 (78%) had ≥1 complete evaluations (2 blood cultures and neutrophil values at 0, 12, and 24 hours), resulting in 188 complete LOS evaluations. The gestational age was 28 ± 4 weeks and LOS evaluation occurred at 29 ± 34 days (SD; 4-197 days). Sixty-one (35%) infants had proven LOS, 48 (23%) were suspect, and 71 (38%) were noninfected. ROC comparing proven vs noninfected was ≤0.56 for total neutrophils, immature neutrophils, and immature to total neutrophil ratio at 0, 12, and 24 hours and similar for proven + suspect vs noninfected. ROC for neutrophil value scores and absence of LOS was 0.56. CONCLUSIONS Screening neutrophil values are poor predictors of LOS in neonates with a central venous catheter, as are serial neutrophils and the neutrophil value score. Alternative biomarkers are needed.
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Alonso-Ojembarrena A, Martínez-Díaz JV, Lechuga-Sancho AM, Galán-Sánchez F, Lubián-López SP. Broad spectrum antibiotics in newborns increase multi-drug resistant infections. J Chemother 2019; 31:81-85. [PMID: 30676292 DOI: 10.1080/1120009x.2018.1556832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Our objective was to determine if broad spectrum antibiotics (BSA) are associated with multi-resistant bacterial (MRB) infections in neonatal patients. We conducted a case-control study with two groups of patients: those with and without a MRB infection. We included 43 cases and 43 controls. MRB strains were: 21 S. maltophila (49%), 11 ESBL-producing Enterobacteriae (25%), 8 P. aeruginosa (19%) and 3 MRSA (7%). Odds ratio (OR) for MRB after seven days of carbapenems was 4.25 (95% confidence interval (CI) 1.4-17.4) and OR for MRB after seven days of third generation cephalosporin was 8 (95% CI 1.1-34.9). BSA longer than seven days, increases MRB infections 22.5 times in patients with bronchopulmonary dysplasia (BPD). Our data show a clear association between the use of BSA and the development of MRB infections, especially in BPD. Although we cannot state this is a causal relationship, we can recommend avoiding prolonged treatment with these antibiotics in preterm babies at risk of BPD.
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Affiliation(s)
| | - José Vicente Martínez-Díaz
- b Department of Maternal and Child Health and Radiology. School of Medicine . University of Cádiz , Spain
| | - Alfonso María Lechuga-Sancho
- a Neonatal Intensive Care Unit . Puerta del Mar University Hospital , Cádiz . Spain.,c Department of Pediatrics . Puerta del Mar University Hospital , Cádiz . Spain
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Satar M, Arısoy AE, Çelik İH. Turkish Neonatal Society guideline on neonatal infections-diagnosis and treatment. Turk Arch Pediatr 2018; 53:S88-S100. [PMID: 31236022 PMCID: PMC6568293 DOI: 10.5152/turkpediatriars.2018.01809] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Neonatal infections are a major cause of morbidity and mortality in the first month of life, especially in developing countries. Despite advances in neonatology, neonatal infections still haves clinical importance because of nonspecific signs and symptoms, no perfect diagnostic marker, and interference with non-infectious diseases of newborns. Diagnosis is typically made by clinical and laboratory findings. Empiric antibiotic therapy should be started in a newborn with signs and symptoms of infection after cultures are taken according to the time of the signs and symptoms, risk factors, admission from community or hospital, focus of infection, and antibiotic susceptibility estimation. Treatment should be continued according to clinical findings and culture results. Intrapartum antibiotic prophylaxis, proper hand washing, aseptic techniques for invasive procedures, appropriate neonatal intensive care unit design, isolation procedures, and especially breast milk use are needed to prevent infections. The use of diagnosis and treatment protocols increases clinical success.
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Affiliation(s)
- Mehmet Satar
- Division of Neonatology, Department of Pediatrics, Çukurova University, Faculty of Medicine, Adana, Turkey
| | - Ayşe Engin Arısoy
- Division of Neonatology, Department of Pediatrics, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - İstemi Han Çelik
- Department of Neonatology, Etlik Zübeyde Hanım Womens' Diseases Training and Research Hospital, Ankara, Turkey
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Hayat S, Muzammil S, Rasool MH, Nisar Z, Hussain SZ, Sabri AN, Jamil S. In vitroantibiofilm and anti-adhesion effects of magnesium oxide nanoparticles against antibiotic resistant bacteria. Microbiol Immunol 2018; 62:211-220. [DOI: 10.1111/1348-0421.12580] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 12/19/2017] [Accepted: 01/15/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Sumreen Hayat
- Department of Microbiology; Government College University; Jhang Road Faisalabad Pakistan
- Department of Microbiology and Molecular Genetics; University of the Punjab; Quaid-e-Azam Campus, Canal Road Lahore Pakistan
| | - Saima Muzammil
- Department of Microbiology; Government College University; Jhang Road Faisalabad Pakistan
| | | | - Zonaira Nisar
- Department of Microbiology; Government College University; Jhang Road Faisalabad Pakistan
| | - Syed Zajif Hussain
- Department of Chemistry; Syed Babar Ali School of Science and Engineering; Lahore University of Management Sciences; Sector U, DHA Lahore Pakistan
| | - Anjum Nasim Sabri
- Department of Microbiology and Molecular Genetics; University of the Punjab; Quaid-e-Azam Campus, Canal Road Lahore Pakistan
| | - Saba Jamil
- Department of Chemistry; University of Agriculture; Agriculture University Road, Faisalabad Pakistan
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14
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Nordberg V, Jonsson K, Giske CG, Iversen A, Aspevall O, Jonsson B, Camporeale A, Norman M, Navér L. Neonatal intestinal colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae-a 5-year follow-up study. Clin Microbiol Infect 2018; 24:1004-1009. [PMID: 29326011 DOI: 10.1016/j.cmi.2017.12.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/14/2017] [Accepted: 12/28/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To analyse Klebsiella pneumoniae (KP) isolates from an outbreak of extended-spectrum β-lactamase (ESBL)-producing KP and Escherichia coli (EC) among infants admitted to neonatal intensive care units and to determine the duration of the intestinal colonization. METHODS We performed a prospective cohort study of intestinal ESBL-KP/ESBL-EC colonized neonates after a 5-month outbreak in two neonatal intensive care units. Whole genome sequencing, multilocus sequence typing, core genome multilocus sequence typing, pulsed-field electrophoresis and PCR for blaCTX-M were performed on the first isolates. Stool cultures were performed every second month after discharge until 2 years after discharge and at 5 years of age. The last positive samples were analysed with pulsed-field gel electrophoresis and PCR for blaCTX-M. The intestinal relative dominance of ESBL-producing Enterobacteriaceae was determined. RESULTS Thirteen of 17 patients colonized with ESBL-KP/ESBL-EC survived. Isolates from 16 of 17 patients were available for analysis and featured the same strain type of ESBL-KP: sequence type 101. The strain had capsule type K29 and harboured blaCTX-M-15. The virulence genes irp1, irp2, iutA, kfu and mrk were detected in all isolates. The median length of colonization was 12.5 months (range, 5-68 months). After 2 years, two of 13 patients were carriers of ESBL-KP and one of 13 of ESBL-EC. At 5 years of age, one neonate was colonized with ESBL-EC. No infant experienced an ESBL-KP/EC-infection during follow-up. CONCLUSIONS Two years after discharge, almost one fourth of the study participants were ESBL/KP-EC carriers. ESBL-KP sequence type 101 persisted in two of 13 children for 23 to 26 months. One patient was colonized with ESBL-EC at age 5 years.
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Affiliation(s)
- V Nordberg
- Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Paediatrics, Karolinska Institutet, Sweden.
| | - K Jonsson
- Department of Neonatal Medicine, Karolinska University Hospital, Sweden
| | - C G Giske
- Department of Clinical Microbiology, Karolinska University Hospital, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Sweden
| | - A Iversen
- Department of Clinical Microbiology, Karolinska University Hospital, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Sweden
| | - O Aspevall
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - B Jonsson
- Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - A Camporeale
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Sweden
| | - M Norman
- Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Paediatrics, Karolinska Institutet, Sweden
| | - L Navér
- Department of Neonatal Medicine, Karolinska University Hospital, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Paediatrics, Karolinska Institutet, Sweden
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Sana F, Satti L, Zaman G, Gardezi A, Imtiaz A, Ahmed A, Khadim MT. Pattern of Gram-negative bloodstream infections and their antibiotic susceptibility profiles in a neonatal intensive care unit. J Hosp Infect 2017; 98:243-244. [PMID: 29128348 DOI: 10.1016/j.jhin.2017.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 11/15/2022]
Affiliation(s)
- F Sana
- Department of Microbiology, Armed Forces Institute of Pathology, National Institute of Medical Sciences, Rawalpindi, Pakistan
| | - L Satti
- Department of Microbiology, Armed Forces Institute of Pathology, National Institute of Medical Sciences, Rawalpindi, Pakistan.
| | - G Zaman
- Department of Microbiology, Armed Forces Institute of Pathology, National Institute of Medical Sciences, Rawalpindi, Pakistan
| | - A Gardezi
- Department of Microbiology, Armed Forces Institute of Pathology, National Institute of Medical Sciences, Rawalpindi, Pakistan
| | - A Imtiaz
- Department of Microbiology, Armed Forces Institute of Pathology, National Institute of Medical Sciences, Rawalpindi, Pakistan
| | - A Ahmed
- Department of Microbiology, Armed Forces Institute of Pathology, National Institute of Medical Sciences, Rawalpindi, Pakistan
| | - M T Khadim
- Department of Microbiology, Armed Forces Institute of Pathology, National Institute of Medical Sciences, Rawalpindi, Pakistan
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16
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Gilfillan M, Bhandari V. Biomarkers for the diagnosis of neonatal sepsis and necrotizing enterocolitis: Clinical practice guidelines. Early Hum Dev 2017; 105:25-33. [PMID: 28131458 DOI: 10.1016/j.earlhumdev.2016.12.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Sepsis and necrotizing enterocolitis are major contributors to morbidity and mortality in neonates, especially in those born preterm. While therapeutic interventions are available for both (for e.g. antibiotics), a major dilemma is early diagnosis so that these interventions can be done in a timely manner. As clinical evaluation alone is unreliable in identifying infants in the early stages of neonatal sepsis or necrotizing enterocolitis, there is a need to find specific biomarkers associated with these conditions to improve diagnostic capabilities. Optimal use of biomarkers in the identification and management of affected neonates requires an understanding of the properties of each marker within the timeline of the inflammatory response. We propose that early- and mid-phase markers such as neutrophil CD64 and procalcitonin should be combined with the late-phase biomarker C-reactive protein for maximal diagnostic benefit. Appropriately powered trials evaluating the serial measurements of these markers in decisions related to antibiotic stewardship in the neonatal population are indicated, in addition to more studies investigating other potentially useful biomarkers.
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Affiliation(s)
- Margaret Gilfillan
- Section of Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Vineet Bhandari
- Section of Neonatal-Perinatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
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Abstract
PURPOSE OF REVIEW Antibiotics have not only saved lives and improved outcomes, but they also influence the evolving microbiome. This review summarizes reports on neonatal infections and variation in antibiotic utilization, discusses the emergence of resistant organisms, and presents data from human neonates and animal models demonstrating the impact of antibiotics on the microbiome, and how microbiome alterations impact health. The importance of antibiotic stewardship is also discussed. RECENT FINDINGS Infections increase neonatal morbidity and mortality. Furthermore, the clinical presentation of infections can be subtle, prompting clinicians to empirically start antibiotics when infection is a possibility. Antibiotic-resistant infections are a growing problem. Cohort studies have identified extensive center variations in antibiotic usage and associations between antibiotic exposures and outcomes. Studies of antibiotic-induced microbiome alterations and downstream effects on the developing immune system have increased our understanding of the mechanisms underlying the associations between antibiotics and adverse outcomes. The emergence of resistant microorganisms and recent evidence linking antibiotic practice variations with health outcomes has led to the initiation of antibiotic stewardship programs. SUMMARY The review encourages practitioners to assess local antibiotic use with regard to local microbiology, and to adopt steps to reduce infections and use antibiotics wisely.
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Iqbal J, Dufendach KR, Wellons JC, Kuba MG, Nickols HH, Gómez-Duarte OG, Wynn JL. Lethal neonatal meningoencephalitis caused by multi-drug resistant, highly virulent Escherichia coli. Infect Dis (Lond) 2016; 48:461-6. [PMID: 27030919 DOI: 10.3109/23744235.2016.1144142] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Neonatal meningitis is a rare but devastating condition. Multi-drug resistant (MDR) bacteria represent a substantial global health risk. This study reports on an aggressive case of lethal neonatal meningitis due to a MDR Escherichia coli (serotype O75:H5:K1). Serotyping, MDR pattern and phylogenetic typing revealed that this strain is an emergent and highly virulent neonatal meningitis E. coli isolate. The isolate was resistant to both ampicillin and gentamicin; antibiotics currently used for empiric neonatal sepsis treatment. The strain was also positive for multiple virulence genes including K1 capsule, fimbrial adhesion fimH, siderophore receptors iroN, fyuA and iutA, secreted autotransporter toxin sat, membrane associated proteases ompA and ompT, type II polysaccharide synthesis genes (kpsMTII) and pathogenicity-associated island (PAI)-associated malX gene. The presence of highly-virulent MDR organisms isolated in neonates underscores the need to implement rapid drug resistance diagnostic methods and should prompt consideration of alternate empiric therapy in neonates with Gram negative meningitis.
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Affiliation(s)
- Junaid Iqbal
- a Department of Pediatrics , Vanderbilt University , Nashville , TN , USA
| | - Kevin R Dufendach
- a Department of Pediatrics , Vanderbilt University , Nashville , TN , USA
| | - John C Wellons
- b Department of Neurosurgery , Vanderbilt University , Nashville , TN , USA
| | - Maria G Kuba
- c Department of Pathology, Microbiology and Immunology , Vanderbilt University , Nashville , TN , USA
| | - Hilary H Nickols
- c Department of Pathology, Microbiology and Immunology , Vanderbilt University , Nashville , TN , USA
| | | | - James L Wynn
- d Department of Pediatrics , University of Florida , Gainesville , FL , USA
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Mussap M, Ferrari M, Fanos V. Laboratory medicine meets precision medicine: The paradigm of metabolomics in perinatology. Clin Chim Acta 2015; 451:1-3. [DOI: 10.1016/j.cca.2015.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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20
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Denkel LA, Gastmeier P, Piening B. To screen or not to screen mothers of preterm infants for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). J Perinatol 2015; 35:893-4. [PMID: 26507145 DOI: 10.1038/jp.2015.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- L A Denkel
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - B Piening
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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Cailes B, Vergnano S, Kortsalioudaki C, Heath P, Sharland M. The current and future roles of neonatal infection surveillance programmes in combating antimicrobial resistance. Early Hum Dev 2015; 91:613-8. [PMID: 26386612 DOI: 10.1016/j.earlhumdev.2015.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neonatal sepsis is an important cause of morbidity and mortality, particularly in premature or low birth weight babies. Hospital-acquired blood stream infections represent a significant and largely preventable cause of disease in this population. Neonatal units have been identified as a common site for the development and transmission of antimicrobial-resistant pathogens, a significant issue in modern medicine. Neonatal surveillance programmes collect prospective data on infection rates and may be used to optimise therapy, benchmark practice and develop quality improvement programmes. Despite this, the number of networks is relatively few and these are largely concentrated in resource-rich nations. Furthermore, surveillance definitions may vary between programmes impairing our ability to draw comparisons between them. Better harmonisation is required between networks to ensure that they achieve their potential as a valuable tool for benchmarking of hospital-acquired infection rates between units.
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Affiliation(s)
- Benjamin Cailes
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK; Monash University, Melbourne, Australia.
| | - Stefania Vergnano
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
| | - Christina Kortsalioudaki
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
| | - Paul Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
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