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Gashaw M, Ali S, Berhane M, Tesfaw G, Eshetu B, Workneh N, Seeholzer T, Froeschl G, Kroidl A, Wieser A, Gudina EK. Neonatal Sepsis Due to Multidrug-resistant Bacteria at a Tertiary Teaching Hospital in Ethiopia. Pediatr Infect Dis J 2024; 43:687-693. [PMID: 38656939 PMCID: PMC11191060 DOI: 10.1097/inf.0000000000004364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The burden of multidrug-resistant bacterial infections in low-income countries is alarming. This study aimed to identify the bacterial etiologies and antibiotic resistance patterns among neonates in Jimma, Ethiopia. METHODS An observational longitudinal study was conducted among 238 presumptive neonatal sepsis cases tested with blood and/or cerebrospinal fluid culture. The bacterial etiologies were confirmed using matrix-assisted laser desorption ionization-time of flight mass spectrometry. The antibiotic resistance patterns were determined using the automated disc diffusion method (Bio-Rad) and the results were interpreted based on the European Committee on Antimicrobial Susceptibility Testing 2021 breakpoints. Extended-spectrum β-lactamases were detected using a double disc synergy test and confirmed by Mast discs (Mast Diagnostica GmbH). RESULTS A total of 152 pathogens were identified. Of these, Staphylococcus aureus (18.4%) was the predominant isolate followed by Klebsiella pneumoniae (15.1%) and Escherichia coli (10.5%). All the isolates exhibited a high rate of resistance to first- and second-line antibiotics ranging from 73.3% for gentamicin to 93.3% for ampicillin. Furthermore, 74.4% of the Gram-negative isolates were extended-spectrum β-lactamase producers and 57.1% of S. aureus strains were methicillin resistant. The case fatality rate was 10.1% and 66.7% of the deaths were attributable to infections by multidrug-resistant pathogens. CONCLUSIONS The study revealed a high rate of infections with multidrug-resistant pathogens. This poses a significant challenge to the current global and national target to reduce neonatal mortality rates. To address these challenges, it is important to employ robust infection prevention practices and continuous antibiotic resistance testing to allow targeted therapy.
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Affiliation(s)
- Mulatu Gashaw
- From the School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Solomon Ali
- Department of Medical Microbiology, Parasitology, and Immunology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Getnet Tesfaw
- From the School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Beza Eshetu
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Netsanet Workneh
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Thomas Seeholzer
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
| | - Guenter Froeschl
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU)
| | - Arne Kroidl
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU)
| | - Andreas Wieser
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU)
- Max von Pettenkofer-Institute (Medical Microbiology), LMU, Munich, Germany
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Koerner R, Bendixen MM, Monk A, Lamberti MF, Lorca GL, Neu J, Parker LA. A Scoping Review of the Oral Microbiome in Preterm Infants. Am J Perinatol 2024; 41:e2990-e3002. [PMID: 37907200 PMCID: PMC11058105 DOI: 10.1055/s-0043-1776344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
The purpose of this scoping review was to examine the oral microbiome composition in preterm infants, sampling and collection methods, as well as exposures associated with oral microbiome composition and health implications. We conducted a scoping review of the literature using the Arskey and O'Malley framework. We identified a total of 13 articles which met our inclusion criteria and purpose of this scoping review. Articles included in this review compared the oral microbiome in preterm infants to term infants, examined alterations to the oral microbiome over time, compared the oral microbiome to different body site microbiomes, and explored associations with clinically relevant covariates and outcomes. Exposures associated with the diversity and composition of the oral microbiome in preterm infants included delivery mode, oral feeding, oropharyngeal care, skin-to-skin care, and antibiotics. Day of life and birth weight were also associated with oral microbiome composition. The oral microbiome may be associated with the composition of the tracheal and gut microbiomes, likely due to their proximity. Alpha and beta diversity findings varied across studies as well as the relative abundance of taxa. This is likely due to the different sampling techniques and timing of collection, as well as the wide range of infant clinical characteristics. Multiple factors may influence the composition of the oral microbiome in preterm infants. However, given the heterogeneity of sampling techniques and results within this review, the evidence is not conclusive on the development as well as short- and long-term implications of the oral microbiome in preterm infants and needs to be explored in future research studies. KEY POINTS: · Day of life is a critical factor in oral microbiome development in preterm infants.. · The oral microbiome may be associated with tracheal and gut microbiome colonization.. · Future research should examine sampling methodology for examining the oral microbiome.. · Future research should explore associations with the oral microbiome and adverse health outcomes..
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Affiliation(s)
- Rebecca Koerner
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Marion M. Bendixen
- Department of Family, Community and Health System Science, University of Florida, Gainesville, Florida
| | - Angela Monk
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Monica F.T. Lamberti
- Department of Microbiology and Cell Science University of Florida, Microbiology and Cell Science, Gainesville, Florida
| | - Graciela L. Lorca
- Department of Microbiology and Cell Science University of Florida, Microbiology and Cell Science, Gainesville, Florida
| | - Josef Neu
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Leslie A. Parker
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
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Miranda S, Harahap A, Husada D, Faramarisa FN. Risk factors of multidrug-resistant organisms neonatal sepsis in Surabaya tertiary referral hospital: a single-center study. BMC Pediatr 2024; 24:153. [PMID: 38424519 PMCID: PMC10902940 DOI: 10.1186/s12887-024-04639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Bacterial organisms causing neonatal sepsis have developed increased resistance to commonly used antibiotics. Antimicrobial resistance is a major global health problem. The spread of Multidrug-Resistant Organisms (MDROs) is associated with higher morbidity and mortality rates. This study aimed to determine the risk factors for developing MDRO neonatal sepsis in the Neonatal Intensive Care Unit (NICU), dr. Ramelan Navy Central Hospital, in 2020-2022. METHODS A cross-sectional study was performed on 113 eligible neonates. Patients whose blood cultures were positive for bacterial growth and diagnosed with sepsis were selected as the study sample. Univariate and multivariate analysis with multiple logistic regression were performed to find the associated risk factors for developing multidrug-resistant organism neonatal sepsis. A p-value of < 0.05 was considered significant. RESULTS Multidrug-resistant organisms were the predominant aetiology of neonatal sepsis (91/113, 80.5%). The significant risk factors for developing MDRO neonatal sepsis were lower birth weight (OR: 1.607, 95% CI: 1.003 - 2.576, p-value: 0.049), history of premature rupture of the membrane (ProM) ≥ 18 (OR: 3.333, 95% CI: 2.047 - 5.428, p-value < 0.001), meconium-stained amniotic fluid (OR: 2.37, 95% CI: 1.512 - 3.717, p-value < 0.001), longer hospital stays (OR: 5.067, 95% CI: 2.912 - 8.815, p-value < 0.001), lower Apgar scores (OR: 2.25, 95% CI: 1.442 - 3.512, p-value < 0.001), and the use of respiratory support devices, such as invasive ventilation (OR: 2.687, 95% CI: 1.514 - 4.771, p-value < 0.001), and non-invasive ventilation (OR: 2, 95% CI: 1.097 - 3.645, p-value: 0.024). CONCLUSIONS Our study determined various risk factors for multidrug-resistance organism neonatal sepsis and underscored the need to improve infection control practices to reduce the existing burden of drug-resistant sepsis. Low-birth-weight, a maternal history of premature rupture of the membrane lasting more than 18 hours, meconium-stained amniotic fluid, longer hospital stays, a low Apgar score, and the use of ventilators were the risk factors for developing drug-resistant neonatal sepsis.
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Affiliation(s)
- Stefani Miranda
- Department of Child Health, Faculty of Medicine, Hang Tuah University/dr. Ramelan Navy Central Hospital, Jalan Gadung No. 1, Surabaya, East Java, 60244, Indonesia.
| | - Aminuddin Harahap
- Department of Child Health, dr. Ramelan Navy Central Hospital, Jalan Gadung No.1, Surabaya, East Java, 60244, Indonesia
| | - Dominicus Husada
- Department of Child Health, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo Academic General Hospital, Jalan Prof. Dr. Moestopo 6-8, Surabaya, East Java, 60286, Indonesia
| | - Fara Nayo Faramarisa
- Department of Clinical Microbiology, dr. Ramelan Navy Central Hospital, Jalan Gadung No.1, Surabaya, East Java, 60244, Indonesia
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Sherif M, Abera D, Desta K. Prevalence and antibiotic resistance pattern of bacteria from sepsis suspected neonates at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. BMC Pediatr 2023; 23:575. [PMID: 37980512 PMCID: PMC10656775 DOI: 10.1186/s12887-023-04399-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Neonatal sepsis is the major cause of neonatal mortality and morbidity, especially in low and middle-income countries. Continuous monitoring of pathogens and their antibiotic resistance pattern is crucial for managing neonatal sepsis. This study aimed to determine neonatal sepsis due to bacteria, antibiotic resistance patterns, associated risk factors and patient outcomes at St. Paul's Hospital Millennium Medical College. METHOD An institutional-based cross-sectional study was conducted on 400 neonates suspected of sepsis at St. Paul's Hospital Millennium Medical College from March 2020 to July 2020. A questionnaire was used to collect socio-demographic information, clinical parameters and potential risk factors from study participants. About 2ml of blood was drawn aseptically and inoculated into Tryptone Soya Broth at the patient's bedside. Bacterial identification was performed by using standard microbiological techniques. The disk diffusion method was used to determine the antibiotic susceptibility patterns of each isolated bacteria. Data entry and analysis were done using Statistical Package for Social Sciences (SPSS) version 20 software. Bivariate and multivariable logistic regressions were used to assess associated risk factors of neonatal sepsis. A p-value less than 0.05 was considered statically significant with a 95% confidence interval. RESULTS The overall prevalence of neonatal septicemia was 21% (84/400). Of these, 67 (79.8%) and 17 (20.2%) were gram-negative and gram-positive bacteria, respectively. Klebsiella spp, 37 (44%), E. coli 19 (21.6%) and Coagulase negative Staphylococci 13 (15.47%) were the leading cause of neonatal sepsis. Ciprofloxacin and amikacin were the most effective antibiotics for gram-negative and gram-positive bacteria. Multidrug resistance was observed in 84% of the bacterial isolates. Low birth weight and preterm were associated with neonatal septicemia (AOR = 49.90, 95% CI = 15.14-123.081, P = 0.002) and (AOR = 18.20, 95% CI = 6.835-27.541, P = 0.004) respectively. CONCLUSION Klebsiella spp and E. coli were frequently isolated bacteria in our study. The proportion of multidrug-resistance was significantly high. Most isolated bacteria were resistant to ampicillin, ceftazidime, cefotaxime and gentamycin, which indicates the necessity of continuous evaluation of antibiotic resistance rate.
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Affiliation(s)
- Merema Sherif
- St Paul hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dessie Abera
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Kassu Desta
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Yang Q, Kamat S, Mohamed N, Valdez RR, Lin S, Su M, Quintana A, Kiratisin P, Rodríguez-Zulueta AP, Brink A. Antimicrobial Susceptibility Among Gram-Negative Isolates in Pediatric Patients in Latin America, Africa-Middle East, and Asia From 2016-2020 Compared to 2011-2015: Results From the ATLAS Surveillance Study. J Pediatric Infect Dis Soc 2023; 12:459-470. [PMID: 37643742 PMCID: PMC10797666 DOI: 10.1093/jpids/piad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) data in the pediatric population are limited, particularly in developing countries. This study assessed the AMR profile and key resistance phenotypes and genotypes for Gram-negative bacteria (GNB) isolates collected as part of the Antimicrobial Testing Leadership and Surveillance program from pediatric patients in Latin America, Africa-Middle East, and Asia in 2016-2020 versus 2011-2015. METHODS Minimum inhibitory concentrations by broth microdilution methodology were interpreted per the Clinical and Laboratory Standards Institute. European Committee on Antimicrobial Susceptibility Testing breakpoints were used for interpreting colistin activity. β-lactamase genes were screened by polymerase chain reaction and sequencing. RESULTS For Acinetobacter baumannii, low susceptibility (<60.0%) was observed for all antimicrobials, except colistin (≥92.9%), across regions and year periods. Ceftazidime-avibactam, amikacin, colistin, and meropenem were mostly active (78.6%-100.0%) against Enterobacter cloacae, Escherichia coli, and Klebsiella pneumoniae. For Pseudomonas aeruginosa, susceptibility to ceftazidime-avibactam, amikacin, and colistin was ≥85.9%. Among resistance phenotypes, carbapenem-resistant (CR, ≥44.8%) and difficult-to-treat resistant (DTR, ≥37.1%) rates were the highest in A. baumannii. A consistent increase in CR and DTR K. pneumoniae was noted across regions over time. Extended-spectrum β-lactamases (ESBL)-producing K. pneumoniae (32.6%-55.6%) were more frequent than ESBL-producing E. coli (25.3%-37.1%). CTX-M was the dominant ESBL among Enterobacterales. NDM-positive Enterobacterales species and VIM-positive P. aeruginosa were identified across regions. CONCLUSIONS This study identified high susceptibility to few agents for key GNB in pediatric patients. Continued surveillance of resistance phenotypes and genotypes at regional levels may help to guide appropriate treatment decisions.
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Affiliation(s)
- Qiwen Yang
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | - Ming Su
- Pfizer Ltd., Shanghai, China
| | | | - Pattarachai Kiratisin
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Adrian Brink
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Lima CSSDC, Lima HAR, Silva CSDAGE. Late-onset neonatal infections and bacterial multidrug resistance. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2022068. [PMID: 37255111 DOI: 10.1590/1984-0462/2023/41/2022068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This study aims to describe bacterial and antimicrobial sensibilities in late-onset healthcare-associated infections (HAIs) with laboratory confirmation in a Neonatal Intensive Care Unit (NICU) of a public hospital in Ceará. METHODS This was a cross-sectional study conducted from January 2013 to December 2017. The bacterial types involved in late-onset HAIs, their sensitivity to antimicrobials, and their multidrug resistance were evaluated. The latter was classified according to the criteria revised by the Pan-American Health Organization as multidrug resistance (MDR), extended drug resistance (XDR), or pandrug resistance (PDR). The description of the variables was performed through proportions and frequency distribution depicted in tables. RESULTS Of the 427 patients with late-onset HAIs, 47 (11.0%) had bacterial infections confirmed by blood cultures, and 7 (14.9%) had infections caused by MDR bacteria. Among the types of bacteria, 26 (55.3%) were Gram-negative bacteria, and 21 (44.7%) were Gram-positive bacteria. Among the Gram-negative bacteria, 92.3% (n=24) showed resistance to more than one antimicrobial, especially to ampicillin (81.2%), cefepime (33.1%), gentamicin (19.4%), and piperacillin/tazobactam (17.2%). Among the MDR ones, three cases had Klebsiella pneumoniae, and three had Pseudomonas aeruginosa, classified as two MDR and one XDR, and three XDR, respectively. Gram-positive resistance to penicillin was the most common one (80.0%), and approximately half of the strains being resistant to oxacillin. Susceptibility was high to vancomycin (97.5%), but one microorganism was resistant to oxacillin and vancomycin. CONCLUSIONS The emergence of MDR strains is a reality in NICUs, carrying the risk of therapeutic failure and requiring continuous prevention protocols aimed at minimizing the risks of contamination by bacteria with high morbidity and mortality.
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Affiliation(s)
| | - Hermano Alexandre Rocha Lima
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Community Health, Federal University of Ceará, Fortaleza, CE, Brazil
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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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Majigo M, Makupa J, Mwazyunga Z, Luoga A, Kisinga J, Mwamkoa B, Kim S, Joachim A. Bacterial Aetiology of Neonatal Sepsis and Antimicrobial Resistance Pattern at the Regional Referral Hospital, Dar es Salam, Tanzania; A Call to Strengthening Antibiotic Stewardship Program. Antibiotics (Basel) 2023; 12:antibiotics12040767. [PMID: 37107129 PMCID: PMC10135403 DOI: 10.3390/antibiotics12040767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
The diagnosis of neonatal sepsis in lower-income countries is mainly based on clinical presentation. The practice necessitates empirical treatment with limited aetiology and antibiotic susceptibility profile knowledge, prompting the emergence and spread of antimicrobial resistance. We conducted a cross-sectional study to determine the aetiology of neonatal sepsis and antimicrobial resistance patterns. We recruited 658 neonates admitted to the neonatal ward with signs and symptoms of sepsis and performed 639 automated blood cultures and antimicrobial susceptibility testing. Around 72% of the samples were culture positive; Gram-positive bacteria were predominantly isolated, contributing to 81%. Coagulase-negative Staphylococci were the most isolates, followed by Streptococcus agalactiae. Overall, antibiotic resistance among Gram-positive pathogens ranged from 23% (Chloramphenicol) to 93% (Penicillin) and from 24.7% (amikacin) to 91% (ampicillin) for Gram-negative bacteria. Moreover, about 69% of Gram-positive and 75% of Gram-negative bacteria were multidrug-resistant (MDR). We observed about 70% overall proportion of MDR strains, non-significantly more in Gram-negative than Gram-positive pathogens (p = 0.334). In conclusion, the pathogen causing neonatal sepsis in our setting exhibited a high resistance rate to commonly used antibiotics. The high rate of MDR pathogens calls for strengthening antibiotic stewardship programs.
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Affiliation(s)
- Mtebe Majigo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Jackline Makupa
- Medipeace Global Health, Dar es Salaam P.O. Box 77978, Tanzania
| | - Zivonishe Mwazyunga
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Anna Luoga
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Julius Kisinga
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Bertha Mwamkoa
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Sukyung Kim
- Medipeace Global Health, Dar es Salaam P.O. Box 77978, Tanzania
| | - Agricola Joachim
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
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de Souza ZN, de Moura DF, de Almeida Campos LA, Córdula CR, Cavalcanti IMF. Antibiotic resistance profiles on pathogenic bacteria in the Brazilian environments. Arch Microbiol 2023; 205:185. [PMID: 37043091 DOI: 10.1007/s00203-023-03524-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
The present study aimed to elaborate a review of multidrug-resistant (MDR) bacteria in soil, food, aquatic environments, cattle, poultry, and swine farms in Brazil. Initially, the literature database for published papers from 2012 to 2023 was Scientific Electronic Library Online (SciELO), U.S. National Library of Medicine (PubMed), and Google Scholar, through the descriptors: antimicrobial resistance, resistance profile, multidrug resistance, environmental bacteria, and pathogenic bacteria. The studies demonstrated the prevalence of pathogenic and resistant bacteria in environments that favor their rapid dissemination. Bacteria of medical importance, such as Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Listeria monocytogenes, Salmonella spp., Shigella spp., Vibrio spp., were present in samples from animal farms and foods, including cheese and milk, urban aquatic environments, hospital effluents, and shrimp farms. Studies suggested that important bacteria have been disseminated through different niches with easy contact with humans, animals, and food, demonstrating the danger of the emergence of increasingly difficult conditions for treating and controlling these infections. Thus, better understanding and characterizing the resistance profiles of bacteria in these regions, mainly referring to MDR bacteria, can help develop solutions to prevent the progression of this public health problem.
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Affiliation(s)
- Zion Nascimento de Souza
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Danielle Feijó de Moura
- Laboratory of Microbiology and Immunology, Academic Center of Vitória (CAV), Federal University of Pernambuco (UFPE), Rua do Alto do Reservatório s/n, Bela Vista, Vitória de Santo Antão, Pernambuco, 55608-680, Brazil
| | - Luís André de Almeida Campos
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Carolina Ribeiro Córdula
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil
| | - Isabella Macário Ferro Cavalcanti
- Keizo Asami Institute (iLIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, 50670-901, Brazil.
- Laboratory of Microbiology and Immunology, Academic Center of Vitória (CAV), Federal University of Pernambuco (UFPE), Rua do Alto do Reservatório s/n, Bela Vista, Vitória de Santo Antão, Pernambuco, 55608-680, Brazil.
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Dutra Lima DM, Rezende RV, Oliveira Diniz LM, Anchieta LM, Maia de Castro Romanelli R. Evaluation of antimicrobial consumption in the neonatal population undergoing to stewardship programs: A systematic review Antimicrobial consumption in neonatal population. J Hosp Infect 2023; 135:106-118. [PMID: 36958700 DOI: 10.1016/j.jhin.2023.03.011] [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: 12/22/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The indiscriminate antimicrobials use in neonatal sepsis treatment contributes to abusive consumption and optimize prescription programs are encouraged as way to reduce the inappropriate use. Thus, the objective was to evaluate the impact of intervention programs for adequate antimicrobial use (Antimicrobial Stewardship Programs - ASP) in consumption measurements of such drugs in neonatology. METHODS The search for articles was performed in electronic databases and manual search for citations in publications initially identified. Electronic databases searched were BVS, Cochrane Library, Embase, MEDLINE/PubMed, SciELO, Scopus and Web of Science. There was no date or period limit for including of articles. The PICO question was defined as populations of neonates admitted to neonatal intensive care units (NICU) (P) undergoing an intervention program to optimize antimicrobial therapy (I) in relation to neonates not exposed to the program (C) and the outcome obtained in antimicrobials consumption (O). RESULTS The initial search in databases resulted in 1223 articles. Articles were screened and sixteen original studies related to subject were selected, which conducted a quantitative approach to antimicrobials consumption for population of interest. Most articles used days of therapy (DOT) as the main measure of antimicrobial consumption and have had a high-quality rating by Newcastle Ottawa scale (NOS). All studies were carried out in local hospitals at a single-centre and most ones in high-income countries. CONCLUSION Of all studies resulting from search, few evaluated antimicrobial consumption in Neonatology. New studies are needed, and DOT proved to be the most adequate metric to measure consumption.
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Affiliation(s)
- Dalila Maria Dutra Lima
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Belo Horizonte, MG, Brazil.
| | | | - Lilian Martins Oliveira Diniz
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil.
| | - Lêni Márcia Anchieta
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Unidade Neonatal, Belo Horizonte, MG, Brazil.
| | - Roberta Maia de Castro Romanelli
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Comissão de Controle e Infecção Hospitalar, Belo Horizonte, MG, Brazil.
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11
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Patry A, Bothorel P, Labrunie A, Renesme L, Lehours P, Benard M, Dubois D, Ponthier L, Meyer S, Norbert K, Villeneuve L, Jouvencel P, Leysenne D, Chainier D, Luce S, Grélaud C, Ploy MC, Bedu A, Garnier F. Dynamics of the digestive acquisition of bacterial carriage and integron presence by French preterm newborns according to maternal colonization: The DAIR3N multicentric study. Front Microbiol 2023; 14:1148319. [PMID: 36998410 PMCID: PMC10043237 DOI: 10.3389/fmicb.2023.1148319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/21/2023] [Indexed: 03/15/2023] Open
Abstract
ObjectivesThe study aimed to describe the dynamics and risk factors of Gram-negative bacteria (GNB) acquisition in preterm infants.MethodsThis prospective multicenter French study included mothers hospitalized for preterm delivery and their newborns, followed until hospital discharge. Maternal feces and vaginal fluids at delivery, and neonatal feces from birth to discharge were tested for cultivable GNB, potential acquired resistance, and integrons. The primary outcome was the acquisition of GNB and integrons in neonatal feces, and their dynamics, evaluated by survival analysis using the actuarial method. Risk factors were analyzed using Cox models.ResultsTwo hundred thirty-eight evaluable preterm dyads were included by five different centers over 16 months. GNB were isolated in 32.6% of vaginal samples, with 15.4% of strains producing extended-spectrum beta-lactamase (ESBL) or hyperproducing cephalosporinase (HCase), and in 96.2% of maternal feces, with 7.8% ESBL-GNB or HCase-GNB. Integrons were detected in 40.2% of feces and 10.6% of GNB strains. The mean (SD) length of stay of newborns was 39.5 (15.9) days; 4 died in the hospital. At least one infection episode occurred in 36.1% of newborns. The acquisition of GNB and integrons was progressive from birth to discharge. At discharge, half of newborns had ESBL-GNB or HCase-GNB, independently favored by a premature rupture of membranes (Hazard Ratio (HR), 3.41, 95% confidence interval (CI), 1.71; 6.81), and 25.6% had integrons (protective factor: multiple gestation, HR, 0.367, 95% CI, 0.195; 0.693).ConclusionIn preterm newborns, the acquisitions of GNB, including resistant ones, and integrons are progressive from birth to discharge. A premature rupture of membranes favored the colonization by ESBL-GNB or Hcase-GNB.
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Affiliation(s)
- Alice Patry
- INSERM UMR, Limoges University, Limoges University Hospital, Limoges, France
| | - Philippe Bothorel
- Department of Pediatrics, Mother-Child Hospital, Limoges University Hospital, Limoges, France
| | - Anaïs Labrunie
- Epidemiology, Biostatistics, and Research Methodology Centre (CEBIMER), Limoges University Hospital, Limoges, France
| | - Laurent Renesme
- Department of Pediatrics, Neonatology and Maternity Unit, Pellegrin University Hospital, Bordeaux, France
| | - Philippe Lehours
- Bacteriology Laboratory, Pellegrin University Hospital, Bordeaux, France
| | - Melinda Benard
- Department of Pediatrics and Neonatology, CHU Toulouse, Toulouse, France
| | - Damien Dubois
- Bacteriology and Hygiene Department, Federative Institute of Biology, CHU Toulouse University Hospital, Toulouse, France
| | - Laure Ponthier
- Department of Pediatrics, Mother-Child Hospital, Limoges University Hospital, Limoges, France
| | - Sylvain Meyer
- INSERM UMR, Limoges University, Limoges University Hospital, Limoges, France
| | | | | | - Philippe Jouvencel
- Department of Pediatrics and Neonatology, « Côte Basque » Hospital, Bayonne, France
| | - David Leysenne
- Microbiology Laboratory, « Côte Basque » Hospital, Bayonne, France
| | - Delphine Chainier
- INSERM UMR, Limoges University, Limoges University Hospital, Limoges, France
| | - Sandrine Luce
- Epidemiology, Biostatistics, and Research Methodology Centre (CEBIMER), Limoges University Hospital, Limoges, France
| | - Carole Grélaud
- INSERM UMR, Limoges University, Limoges University Hospital, Limoges, France
| | - Marie-Cecile Ploy
- INSERM UMR, Limoges University, Limoges University Hospital, Limoges, France
| | - Antoine Bedu
- Department of Pediatrics, Mother-Child Hospital, Limoges University Hospital, Limoges, France
| | - Fabien Garnier
- INSERM UMR, Limoges University, Limoges University Hospital, Limoges, France
- *Correspondence: Fabien Garnier,
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12
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Zhu M, Wang L, Zhuge Z, Li W, Zheng Y, Mai J, Lin Z, Lin J. Risk Factors Associated with Multi-Drug Resistance in Neonatal Sepsis Caused by Escherichia coli. Infect Drug Resist 2023; 16:2097-2106. [PMID: 37063937 PMCID: PMC10103785 DOI: 10.2147/idr.s403135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/23/2023] [Indexed: 04/18/2023] Open
Abstract
Background and Objective An increasing number of cases of neonatal sepsis due to extended-spectrum beta-lactamase (ESBL)-producing multi-drug resistant (MDR) Escherichia coli (E. coli) have been reported worldwide. The aim of this study was to explore the risk factors associated with ESBL-producing MDR E. coli among neonates with culture-confirmed E. coli sepsis and thereby to help selection of appropriate empirical antibiotics. Patients and Methods All newborn infants with a confirmed pathogen isolated from blood or cerebrospinal fluid (CSF) from 2016 to 2021 were identified and those with E. coli infection were included in this analysis. We compared a group of neonatal patients with ESBL-producing MDR E. coli sepsis (n=69) to a group with ESBL-negative E. coli (n=70) based on antimicrobial susceptibility reports. We used multivariable regression analysis to determine the risk factors associated with ESBL-producing MDR E. coli strains among the neonates with culture-confirmed E. coli sepsis. Results ESBL-producing MDR E. coli sepsis was more common in premature infants and newborns with hospital-acquired late-onset sepsis (HALOS). The mortality rate of neonatal sepsis caused by ESBL-producing E. coli was about twice as that of sepsis caused by ESBL-negative E. coli. Antepartum exposure to cephalosporins (OR=25.191, 95% CI: 3.184-199.326, P<0.01) and parenteral nutrition for more than 1 week (OR=4.495, 95% CI: 2.009-10.055, P<0.01) were independent risk factors for neonatal infection with ESBL-producing stains among infants with E. coli sepsis. Conclusion E. coli remains the most common Gram-negative bacterial pathogen causing neonatal sepsis. A higher proportion of ESBL-producing MDR E. coli is seen in premature infants and those newborns with HALOS and is associated with higher mortality. Antepartum use of cephalosporins and prolonged use of parenteral nutrition may be important factors to consider in the selection of empirical antibiotics for use in neonatal sepsis caused by gram-negative rods prior to the availability of the results of antimicrobial susceptibility.
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Affiliation(s)
- Minli Zhu
- Key Laboratory of Perinatal Medicine of Wenzhou, Department of Neonatology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China
| | - Leying Wang
- Key Laboratory of Perinatal Medicine of Wenzhou, Department of Neonatology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China
| | - Zhangming Zhuge
- Key Laboratory of Perinatal Medicine of Wenzhou, Department of Neonatology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China
| | - Wei Li
- Key Laboratory of Perinatal Medicine of Wenzhou, Department of Neonatology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China
- Zhijin People’s Hospital of Guizhou Province, Guizhou, 552100, People’s Republic of China
| | - Yihui Zheng
- Key Laboratory of Perinatal Medicine of Wenzhou, Department of Neonatology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China
| | - Jingyun Mai
- Key Laboratory of Perinatal Medicine of Wenzhou, Department of Neonatology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China
| | - Zhenlang Lin
- Key Laboratory of Perinatal Medicine of Wenzhou, Department of Neonatology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China
- Zhenlang Lin, Department of Neonatology, the Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China, Tel +86 13806689800, Email
| | - Jing Lin
- Key Laboratory of Perinatal Medicine of Wenzhou, Department of Neonatology, the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Correspondence: Jing Lin, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA, Tel +1-212-241-6186, Fax +1-212534-5207, Email
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13
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Gan MY, Lee WL, Yap BJ, Seethor STT, Greenberg RG, Pek JH, Tan B, Hornik CPV, Lee JH, Chong SL. Contemporary Trends in Global Mortality of Sepsis Among Young Infants Less Than 90 Days: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:890767. [PMID: 35722477 PMCID: PMC9204066 DOI: 10.3389/fped.2022.890767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Current knowledge on the global burden of infant sepsis is limited to population-level data. We aimed to summarize global case fatality rates (CFRs) of young infants with sepsis, stratified by gross national income (GNI) status and patient-level risk factors. Methods We performed a systematic review and meta-analysis on CFRs among young infants < 90 days with sepsis. We searched PubMed, Cochrane Central, Embase, and Web of Science for studies published between January 2010 and September 2019. We obtained pooled CFRs estimates using the random effects model. We performed a univariate analysis at patient-level and a meta-regression to study the associations of gestational age, birth weight, onset of sepsis, GNI, age group and culture-proven sepsis with CFRs. Results The search yielded 6314 publications, of which 240 studies (N = 437,796 patients) from 77 countries were included. Of 240 studies, 99 were conducted in high-income countries, 44 in upper-middle-income countries, 82 in lower-middle-income countries, 6 in low-income countries and 9 in multiple income-level countries. Overall pooled CFR was 18% (95% CI, 17-19%). The CFR was highest for low-income countries [25% (95% CI, 7-43%)], followed by lower-middle [25% (95% CI, 7-43%)], upper-middle [21% (95% CI, 18-24%)] and lowest for high-income countries [12% (95% CI, 11-13%)]. Factors associated with high CFRs included prematurity, low birth weight, age less than 28 days, early onset sepsis, hospital acquired infections and sepsis in middle- and low-income countries. Study setting in middle-income countries was an independent predictor of high CFRs. We found a widening disparity in CFRs between countries of different GNI over time. Conclusion Young infant sepsis remains a major global health challenge. The widening disparity in young infant sepsis CFRs between GNI groups underscore the need to channel greater resources especially to the lower income regions. Systematic Review Registration [www.crd.york.ac.uk/prospero], identifier [CRD42020164321].
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Affiliation(s)
- Ming Ying Gan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Li Lee
- Duke-NUS Medical School, Singapore, Singapore
| | - Bei Jun Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Rachel G Greenberg
- Department of Paediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Jen Heng Pek
- Emergency Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Bobby Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Christoph Paul Vincent Hornik
- Division of Critical Care Medicine, Department of Paediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Jan Hau Lee
- Duke-NUS Medical School, Singapore, Singapore
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shu-Ling Chong
- Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
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14
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Chambers CA, Dadelahi AS, Moley CR, Olson RM, Logue CM, Skyberg JA. Nucleotide receptors mediate protection against neonatal sepsis and meningitis caused by alpha-hemolysin expressing Escherichia coli K1. FASEB J 2022; 36:e22197. [PMID: 35147989 DOI: 10.1096/fj.202101485r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/30/2021] [Accepted: 01/20/2022] [Indexed: 01/15/2023]
Abstract
Neonatal meningitis-associated Escherichia coli (NMEC) is among the leading causes of bacterial meningitis and sepsis in newborn infants. Several virulence factors have been identified as common among NMEC, and have been shown to play an important role in the development of bacteremia and/or meningitis. However, there is significant variability in virulence factor expression between NMEC isolates, and relatively little research has been done to assess the impact of variable virulence factor expression on immune cell activation and the outcome of infection. Here, we investigated the role of NMEC strain-dependent P2X receptor (P2XR) signaling on the outcome of infection in neonatal mice. We found that alpha-hemolysin (HlyA)-expressing NMEC (HlyA+ ) induced robust P2XR-dependent macrophage cell death in vitro, while HlyA- NMEC did not. P2XR-dependent cell death was inflammasome independent, suggesting an uncoupling of P2XR and inflammasome activation in the context of NMEC infection. In vivo inhibition of P2XRs was associated with increased mortality in neonatal mice infected with HlyA+ NMEC, but had no effect on the survival of neonatal mice infected with HlyA- NMEC. Furthermore, we found that P2XR-dependent protection against HlyA+ NMEC in vivo required macrophages, but not neutrophils or NLRP3. Taken together, these data suggest that HlyA+ NMEC activates P2XRs which in turn confers macrophage-dependent protection against infection in neonates. In addition, our findings indicate that strain-dependent virulence factor expression should be taken into account when studying the immune response to NMEC.
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Affiliation(s)
- Catherine A Chambers
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
| | - Alexis S Dadelahi
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
| | - Charles R Moley
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
| | - Rachel M Olson
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
| | - Catherine M Logue
- Department of Population Heath, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Jerod A Skyberg
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
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15
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Thomas R, Ondongo-Ezhet C, Motsoaledi N, Sharland M, Clements M, Velaphi S. Incidence and All-Cause Mortality Rates in Neonates Infected With Carbapenem Resistant Organisms. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.832011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IntroductionMultidrug-resistant, Gram-negative infections, particularly due to carbapenem resistant organisms (CRO), have increased globally. Few studies have reported on the burden of CRO in neonates from low-middle income countries (LMIC). This study aimed to determine the incidence and mortality rates of culture-confirmed Gram-negative infections, with a special focus on CRO in a neonatal unit from a LMIC.Materials and MethodsPositive bacterial cultures from sterile sites of infants admitted in the neonatal unit from the 1st January 2018 to 31st December 2019, were reviewed retrospectively. Type of organism, susceptibility and outcomes were recorded. Data on Gram-negative isolates, including the CRO, were extracted. Rates and outcomes were analysed.ResultsThere were 2219 neonates with organisms isolated from sterile sites (blood and cerebrospinal fluid), accounting for 30% of all admissions, giving a neonatal sepsis incidence of 17.9/1000 patient-days. There was a total of 1746 positive isolates (excluding coagulase negative Staphyloccocus). Of these, 1706 (98%) were isolated from blood, and 40 (2%) from cerebrospinal fluid. Overall, 1188 (68%) were Gram-negative, 371 (21%) Gram-positive and 187 (10.7%) fungal isolates. The common Gram-negatives were Acinetobacter baumannii (526/1188;44%) and Klebsiella pneumoniae (469/1188;40%). Carbapenem resistance was observed in 359 (68%) of the Acinetobacter baumannii (CRAB) and in 103 (18%) of the Enterobacterales (CRE) isolates, with 98% of CRE being Klebsiella pneumoniae (CR-Klebs). Twenty-four (41%) of Pseudomonas species were carbapenem resistant. Overall, carbapenem resistance was seen in 42% of all Gram-negative organisms. The rate of CRAB and CRE were 2.9 and 0.8/1000 patient-days respectively. The overall, all-cause in-hospital mortality rate in infants with Gram-negative isolates was 22%, with higher mortality rate in those infected with CRO compared to non-CRO (34% vs 13%; OR 3.44; 95% CI 2.58–4.60; p < 0.001). The mortality rate in infants with CRE was higher than those with CRAB (48% vs 33%; OR 1.85; 95% CI 1.18–2.89; p = 0.007).ConclusionWe observed a high incidence of positive cultures from sterile sites. The common organisms isolated were Gram-negatives, and among these carbapenem resistance was high and was associated with high mortality. Mortality was higher in infants with CRE compared to those with CRAB.
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16
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Zhang Y, Cao B, Cao W, Miao H, Wu L. Clinical Characteristics and Death Risk Factors of Severe Sepsis in Children. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4200605. [PMID: 35111234 PMCID: PMC8803443 DOI: 10.1155/2022/4200605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/18/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
Sepsis is a systemic inflammatory response syndrome caused by viral infection. The circulatory dysfunction caused by sepsis is also called septic shock or septic shock. The main characteristics are rapid onset, rapid changes, and involvement. Multiple organs in the body make diagnosis difficult, which seriously threatens the survival of patients. As many as one million people worldwide die every year because of SIRS, it is also the leading cause of death among children in hospital ICUs. This article is aimed at studying the clinical characteristics of severe sepsis in children and the risk factors for death. Based on the analysis of the pathogenesis of sepsis and the treatment of septic shock, 65 cases of children with PICU sepsis admitted to a hospital were selected. Data, to study its clinical characteristics and risk factors for death. The results of the study showed that despite the interaction among the removal factors of the three indexes of serum lactic acid value, PCIS level, and the number of organs involved in MODS, they are still related to the mortality of children with severe sepsis.
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Affiliation(s)
- Ying Zhang
- Department of Neonatology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, China
| | - Buqing Cao
- Department of Laboratory Medicine, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi 530001, China
| | - Weihong Cao
- Department of Pediatrics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, Hubei 443000, China
| | - Hongjun Miao
- Emergency Department, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Lihui Wu
- Emergency Department, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
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Shadbolt R, We MLS, Kohan R, Porter M, Athalye-Jape G, Nathan E, Shrestha D, Strunk T. Neonatal Staphylococcus Aureus Sepsis: a 20-year Western Australian experience. J Perinatol 2022; 42:1440-1445. [PMID: 35752689 PMCID: PMC9616716 DOI: 10.1038/s41372-022-01440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to characterise neonatal Staphylococcus aureus (SA) sepsis in Western Australia (WA) between 2001 and 2020 at the sole tertiary neonatal intensive care unit (NICU), examine risk factors for sepsis in the cohort, and compare short- and long-term outcomes to control infants without any sepsis. METHODS Retrospective cohort study at the Neonatal Directorate at King Edward Memorial Hospital (KEMH) and Perth Children's Hospital, using electronic databases and patient medical records. RESULTS The overall incidence of SA sepsis was 0.10 per 1000 live births (62/614207). From 2001 to 2010 the incidence was 0.13/1000 live births, reducing to 0.07/1000 live births from 2011 to 2020. SA was most frequently isolated from endotracheal aspirates, and infants with SA sepsis had longer median duration of ventilatory support than those without any sepsis (31 days vs 18 days respectively, p < 0.001). In our cohort, SA sepsis was associated with worse neurodevelopmental outcomes compared to infants without any sepsis. CONCLUSIONS The incidence of neonatal SA sepsis has reduced over the last 20 years, suggesting potential effectiveness of the preventative interventions implemented. Endotracheal tube (ETT) colonisation and prolonged ventilation may be under-recognised as potential sources of SA infection. Our study suggests SA sepsis may negatively impact neurodevelopmental outcomes.
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Affiliation(s)
- Rachel Shadbolt
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia, Perth, WA Australia
| | - Michael Lee Shee We
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia, Perth, WA Australia
| | - Rolland Kohan
- Centre for Neonatal Research and Education and Division of Paediatrics, Medical School, University of Western Australia, Perth, WA, Australia. .,Telethon Kids Institute, Perth, WA, Australia. .,Neonatal Directorate, Child and Adolescent Health Service, Perth, WA, Australia.
| | - Michelle Porter
- grid.2824.c0000 0004 0589 6117Microbiology Department, PathWest Laboratories, Perth, WA Australia
| | - Gayatri Athalye-Jape
- grid.1012.20000 0004 1936 7910Centre for Neonatal Research and Education and Division of Paediatrics, Medical School, University of Western Australia, Perth, WA Australia ,grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, WA Australia ,Neonatal Directorate, Child and Adolescent Health Service, Perth, WA Australia
| | - Elizabeth Nathan
- grid.415259.e0000 0004 0625 8678Division of Obstetrics and Gynaecology, University of Western Australia and the Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, WA Australia
| | - Damber Shrestha
- Neonatal Directorate, Child and Adolescent Health Service, Perth, WA Australia
| | - Tobias Strunk
- grid.1012.20000 0004 1936 7910Centre for Neonatal Research and Education and Division of Paediatrics, Medical School, University of Western Australia, Perth, WA Australia ,grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, WA Australia ,Neonatal Directorate, Child and Adolescent Health Service, Perth, WA Australia
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Yu Y, Dong Q, Li S, Qi H, Tan X, Ouyang H, Hu J, Li W, Wang T, Yang Y, Gong X, He X, Chen P. Etiology and clinical characteristics of neonatal sepsis in different medical setting models: A retrospective multi-center study. Front Pediatr 2022; 10:1004750. [PMID: 36275054 PMCID: PMC9581286 DOI: 10.3389/fped.2022.1004750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE General hospitals admit lower gestational age neonates than maternal and child health care centers, therefore associated with a higher morbidity and mortality. This study aimed to assess the etiology and clinical characteristics of neonatal sepsis in different medical setting models. METHODS Neonates admitted to 5 tertiary medical centers, including one national general hospital, two maternal and child health care hospitals and two regional general hospitals, in central-south China with culture-proven sepsis between January 2010 and December 2019 were included in the study. We compared maternal and neonatal characteristics, pathogen distribution, treatment and neonatal outcomes among 3 different medical setting models in this retrospective cohort. RESULTS We identified 757 episodes of culture-proven sepsis in 757 neonates. The predominant pathogens were coagulase-negative staphylococci, Klebsiella pneumoniae, Escherichia coli and Group B streptococci. A total of 683 neonates with detailed information were involved in further comparison; 54.6% were from the national general hospital, 35.9% were from the maternal and child health care hospital, and 9.5% were from the regional general hospital. Neonates in national and regional general hospitals had significantly lower gestational age and birthweight (P < 0.001). Patterns of pathogen distribution were different among these medical setting models. Early-onset sepsis was more common in maternal and child health care hospitals (61.4% vs. 42.1% vs. 46.7%, P < 0.001), while hospital-acquired late-onset sepsis was more common in national and regional general hospitals (32.7% vs. 33.3% vs. 11.4%, P < 0.001). The proportion of complications or comorbidities of neonates in maternal and child health care hospitals were significantly lower than neonates in national and regional general hospitals (P < 0.001). The case fatality rate was significantly higher in regional general hospitals (10.8% vs. 3.2% vs. 0.8%, P = 0.001). CONCLUSION We report distinct patterns of clinical characteristics, pathogens and outcomes in patient subgroups with neonatal sepsis from national general hospital, maternal and child health care hospital and regional general hospital. It might have some implications for improvement of prevention, management and empirical antibiotic use in neonatal sepsis in different setting models, especially in resource-limited settings from middle and low-income countries.
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Affiliation(s)
- Yuanqiang Yu
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, China
| | - Qingyi Dong
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Suping Li
- Department of Neonatology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Huaxue Qi
- Department of Neonatology, Changsha Hospital for Maternal / Child Health Care, Changsha, China
| | - Xin Tan
- Department of Pediatrics, The First Hospital of Changsha, Changsha, China
| | - Hong Ouyang
- Department of Neonatology, Xiangtan Central Hospital, Xiangtan, China
| | - Jintao Hu
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen Li
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tao Wang
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yonghui Yang
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyun Gong
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaori He
- Department of Neonatology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Pingyang Chen
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, China
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Hocking L, Ali GC, d’Angelo C, Deshpande A, Stevenson C, Virdee M, Guthrie S. A rapid evidence assessment exploring whether antimicrobial resistance complicates non-infectious health conditions and healthcare services, 2010-20. JAC Antimicrob Resist 2021; 3:dlab171. [PMID: 34806009 PMCID: PMC8599069 DOI: 10.1093/jacamr/dlab171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Antimicrobial resistance (AMR) is one of the greatest public health threats at this time. While there is a good understanding of the impacts of AMR on infectious diseases, an area of less focus is the effects AMR may be having on non-communicable health conditions (such as cancer) and healthcare services (such as surgery). Therefore, this study aimed to explore what impact AMR is currently having on non-communicable health conditions, or areas of health services, where AMR could be a complicating factor impacting on the ability to treat the condition and/or health outcomes. To do this, a rapid evidence assessment of the literature was conducted, involving a systematic approach to searching and reviewing the evidence. In total, 101 studies were reviewed covering surgery, organ transplants, cancer, ICUs, diabetes, paediatric patients, immunodeficiency conditions, liver and kidney disease, and physical trauma. The results showed limited research in this area and studies often use a selective population, making the results difficult to generalize. However, the evidence showed that for all health conditions and healthcare service areas reviewed, at least one study demonstrated a higher risk of death for patients with resistant infections, compared with no or drug-susceptible infections. Poor health outcomes were also associated with resistant infections in some instances, such as severe sepsis and failure of treatments, as well as a greater need for invasive medical support. While there are gaps in the evidence base requiring further research, efforts are also needed within policy and practice to better understand and overcome these challenges.
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Affiliation(s)
- Lucy Hocking
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, UK
- Corresponding author. E-mail:
| | | | | | | | | | - Mann Virdee
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, UK
| | - Susan Guthrie
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, UK
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Garduno A, Martín-Loeches I. Efficacy and appropriateness of novel antibiotics in response to antimicrobial-resistant Gram-negative bacteria in patients with sepsis in the ICU. Expert Rev Anti Infect Ther 2021; 20:513-531. [PMID: 34727820 DOI: 10.1080/14787210.2022.1999804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There is an ever-increasing range of antibiotic-resistant pathogens that have led to higher community-acquired infections, and substantial mortality rates in critically ill patients. AREAS COVERED We have critically appraised available evidence through a structured literature review, investigating effective empiric antibiotic administration and appropriateness on outcomes of critically ill patients with an increased risk of developing resistant pathogens. The use of new antibiotics should be determined based on relevant knowledge of their spectrum and properties to provide effective mode of action for critically ill patients. EXPERT OPINION Restricting severely ill patients access to new broad-spectrum empirical drugs is not the answer. Rather there should be a focus on identifying host response to infection to differentiate between colonization or contamination and true infection, and the sensitivity to antibiotics used in the intensive care unit (ICU). Management relies on adequate antibiotic administration, the ability to monitor response, and facilitate the cessation of antibiotic treatment. The major determinant of patient success in a patient with a severe infection is the 'right' antibiotic or complementary course of treatment. As an overarching criterion, the following 3 appropriate "Ds" should be considered: Dosing, Duration and De-escalation to empirically assess the right antibiotic optimal antimicrobial selection.
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Affiliation(s)
- Alexis Garduno
- Department of Clinical Medicine, Intensive Care Translational Research, Trinity College Dublin
| | - Ignacio Martín-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, (Ireland)
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21
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Branstetter JW, Barker L, Yarbrough A, Ross S, Stultz JS. Challenges of Antibiotic Stewardship in the Pediatric and Neonatal Intensive Care Units. J Pediatr Pharmacol Ther 2021; 26:659-668. [PMID: 34588929 DOI: 10.5863/1551-6776-26.7.659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 07/01/2021] [Indexed: 12/14/2022]
Abstract
The goals of antimicrobial stewardship programs (ASPs) are to optimize antimicrobial prescribing habits in order to improve patient outcomes, reduce antimicrobial resistance, and reduce hospital costs. Multiple society-endorsed guidelines and government policies reinforce the importance of ASP implementation. Effective antimicrobial stewardship can impact unique patients, hospitals, and societal antibiotic-resistance burden. The role and subsequent success of these programs has largely been reported in the adult population. Pediatric and neonatal intensive care units present unique challenges for traditional antimicrobial stewardship approaches. The purpose of this review article is to explore the challenges of appropriate antibiotic use in the pediatric and neonatal intensive care units and to summarize strategies ASPs can use to overcome these challenges. These problems include non-specific disease presentations, limited evidence for definitive treatment durations in many pediatric infections, fewer pediatric-trained infectious disease physicians, and applicability of intensive laboratory obtainment, collection, and interpretation. Additionally, many ASP implementation studies evaluating the efficacy of ASPs exclude the PICU and NICU. Areas of focus for pediatric ASPs should likely include appropriate antibiotic initiation, appropriate antibiotic duration, and appropriate antibiotic de-escalation.
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22
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Moghnieh RA, Moussa JA, Aziz MA, Matar GM. Phenotypic and genotypic characterisation of cephalosporin-, carbapenem- and colistin-resistant Gram-negative bacterial pathogens in Lebanon, Jordan and Iraq. J Glob Antimicrob Resist 2021; 27:175-199. [PMID: 34481122 DOI: 10.1016/j.jgar.2021.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 12/15/2022] Open
Abstract
Antimicrobial resistance (AMR) is a worldwide health concern that continues to escalate. A PubMed literature search identified articles from January 2015-August 2020 reviewing cephalosporin-, carbapenem- and colistin-resistant Gram-negative bacteria (GNB) in Lebanon, Jordan and Iraq, specifically focused on three main pathogens, namely Acinetobacter spp., Enterobacteriaceae (i.e. Escherichia coli and Klebsiella spp.) and Pseudomonas aeruginosa. Sixty-seven relevant articles published within the past 5 years highlighting trends in AMR in Lebanon, Jordan and Iraq were included. Increased resistance to carbapenems in Acinetobacter spp. isolates was observed in Lebanon, Jordan and Iraq; colistin resistance remained relatively low. Studies on Enterobacteriaceae isolates were more varied, with high rates of carbapenem and cephalosporin resistance and lower levels of colistin resistance in Lebanon. Studies from Iraq found high cephalosporin and colistin resistance along with increased susceptibility to carbapenems. In Jordan, most studies recorded high resistance to cephalosporins along with high susceptibility to carbapenems and colistin. Studies on P. aeruginosa isolates were limited: most isolates in Lebanon were carbapenem-resistant and colistin-susceptible; studies in Iraq showed varying levels of resistance to carbapenems and cephalosporins with high susceptibility to colistin; and studies in Jordan found varying levels of susceptibility to carbapenems, cephalosporins and colistin. The most commonly observed resistance mechanisms in GNB were genetic modifications causing increased expression of antimicrobial-inactivating enzymes and decreased permeability. Overall, this review highlights the concerning rise in AMR and the need for improved understanding of the resistance mechanisms to better inform healthcare providers when recommending treatment for patients in this region.
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Affiliation(s)
- Rima A Moghnieh
- Department of Internal Medicine, Division of Infectious Diseases, Makassed General Hospital, Beirut, Lebanon; Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon; Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.
| | | | | | - Ghassan M Matar
- Department of Experimental Pathology, Immunology & Microbiology, Center for Infectious Diseases Research, WHO Collaborating Center for Reference & Research on Bacterial Pathogens, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Solomon S, Akeju O, Odumade OA, Ambachew R, Gebreyohannes Z, Van Wickle K, Abayneh M, Metaferia G, Carvalho MJ, Thomson K, Sands K, Walsh TR, Milton R, Goddard FGB, Bekele D, Chan GJ. Prevalence and risk factors for antimicrobial resistance among newborns with gram-negative sepsis. PLoS One 2021; 16:e0255410. [PMID: 34343185 PMCID: PMC8330902 DOI: 10.1371/journal.pone.0255410] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Newborn sepsis accounts for more than a third of neonatal deaths globally and one in five neonatal deaths in Ethiopia. The first-line treatment recommended by WHO is the combination of gentamicin with ampicillin or benzylpenicillin. Gram-negative bacteria (GNB) are increasingly resistant to previously effective antibiotics. OBJECTIVES Our goal was to estimate the prevalence of antibiotic-resistant gram-negative bacteremia and identify risk factors for antibiotic resistance, among newborns with GNB sepsis. METHODS At a tertiary hospital in Ethiopia, we enrolled a cohort pregnant women and their newborns, between March and December 2017. Newborns who were followed up until 60 days of life for clinical signs of sepsis. Among the newborns with clinical signs of sepsis, blood samples were cultured; bacterial species were identified and tested for antibiotic susceptibility. We described the prevalence of antibiotic resistance, identified newborn, maternal, and environmental factors associated with multidrug resistance (MDR), and combined resistance to ampicillin and gentamicin (AmpGen), using multivariable regression. RESULTS Of the 119 newborns with gram-negative bacteremia, 80 (67%) were born preterm and 82 (70%) had early-onset sepsis. The most prevalent gram-negative species were Klebsiella pneumoniae 94 (79%) followed by Escherichia coli 10 (8%). Ampicillin resistance was found in 113 cases (95%), cefotaxime 104 (87%), gentamicin 101 (85%), AmpGen 101 (85%), piperacillin-tazobactam 47 (39%), amikacin 10 (8.4%), and Imipenem 1 (0.8%). Prevalence of MDR was 88% (n = 105). Low birthweight and late-onset sepsis (LOS) were associated with higher risks of AmpGen-resistant infections. All-cause mortality was higher among newborns treated with ineffective antibiotics. CONCLUSION There was significant resistance to current first-line antibiotics and cephalosporins. Additional data are needed from primary care and community settings. Amikacin and piperacillin-tazobactam had lower rates of resistance; however, context-specific assessments of their potential adverse effects, their local availability, and cost-effectiveness would be necessary before selecting a new first-line regimen to help guide clinical decision-making.
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Affiliation(s)
- Semaria Solomon
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Oluwasefunmi Akeju
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Oludare A. Odumade
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rozina Ambachew
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Kimi Van Wickle
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mahlet Abayneh
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gesit Metaferia
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Maria J. Carvalho
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Department of Medical Sciences, Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Kathryn Thomson
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Kirsty Sands
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Timothy R. Walsh
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Department of Zoology, Ineos Oxford Institute of Antimicrobial Research, University of Oxford, Oxford, United Kingdom
| | - Rebecca Milton
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | | | - Delayehu Bekele
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Grace J. Chan
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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First Report of Multi-resistant Escherichia fergusonii Isolated from Children Under Two Months of Age in Intensive Care Unit. Jundishapur J Microbiol 2021. [DOI: 10.5812/jjm.116000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Gram-negative bacilli are primarily responsible for the most common pediatric infections. Frequently, Escherichia fergusonii is identified as E. coli because of its close genetic proximity. Objectives: We aimed at the isolation and identification of multi-resistant strains of E. fergusonii, affecting children under two months of age. Methods: Strains were isolated from infectious processes and were identified phenotypically and molecularly. The microdilution method (MicroScan, autoSCAN-4) and the disk diffusion method (modified Kirby Bauer) were used to analyze antibiotic susceptibility. Results: Strains isolated were multi-resistant. Molecular identification provided the correct taxonomic assignment. Escherichia fergusonii strains were wrongly identified as E. coli with the phenotypic identification method. In addition, Pseudomonas aeruginosa and Klebsiella pneumoniae were identified. The best sensitivity results were obtained with Ceftazidime/avibactam and ceftolozane/tazobactam. Conclusions: We provided the first report of isolation and identification of multi-resistant E. fergusonii strains affecting children under two months of age in a neonatal intensive care unit.
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Mukherjee S, Mitra S, Dutta S, Basu S. Neonatal Sepsis: The Impact of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae. Front Med (Lausanne) 2021; 8:634349. [PMID: 34179032 PMCID: PMC8225938 DOI: 10.3389/fmed.2021.634349] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/26/2021] [Indexed: 01/12/2023] Open
Abstract
The convergence of a vulnerable population and a notorious pathogen is devastating, as seen in the case of sepsis occurring during the first 28 days of life (neonatal period). Sepsis leads to mortality, particularly in low-income countries (LICs) and lower-middle-income countries (LMICs). Klebsiella pneumoniae, an opportunistic pathogen is a leading cause of neonatal sepsis. The success of K. pneumoniae as a pathogen can be attributed to its multidrug-resistance and hypervirulent-pathotype. Though the WHO still recommends ampicillin and gentamicin for the treatment of neonatal sepsis, K. pneumoniae is rapidly becoming untreatable in this susceptible population. With escalating rates of cephalosporin use in health-care settings, the increasing dependency on carbapenems, a "last resort antibiotic," has led to the emergence of carbapenem-resistant K. pneumoniae (CRKP). CRKP is reported from around the world causing outbreaks of neonatal infections. Carbapenem resistance in CRKP is largely mediated by highly transmissible plasmid-encoded carbapenemase enzymes, including KPC, NDM, and OXA-48-like enzymes. Further, the emergence of a more invasive and highly pathogenic hypervirulent K. pneumoniae (hvKP) pathotype in the clinical context poses an additional challenge to the clinicians. The deadly package of resistance and virulence has already limited therapeutic options in neonates with a compromised defense system. Although there are reports of CRKP infections, a review on neonatal sepsis due to CRKP/ hvKP is scarce. Here, we discuss the current understanding of neonatal sepsis with a focus on the global impact of the CRKP, provide a perspective regarding the possible acquisition and transmission of the CRKP and/or hvKP in neonates, and present strategies to effectively identify and combat these organisms.
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Affiliation(s)
- Subhankar Mukherjee
- Division of Bacteriology, Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shravani Mitra
- Division of Bacteriology, Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shanta Dutta
- Division of Bacteriology, Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Sulagna Basu
- Division of Bacteriology, Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata, India
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A Systemic Review and Meta-analysis of the Leading Pathogens Causing Neonatal Sepsis in Developing Countries. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6626983. [PMID: 34195273 PMCID: PMC8203353 DOI: 10.1155/2021/6626983] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 05/13/2021] [Indexed: 11/17/2022]
Abstract
Background Neonatal sepsis is one of the major public health problems globally, particularly, in developing countries. Klebsiella, Staphylococcus aureus, Coagulase-negative Staphylococcus, and Escherichia coli are the common pathogens for neonatal sepsis in developing countries. However, the pooled estimate of common pathogens causing neonatal sepsis in developing countries is still unknown. Therefore, this study is aimed at computing the pooled proportion of the leading cause of pathogens for neonatal sepsis in developing countries. Methods We strictly followed the Preferred Reporting Items for Systemic Reviews and Meta-analysis guidelines to report this systematic review and meta-analysis. PubMed, Cochrane Library, Web of Science, CINAHL, Science Direct, and other search engines such as Google Scholar, Africa Journals Online, and Hinari were used to obtain studies related to the leading cause of pathogens for neonatal sepsis in developing countries. The search was done from October 1 to December 30, 2018, by considering both published and gray literature. Studies were evaluated based on the PRISMA guideline checklist by using their titles, abstracts, and full texts. Studies were extracted using Microsoft Excel spreadsheets, and STATA software version 14 was used to analyze data. Heterogeneity between studies was checked based on Cochran's Q-test and the corresponding I2 statistic test. Results The pooled prevalence of the leading cause of pathogens of neonatal sepsis in developing countries were Klebsiella (26.36%), Staphylococcus aureus (23.22%), Coagulase-negative Staphylococcus (23.22%), and Escherichia coli (15.30%). Common pathogens were varied across regions; for instance, pooled isolated Coagulase-negative Staphylococcus was 25.98% in Africa, 16.62% in Asia, and 36.71% in Latin America, and Klebsiella was 29.80% in Africa, 23.21% in Asia, and 22.00% in Latin America. Also, Staphylococcus aureus was 27.87% in Africa and 18.28% in Asia, and Escherichia coli was 22.97% in Asia and 9.43% in Africa. Conclusions This study highlights that the more prevalent common isolated pathogens in developing countries were Klebsiella, Staphylococcus aureus, Coagulase-negative Staphylococcus, and Escherichia coli, Klebsiella, and Staphylococcus aureus pathogens were predominantly high in Africa as compared to other Asian and Latin American countries. At the same time, Coagulase-negative Staphylococcus was more prevalent in Latin America compared to other regions. Escherichia coli is more dominant in Asia as compared to Africa and Latin America.
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Antimicrobial use for treatment of healthcare-associated infections and bacterial resistance in a reference neonatal unit. J Pediatr (Rio J) 2021; 97:329-334. [PMID: 32592659 PMCID: PMC9432030 DOI: 10.1016/j.jped.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The use of broad-spectrum antimicrobials, such as third and fourth-generation, are responsible for emergence of multidrug-resistant microorganisms in neonatal units. Furthermore, antimicrobial daily doses are not standardized in neonatology. This study aimed to investigate the association between the use of antimicrobial broad spectrum to bacterial sensitivity profile in a referral unit of neonatal progressive care. METHODS This is a cohort study conducted in a referral neonatal progressive care unit from January 2008 to December 2016. The data of all hospitalized neonates was collected daily. The infection criteria used were the standardized national criteria, based on definitions of Center for Diseases Control and Prevention. In this study, the use of antimicrobials was evaluated as antimicrobial-day (ATM-day) and the ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was also calculated. The study was approved by the Institutional Review Board of the Universidade Federal de Minas Gerais (ETIC 312/08 e CAAE 58973616.2.0000.5149). RESULTS From 2008 to 2016, 2751 neonates were hospitalized, corresponding to 60,656 patient-days. The ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was 1,3 in the first period and 4,3 in the second period (p=0,005). CONCLUSION It was observed that use of broad-spectrum antimicrobials, especially those with coverage for Gram-negative bacteria, was associated with an increase of multidrug-resistant bacteria.
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Oo NAT, Edwards JK, Pyakurel P, Thekkur P, Maung TM, Aye NSS, Nwe HM. Neonatal Sepsis, Antibiotic Susceptibility Pattern, and Treatment Outcomes among Neonates Treated in Two Tertiary Care Hospitals of Yangon, Myanmar from 2017 to 2019. Trop Med Infect Dis 2021; 6:tropicalmed6020062. [PMID: 33924746 PMCID: PMC8167801 DOI: 10.3390/tropicalmed6020062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022] Open
Abstract
Neonatal sepsis is a leading cause of morbidity and mortality in developing countries. This study aimed to assess the proportion of culture-confirmed sepsis, bacteriological pathogen profile, culture report turnaround times, antibiotic susceptibility patterns, and treatment outcomes of all with neonatal sepsis admitted in two tertiary care hospitals in Yangon, Myanmar, 2017–2019. This was a cross sectional study utilizing a standardized electronic database and paper-based records. Bacteriological profiles and associated factors were analyzed with descriptive statistics and Poisson Regression. Of those with suspected sepsis, 42% were bacteriologically confirmed and 74% of confirmed sepsis was resistant to at least first-line antibiotics. Neonates with late onset sepsis (LOS) (aPR: 1.2 (95% CI: 1.1–1.4, p = 0.008)) were more likely to have bacteriologically confirmed sepsis (45%) versus early onset sepsis (38%). Gram-negative organisms were most commonly isolated (63%), associated with multidrug-resistant organisms and with a high case-fatality rate (64%). These findings suggest that enhanced national guidance regarding infection control and prevention, antibiotic stewardship, and first-line antibiotic choices need to be provided. The link between LOS with infection and prevention protocols needs to be further explored in this context to decrease sepsis risk, neonatal mortality, and reduce further antimicrobial resistance.
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Affiliation(s)
- Nan Aye Thida Oo
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar;
- Correspondence: ; Tel.: +95-9-5126148
| | - Jeffrey K. Edwards
- Department of Global Health, University of Washington, Seattle, WA 98195, USA;
| | - Prajjwal Pyakurel
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan 56700, Nepal;
| | - Pruthu Thekkur
- Centre for Operational Research, International Union against Tuberculosis and Lung Disease (The Union), 68 Boulevard Saint Michel, 75006 Paris, France;
| | - Thae Maung Maung
- Department of Medical Research, Ministry of Health and Sports, Yangon 11191, Myanmar;
| | - Nant San San Aye
- Neonatal Intensive Care Unit, Central Women Hospital, Yangon 11121, Myanmar;
| | - Hla Myat Nwe
- Department of Neonatology, Yangon Children Hospital, Yangon 11191, Myanmar;
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Antibiotic Resistance Patterns of Bacterial Isolates from Neonatal Sepsis Patients at University Hospital of Leipzig, Germany. Antibiotics (Basel) 2021; 10:antibiotics10030323. [PMID: 33808878 PMCID: PMC8003699 DOI: 10.3390/antibiotics10030323] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/19/2022] Open
Abstract
Neonatal sepsis caused by resistant bacteria is a worldwide concern due to the associated high mortality and increased hospitals costs. Bacterial pathogens causing neonatal sepsis and their antibiotic resistance patterns vary among hospital settings and at different points in time. This study aimed to determine the antibiotic resistance patterns of pathogens causing neonatal sepsis and to assess trends in antibiotic resistance. The study was conducted among neonates with culture proven sepsis at the University Hospital of Leipzig between November 2012 and September 2020. Blood culture was performed by BacT/ALERT 3D system. Antimicrobial susceptibility testing was done with broth microdilution method based on ISO 20776-1 guideline. Data were analyzed by SPSS version 20 software. From 134 isolates, 99 (74%) were gram positive bacteria. The most common gram positive and gram negative bacteria were S. epidermidis, 51 (38%) and E. coli, 23 (17%), respectively. S. epidermidis showed the highest resistance to penicillin G and roxithromycin (90% each) followed by cefotaxime, cefuroxime, imipenem, oxacillin, and piperacillin-tazobactam (88% each), ampicillin-sulbactam (87%), meropenem (86%), and gentamicin (59%). Moreover, S. epidermidis showed raising levels of resistance to amikacin, gentamicin, ciprofloxacin, levofloxacin, moxifloxacin, and cotrimoxazol. Gram positive bacteria showed less or no resistance to daptomycin, linezolid, teicoplanin, and vancomycin. E. coli showed the highest resistance to ampicillin (74%) followed by ampicillin-sulbactam (52%) and piperacillin (48%). Furthermore, increasing levels in resistance to ampicillin, ampicillin-sulbactam, piperacillin, and cefuroxime were observed over the years. Encouragingly, E. coli showed significantly declining trends of resistance to ciprofloxacin and levofloxacin, and no resistance to amikacin, colistin, fosfomycin, gentamicin, imipenem, piperacillin-tazobactam, and tobramycin. In conclusion, this study demonstrates that gram positive bacteria were the leading causes of neonatal sepsis. Bacterial isolates were highly resistant to first and second-line empiric antibiotics used in this hospital. The high levels of antibiotic resistance patterns highlight the need for modifying empiric treatment regimens considering the most effective antibiotics. Periodic surveillance in hospital settings to monitor changes in pathogens, and antibiotic resistance patterns is crucial in order to implement optimal prevention and treatment strategies.
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Salama K, Gad A, El Tatawy S. Sepsis profile and outcome of preterm neonates admitted to neonatal intensive care unit of Cairo University Hospital. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2021. [PMCID: PMC7916998 DOI: 10.1186/s43054-021-00055-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background This study demonstrates the experience of the neonatal intensive care unit (NICU) of a tertiary referral center in Egypt in management of prematures with neonatal sepsis. This retrospective study included preterm neonates admitted to NICU with clinical and/or laboratory diagnosis of sepsis. Blood culture was done followed by antimicrobial susceptibility testing for positive cases. Neonates with sepsis were classified into early onset sepsis (EOS) and late onset sepsis (LOS). Hematological scoring system (HSS) for detection of sepsis was calculated. Results The study included 153 cases of neonatal sepsis; 63 (41.2%) EOS and 90 (58.8%) LOS. The majority of the neonates had very low or moderately low birth weight (90.9%). All neonates received first-line antibiotics in the form of ampicillin-sulbactam, and gentamicin. Second-line antibiotics were administered to 133 neonates (86.9%) as vancomycin and imipenem-cilastatin. Mortalities were more common among EOS group (p < 0.017). Positive blood cultures were detected in 61 neonates (39.8%) with a total number of 66 cultures. The most commonly encountered organisms were Klebsiella MDR and CoNS (31.8% each). Klebsiella MDR was the most predominant organism in EOS (28.9%), while CoNS was the most predominant in LOS (39.2%) The detected organisms were divided into 3 families; Enterobacteriaceae, non-fermenters, and Gram-positive family. There 3 families were 100% resistant to ampicillin. The highest sensitivity in Enterobacteriaceae and Non-fermenters was for colistin and polymyxin-B. An HSS of 3–8 had a sensitivity and specificity of 62.3% and 57.6%, respectively for diagnosis of culture-proven sepsis. Conclusion Neonatal sepsis was encountered in 21.5% of admitted preterm neonates; LOS was more common (58.8%). Mortality was 51.6%. Klebsiella MDR and CoNS were the most commonly encountered organisms in both EOS and LOS. The isolated families were 100% resistant to ampicillin. The hematological scoring system (HSS) showed limited sensitivity for detection of sepsis.
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Beverly RL, Woonnimani P, Scottoline BP, Lueangsakulthai J, Dallas DC. Peptides from the Intestinal Tract of Breast Milk-Fed Infants Have Antimicrobial and Bifidogenic Activity. Int J Mol Sci 2021; 22:ijms22052377. [PMID: 33673498 PMCID: PMC7956819 DOI: 10.3390/ijms22052377] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
For bioactive milk peptides to be relevant to infant health, they must be released by gastrointestinal proteolysis and resist further proteolysis until they reach their site of activity. The intestinal tract is the likeliest site for most bioactivities, but it is currently unknown whether bioactive milk peptides are present therein. The purpose of the present study was to identify antimicrobial and bifidogenic peptides in the infant intestinal tract. Milk peptides were extracted from infant intestinal samples, and the activities of the bulk peptide extracts were determined by measuring growth of Escherichia coli, Staphylococcus aureus, and Bifidobacterium longum spp. infantis after incubation with serial dilutions. The peptide profiles of active and inactive samples were determined by peptidomics analysis and compared to identify candidate peptides for bioactivity testing. We extracted peptides from 29 intestinal samples collected from 16 infants. Five samples had antimicrobial activity against S. aureus and six samples had bifidogenic activity for B. infantis. We narrowed down a list of 6645 milk peptides to 11 candidate peptides for synthesis, of which 6 fully inhibited E. coli and S. aureus growth at concentrations of 2500 and 3000 µg/mL. This study provides evidence for the potential bioactivity of milk peptides in the infant intestinal tract.
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Affiliation(s)
- Robert L. Beverly
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA; (J.L.); (D.C.D.)
- Correspondence: ; Tel.: +1-217-2278-2672
| | - Prajna Woonnimani
- College of Agricultural Sciences, Oregon State University, Corvallis, OR 97331, USA;
| | - Brian P. Scottoline
- Division of Neonatology, School of Medicine, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Jiraporn Lueangsakulthai
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA; (J.L.); (D.C.D.)
| | - David C. Dallas
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA; (J.L.); (D.C.D.)
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Sumitro KR, Utomo MT, Widodo ADW. Neutrophil-to-Lymphocyte Ratio as an Alternative Marker of Neonatal Sepsis in Developing Countries. Oman Med J 2021; 36:e214. [PMID: 33437537 PMCID: PMC7786268 DOI: 10.5001/omj.2021.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives We sought to analyze the neutrophil-to-lymphocyte ratio (NLR) as an alternative marker of neonatal sepsis. Methods In this cross-sectional study, we undertook consecutive sampling in all inborn neonates admitted to the Neonatal Intensive Care Unit with clinical manifestations of neonatal sepsis. Neonates with congenital anomalies and referred neonates were excluded. Complete blood count, C-reactive protein (CRP), and blood culture were carried out as the septic workup examinations based on the local Clinical Practical Guidelines. NLR is obtained by dividing the absolute count of neutrophils from lymphocytes manually. A cut-off value of NLR is obtained using a receiver operating characteristic curve. Results The median NLR value of the 104 neonates who met the inclusion and exclusion criteria was 3.63 (2.39–6.12). Neonates with NLR of 2.12 have the area under the curve of 0.630 (95% confidence interval (CI): 0.528–0.741) and 0.725 (95% CI: 0.636–0.814) when combined with CRP = 2.70 mg/dL. Neonates with NLR ≥ 2.12 in clinical neotnatal sepsis had almost double the risk of providing positive blood culture results (relative risk = 1.867, 95% CI: 1.077–3.235; p = 0.011). Conclusions NLR, calculated from complete blood count, can be used as an alternative marker of easy and relatively inexpensive neonatal sepsis, especially in developing countries, and detection of proven neonatal sepsis to be better when combined with CRP.
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Affiliation(s)
- Khadijah Rizky Sumitro
- Department of Child Health, Faculty of Medicine, Universitas Airlangga- Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Martono Tri Utomo
- Department of Child Health, Faculty of Medicine, Universitas Airlangga- Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Agung Dwi Wahyu Widodo
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga- Dr. Soetomo Hospital, Surabaya, Indonesia
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Epidemiology of Neonatal Septicemia in the Era of Extended Spectrum Beta-Lactamase Producing Bacteria: A Prospective Study in a Tertiary Referral Hospital. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.3.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A surge of extended spectrum beta lactamase (ESBL)-producers is being witnessed in the neonatal intensive care units (NICUs). Hence, the present study was conducted to analyze both the bacteriological profile and clinical outcome of neonatal septicemia, and to identify the prevalence and sensitivity of the incriminated pathogens with emphasis on ESBL producers. We conducted this study in the NICU of a tertiary referral hospital over a one-year-period. All neonates with a clinical diagnosis of sepsis (371 participants) were enrolled. Blood cultures were performed, and subsequent cultures of various specimens were done according to clinical suspicion. Antibiotic susceptibility tests were carried out and the neonates were followed up until discharge. Out of the 371 neonates, 137 (37%) had positive blood culture results, of whom 49% died versus only 7.7% of neonates with a negative blood culture (P-value< 0.0001). Low birth weight, prematurity, and the duration of hospital stay were considered as positive blood culture risk factors. Meanwhile, among 85 cultures that yielded Gram-negative pathogens, 16 isolates were identified as ESBL producers with Klebsiella pneumoniae being the most frequently encountered isolate (19.7%). Of the neonates inflicted with ESBL-sepsis, 62.5% died versus 11.6% with non-ESBL sepsis. Judicious antibiotic stewardship together with infection control practices can hinder the spread of drug-resistant pathogens. This is especially compelling among the vulnerable population of the NICUs. Meanwhile, rapid diagnostic modalities and timely antibiotic susceptibility tests are of paramount importance to initiate appropriate therapy which can hugely impact the clinical prognosis.
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Khalil N, Blunt HB, Li Z, Hartman T. Neonatal early onset sepsis in Middle Eastern countries: a systematic review. Arch Dis Child 2020; 105:639-647. [PMID: 31969351 DOI: 10.1136/archdischild-2019-317110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Early onset neonatal sepsis (EOS) accounts for a significant portion of neonatal mortality, which accounts for 46% of global under five child mortality. OBJECTIVE This systematic review studies the bacterial aetiology of EOS in the Middle East, susceptibility patterns to recommended empirical antibiotic therapy and whether this differs between high-income and middle-income countries in the region. METHODS Articles were collected from Medline, Web of Science, the Cochrane Library and Index Medicus for the Eastern Mediterranean Region. The articles included in our systematic review met the following criteria: published after January 2000, data relevant to the Middle East, data specific for early onset sepsis, no language restriction. Data on aetiology and susceptibility were extracted from prospective and retrospective studies. Risk of bias was assessed using the Newcastle-Ottawa Scale. This study focused on EOS but does include data regarding neonatal late-onset sepsis antibiotic susceptibility. The data regarding coagulase-negative Staphylococcus species were excluded from final analysis, as possible contaminants. The protocol for this systematic review was registered on PROSPERO: CRD42017060662. RESULTS 33 articles from 10 countries were included in the analysis. There were 2215 cases of culture-positive EOS, excluding coagulase-negative Staphylococcus. In middle-income countries, Klebsiella species (26%), Staphylococcus aureus (17%) and Escherichia coli (16%) were the most common pathogens, in contrast to group B Streptococcus (26%), E. coli (24%) and Klebsiella (9%) in high-income countries. Overall susceptibility to ampicillin/gentamicin and third-generation cephalosporin were 40% and 37%, respectively, in middle-income countries versus 93% and 91%, respectively, in high-income countries. CONCLUSIONS EOS in middle-income countries was more likely to be due to Gram-negative pathogens and less likely to be susceptible to empirical antibiotic therapy. This has important public health implications regarding neonatal mortality in the Middle East region.
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Affiliation(s)
- Nadim Khalil
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA .,Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Heather B Blunt
- Biomedical Libraries, Dartmouth College, Hanover, New Hampshire, USA
| | - Zhongze Li
- Biostatistics Shared Resource, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Tyler Hartman
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Gao XY, Dai YH, Fan DZ, Xie XY, Yang GD, Xiao X, Gao PM. The association between the microbes in the tracheobronchial aspirate fluid and bronchopulmonary dysplasia in preterm infants. Pediatr Neonatol 2020; 61:306-310. [PMID: 32144075 DOI: 10.1016/j.pedneo.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/30/2019] [Accepted: 12/26/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The study aimed to evaluate the association between microbes in the lower respiratory tract (LRT) and the srisk for severe bronchopulmonary dysplasia (sBPD) in premature infants. METHODS We conducted a retrospective, single-center study of preterm infants who were admitted to the neonatal intensive care unit (NICU) of Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, China, between January 2015 and December 2017. The microbes in the LRT were screened by using tracheobronchial aspirate fluid (TAF) culture. RESULTS One hundred and fifty-five infants were included in the analysis. Among 155 infants, 41 were diagnosed with sBPD, and 114 were diagnosed without sBPD. There were significant differences between infants with and without sBPD in regard to birth weight (BW), gestational age (GA), the duration of endotracheal ventilation and supplemental oxygen. The incidence of retinopathy (ROP) and sepsis was higher in the sBPD infants than in the infants without sBPD. There was a difference in the detection rate of Gram-negative bacteria (GNB) between the two groups. Stenotrophomonas maltophilia and Klebsiella pneumoniae were mainly detected in TAF. CONCLUSIONS The LRT microbes were different between infants with and without sBPD, and GNB is more frequently detected in sBPD infants.
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Affiliation(s)
- Xiao-Yan Gao
- Department of Neonatology, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, No. 11 Renmin West Road, Chancheng District, Foshan, 528000, China
| | - Yi-Heng Dai
- Department of Neonatology, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, No. 11 Renmin West Road, Chancheng District, Foshan, 528000, China
| | - Da-Zhi Fan
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, No. 11 Renmin West Road, Chancheng District, Foshan, 528000, China
| | - Xiao-Yun Xie
- Department of Neonatology, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, No. 11 Renmin West Road, Chancheng District, Foshan, 528000, China
| | - Guang-di Yang
- Department of Neonatology, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, No. 11 Renmin West Road, Chancheng District, Foshan, 528000, China
| | - Xin Xiao
- Department of Neonatology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510120, China.
| | - Ping-Ming Gao
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, No. 11 Renmin West Road, Chancheng District, Foshan, 528000, China.
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Monteiro-Neto V, de Souza CD, Gonzaga LF, da Silveira BC, Sousa NCF, Pontes JP, Santos DM, Martins WC, Pessoa JFV, Carvalho Júnior AR, Almeida VSS, de Oliveira NMT, de Araújo TS, Maria-Ferreira D, Mendes SJF, Ferro TAF, Fernandes ES. Cuminaldehyde potentiates the antimicrobial actions of ciprofloxacin against Staphylococcus aureus and Escherichia coli. PLoS One 2020; 15:e0232987. [PMID: 32407399 PMCID: PMC7224478 DOI: 10.1371/journal.pone.0232987] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/24/2020] [Indexed: 12/17/2022] Open
Abstract
Escherichia coli and Staphylococcus aureus are important agents of urinary tract infections that can often evolve to severe infections. The rise of antibiotic-resistant strains has driven the search for novel therapies to replace the use or act as adjuvants of antibiotics. In this context, plant-derived compounds have been widely investigated. Cuminaldehyde is suggested as the major antimicrobial compound of the cumin seed essential oil. However, this effect is not fully understood. Herein, we investigated the in silico and in vitro activities of cuminaldehyde, as well as its ability to potentiate ciprofloxacin effects against S. aureus and E. coli. In silico analyses were performed by using different computational tools. The PASS online and SwissADME programmes were used for the prediction of biological activities and oral bioavailability of cuminaldehyde. For analysis of the possible toxic effects and the theoretical pharmacokinetic parameters of the compound, the Osiris, SwissADME and PROTOX programmes were used. Estimations of cuminaldehyde gastrointestinal absorption, blood brain barrier permeability and skin permeation by using SwissADME; and drug likeness and score by using Osiris, were also evaluated The in vitro antimicrobial effects of cuminaldehyde were determined by using microdilution, biofilm formation and time-kill assays. In silico analysis indicated that cuminaldehyde may act as an antimicrobial and as a membrane permeability enhancer. It was suggested to be highly absorbable by the gastrointestinal tract and likely to cross the blood brain barrier. Also, irritative and harmful effects were predicted for cuminaldehyde if swallowed at its LD50. Good oral bioavailability and drug score were also found for this compound. Cuminaldehyde presented antimicrobial and anti-biofilm effects against S. aureus and E. coli.. When co-incubated with ciprofloxacin, it enhanced the antibiotic antimicrobial and anti-biofilm actions. We suggest that cuminaldehyde may be useful as an adjuvant therapy to ciprofloxacin in S. aureus and E. coli-induced infections.
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Affiliation(s)
- Valério Monteiro-Neto
- Programa de Pós-graduação, Universidade Ceuma, São Luís, MA, Brazil
- Universidade Federal do Maranhão, São Luís, MA, Brazil
| | | | | | - Bruna C. da Silveira
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil
- Faculdades Pequeno Príncipe, Curitiba, PR, Brazil
| | | | | | - Deivid M. Santos
- Programa de Pós-graduação, Universidade Ceuma, São Luís, MA, Brazil
| | | | | | | | | | - Natália M. T. de Oliveira
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil
- Faculdades Pequeno Príncipe, Curitiba, PR, Brazil
| | | | - Daniele Maria-Ferreira
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil
- Faculdades Pequeno Príncipe, Curitiba, PR, Brazil
| | | | - Thiago A. F. Ferro
- Programa de Pós-graduação, Universidade Ceuma, São Luís, MA, Brazil
- * E-mail: (ESF); (TAFF)
| | - Elizabeth S. Fernandes
- Programa de Pós-graduação, Universidade Ceuma, São Luís, MA, Brazil
- Universidade Federal do Maranhão, São Luís, MA, Brazil
- Faculdades Pequeno Príncipe, Curitiba, PR, Brazil
- * E-mail: (ESF); (TAFF)
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Dou L, Meng D, Dong Y, Chen L, Han X, Fan D, Dong H. Dosage regimen and toxicity risk assessment of linezolid in sepsis patients. Int J Infect Dis 2020; 96:105-111. [PMID: 32251797 DOI: 10.1016/j.ijid.2020.03.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 02/19/2020] [Accepted: 03/23/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Significant alterations in the pharmacokinetic characteristics of linezolid are often seen in sepsis patients. The study aimed to identify a target pharmacokinetics/pharmacodynamics (PK/PD) index of the efficacy of linezolid treatment, and to estimate the optimum dosage regimen of linezolid in sepsis patients. METHODS The PK data were modeled using the one-compartment model, which determined the target PK/PD index for successful treatment by logistic regression. The probability of thrombocytopenia was identified by establishing a logistic model. Different dosing regimens were evaluated using Monte Carlo simulation. RESULTS Reaching 80% bacterial eradication required an AUC24/MIC of 100, which defined the therapeutic target. The proposed regimen to attain a cumulative fraction of response ≥80% was 800 mg/12 h (safety probability 66.8%) for sepsis patients with normal renal function or mild kidney damage. By contrast, the target cumulative fraction of response was attained with a standard dosing regimen in sepsis patients on continuous renal replacement therapy [600 mg/12 h (safety probability 49.7%)]. CONCLUSIONS This study identified different dosing strategies to achieve target linezolid PK/PD values according to whether sepsis patients were treated with continuous renal replacement therapy. Due to the high incidence of thrombocytopenia in sepsis patients on continuous renal replacement therapy, therapeutic drug monitoring should be encouraged for optimizing linezolid exposure in sepsis patients.
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Affiliation(s)
- Linjie Dou
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dandan Meng
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yalin Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Lihong Chen
- Department of International Medical Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xinyan Han
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Di Fan
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Haiyan Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
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Lai JCY, Svedin P, Ek CJ, Mottahedin A, Wang X, Levy O, Currie A, Strunk T, Mallard C. Vancomycin Is Protective in a Neonatal Mouse Model of Staphylococcus epidermidis-Potentiated Hypoxic-Ischemic Brain Injury. Antimicrob Agents Chemother 2020; 64:e02003-19. [PMID: 31818825 PMCID: PMC7038267 DOI: 10.1128/aac.02003-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/06/2019] [Indexed: 12/27/2022] Open
Abstract
Infection is correlated with increased risk of neurodevelopmental sequelae in preterm infants. In modeling neonatal brain injury, Toll-like receptor agonists have often been used to mimic infections and induce inflammation. Using the most common cause of bacteremia in preterm infants, Staphylococcus epidermidis, we present a more clinically relevant neonatal mouse model that addresses the combined effects of bacterial infection together with subsequent hypoxic-ischemic brain insult. Currently, there is no neuroprotective treatment for the preterm population. Hence, we tested the neuroprotective effects of vancomycin with and without adjunct therapy using the anti-inflammatory agent pentoxifylline. We characterized the effects of S. epidermidis infection on the inflammatory response in the periphery and the brain, as well as the physiological changes in the central nervous system that might affect neurodevelopmental outcomes. Intraperitoneal injection of postnatal day 4 mice with a live clinical isolate of S. epidermidis led to bacteremia and induction of proinflammatory cytokines in the blood, as well as transient elevations of neutrophil and monocyte chemotactic cytokines and caspase 3 activity in the brain. When hypoxia-ischemia was induced postinfection, more severe brain damage was observed in infected animals than in saline-injected controls. This infection-induced inflammation and potentiated brain injury was inoculum dose dependent and was alleviated by the antibiotic vancomycin. Pentoxifylline did not provide any additional neuroprotective effect. Thus, we show for the first time that live S. epidermidis potentiates hypoxic-ischemic preterm brain injury and that peripheral inhibition of inflammation with antibiotics, such as vancomycin, reduces the extent of brain injury.
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Affiliation(s)
- Jacqueline C Y Lai
- Center for Perinatal Medicine and Health, Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Pernilla Svedin
- Center for Perinatal Medicine and Health, Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - C Joakim Ek
- Center for Perinatal Medicine and Health, Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Amin Mottahedin
- Center for Perinatal Medicine and Health, Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Xiaoyang Wang
- Center for Perinatal Medicine and Health, Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Andrew Currie
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia
- Medical, Molecular and Forensic Sciences, Murdoch University, Perth, Western Australia, Australia
| | - Tobias Strunk
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia
- Neonatal Directorate, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
| | - Carina Mallard
- Center for Perinatal Medicine and Health, Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Touati A, Mairi A. Epidemiology of carbapenemase-producing Enterobacterales in the Middle East: a systematic review. Expert Rev Anti Infect Ther 2020; 18:241-250. [PMID: 32043905 DOI: 10.1080/14787210.2020.1729126] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: The Middle East is actually recognized as endemic for carbapenemases-producing Enterobacterales (CPE) including at least OXA-48-like and NDM-like.Areas covered: We performed a search of PubMed and Scopus using relevant keywords. We included peer-reviewed articles published only in English reporting any data on carbapenemase-producing bacteria from Middle East countries. The last literature search was performed on 26 October 2019. All studies describing carbapenemase-producing Enterobacterales isolated from humans, animals or environmental samples from the Middle East were included.Expert opinion: The Middle-East is considered an endemic region for CPE strains and the extensive international exchange could facilitate the spread of CPE from these countries to other parts of the Globe in which the prevalence of the CPE is low. The expansion of the Middle East conflict has been associated with the rapid collapse of the existing health care system of the concerned countries. Considering that Millions of refugees have fled their country, they could introduce these CPE strains in countries with low endemicity. In conclusion, the health care system actors should take in a count the endemicity of CPE in these countries and develop local surveillance programs to limit the spread of these MDR bacteria.
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Affiliation(s)
- Abdelaziz Touati
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia, Algérie
| | - Assia Mairi
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia, Algérie
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Wattal C, Kler N, Oberoi JK, Fursule A, Kumar A, Thakur A. Neonatal Sepsis: Mortality and Morbidity in Neonatal Sepsis due to Multidrug-Resistant (MDR) Organisms: Part 1. Indian J Pediatr 2020; 87:117-121. [PMID: 31828600 PMCID: PMC6974503 DOI: 10.1007/s12098-019-03106-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/22/2019] [Indexed: 01/23/2023]
Abstract
The major causes of emergence of multidrug-resistant organisms (MDRO) in neonatal sepsis include empiric antibiotic prescriptions, unregulated use of over-the-counter drugs, high incidence of healthcare associated infections (HAI), lack of awareness about antibiotic stewardship program and under staffing of neonatal intensive care units. In general, mortality due to MDRO sepsis is significantly higher as compared to non MDRO sepsis. Reported morbidities include prolonged use of total parenteral nutrition, need for central venous catheter, invasive ventilation, increased duration of hospital stay and neurologic sequelae.
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Affiliation(s)
- Chand Wattal
- Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India.
| | - Neelam Kler
- Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
| | - J K Oberoi
- Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anurag Fursule
- Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anup Kumar
- Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anup Thakur
- Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
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You T, Zhang H, Guo L, Ling KR, Hu XY, Li LQ. Differences in clinical characteristics of early- and late-onset neonatal sepsis caused by Klebsiella pneumoniae. Int J Immunopathol Pharmacol 2020; 34:2058738420950586. [PMID: 32816593 PMCID: PMC7444108 DOI: 10.1177/2058738420950586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 07/27/2020] [Indexed: 01/09/2023] Open
Abstract
To identify differences in the clinical characteristics of early- and late-onset sepsis (EOS and LOS) caused by Klebsiella pneumoniae (K. pneumoniae) and to describe the risk factors for multidrug-resistant K. pneumoniae (MDR-KP) infection. Infants with K. pneumoniae-induced sepsis who were admitted to a children's Hospital between Jan 2000 and Dec 2019 were included. All infants were divided into EOS and LOS groups, as well as MDR-KP and non-MDR-KP groups. Demographics, clinical characteristics, and risk factors were compared between the two groups. One hundred eighty infants (66 with EOS and 114 with LOS) were further analyzed, accounting for 36.8% of sepsis cases caused by MDR-KP. The frequency of respiratory failure, bronchopulmonary dysplasia, and intraventricular hemorrhage were more common in the LOS group and a higher rate of acute respiratory distress syndrome was more common in infants in the EOS group (P < 0.05). K. pneumoniae showed a low sensitivity to penicillin, beta-lactams and cephalosporins, and it showed a high sensitivity to levofloxacin, ciprofloxacin, and amikacin. Prematurity, low birth weight, longer antibiotic exposure time, long duration of peripheral catheter insertion, long mechanical ventilation time, and long parenteral nutrition time were associated with an increased rate of MDR-KP infection by univariate analysis (P < 0.05). The regression analysis identified a long antibiotic exposure time (OR = 1.37, 95% CI: 1.01-1.89) and long parenteral nutrition time (OR = 1.39, 95% CI: 1.01-1.89) as independent risk factors for a MDR-KP infection, and a greater gestational age and birth weight were associated with a lower risk of MDR-KP infection (OR = 0.57, 95% CI: 0.40-0.79). LOS caused by K. pneumoniae may lead to a higher frequency of complications. The risk factors for MDR-KP infection were longer duration of antibiotic exposure and parenteral nutrition. A greater gestational age and larger birth weight may decrease the risk of MDR-KP infection.
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Affiliation(s)
- Ting You
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Han Zhang
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Lu Guo
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Ke-Ran Ling
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Xiao-Yu Hu
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Lu-Quan Li
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
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Dey S, Shabuj MH, Jahan I, Akter H, Akhter M. Is Superbug imminent? Findings of a retrospective study in Bangladesh. J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_80_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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43
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Yusef D, Jahmani T, Kailani S, Al-Rawi R, Khasawneh W, Almomani M. Community-acquired serious bacterial infections in the first 90 days of life: a revisit in the era of multi-drug-resistant organisms. World J Pediatr 2019; 15:580-585. [PMID: 31230257 DOI: 10.1007/s12519-019-00276-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 06/04/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Infants in the first 90 days of life are more prone to develop serious bacterial infections (SBIs). Multi-drug-resistant organisms (MDROs) are emerging as important pathogens causing SBIs. We reviewed the epidemiology of SBIs in infants 0-90 days old and compared the clinical features, laboratory values and final outcome for SBIs due to MDROs vs. non-MDROs. METHODS Episodes of culture-proven SBIs (bacteremia, urinary tract infections, or meningitis) with age at onset of 0-90 days during a 7-year period were retrospectively reviewed. Health care-associated infections were excluded. We collected demographics, clinical features, and laboratory and microbiology data. We compared clinical characteristics, laboratory data, microbiologic results and final outcome for SBIs due to MDROs vs. non-MDROs. RESULTS Ninety-four episodes (88 patients) including bacteremia (42.6%), urinary tract infections (54.3%) and meningitis (3.1%) were caused by Gram-negative bacteria (67%), and Gram-positive bacteria (33%). Escherichia coli, Klebsiella pneumoniae and GBS were the most common causes. MDROs caused SBIs in 39 patients (44.3%). SBIs due to MDROs were associated with more delay in providing targeted antimicrobial therapy compared to non-MDROs (74.4% vs. 0%, P ≤ 0.001), but no difference in case-fatality rate (12.8% vs. 12.2%, P = 1.0). Clinical features or basic laboratory values were not statistically different between the two groups. CONCLUSIONS The bacteriology of SBIs in the first 90 days of life is changing to include more MDROs, which causes more delay in providing targeted antimicrobial therapy. Awareness of the local epidemiology is crucial to ensure appropriate antibiotics are provided in a timely manner.
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Affiliation(s)
- Dawood Yusef
- Pediatric Infectious Diseases, Jordan University of Science and Technology, King Abdullah University Hospital, P.O. Box 3030, Irbid, 22110, Jordan. .,Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. .,Pediatric Department, Jordan University of Science and Technology, Irbid, Jordan.
| | - Tamara Jahmani
- Pediatric Infectious Diseases, Jordan University of Science and Technology, King Abdullah University Hospital, P.O. Box 3030, Irbid, 22110, Jordan.,Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.,Pediatric Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Sajeda Kailani
- Pediatric Infectious Diseases, Jordan University of Science and Technology, King Abdullah University Hospital, P.O. Box 3030, Irbid, 22110, Jordan.,Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.,Pediatric Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Rawan Al-Rawi
- Pediatric Infectious Diseases, Jordan University of Science and Technology, King Abdullah University Hospital, P.O. Box 3030, Irbid, 22110, Jordan.,Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.,Pediatric Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Wasim Khasawneh
- Pediatric Infectious Diseases, Jordan University of Science and Technology, King Abdullah University Hospital, P.O. Box 3030, Irbid, 22110, Jordan.,Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.,Pediatric Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Miral Almomani
- Pediatric Infectious Diseases, Jordan University of Science and Technology, King Abdullah University Hospital, P.O. Box 3030, Irbid, 22110, Jordan.,Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.,Pediatric Department, Jordan University of Science and Technology, Irbid, Jordan
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Epidemiology of group B streptococcal infection in pregnant women and diseased infants in mainland China. Pediatr Neonatol 2019; 60:487-495. [PMID: 31445795 DOI: 10.1016/j.pedneo.2019.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/13/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and an important cause of maternal disease in many countries; however, no accurate population-based epidemiological data on GBS is yet available in mainland China. In this systematic literature review, we obtained published data regarding the maternal GBS colonization rate, incidence of invasive GBS disease in infants, clinical screening, and the associated GBS typing and clinical outcomes in China. The maternal GBS colonization rate in mainland China ranged from 3.7 to 14.52%, and the incidence of invasive GBS disease in infants was 0.55-1.79 per 1000 live births, with a case fatality risk ranging from 6.45 to 7.1%. Serotype III was the dominant serotype that was observed in GBS isolates. GBS detection and identification has become more commonplace, due to the availability of polymerase chain reaction and DNA microarray technologies. Immunizing pregnant women against GBS is an emerging approach through which newborns are protected from GBS. The available data suggest that five GBS serotypes (Ia, Ib, II, III, and V) account for the majority of the cases of GBS disease in mainland China. Furthermore, conjugate vaccines comprising some or all of these serotypes are of potential value in the prevention of GBS infection.
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Morgado-Gamero WB, Mendoza Hernandez M, Castillo Ramirez M, Medina-Altahona J, De La Hoz S, Posso Mendoza H, Parody A, Teixeira EC, Agudelo-Castañeda DM. Antibiotic Resistance of Airborne Viable Bacteria and Size Distribution in Neonatal Intensive Care Units. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3340. [PMID: 31510047 PMCID: PMC6765827 DOI: 10.3390/ijerph16183340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/08/2019] [Accepted: 05/16/2019] [Indexed: 12/16/2022]
Abstract
Despite their significant impact on public health, antibiotic resistance and size distributions of airborne viable bacteria in indoor environments in neonatal intensive care units (NICU) remain understudied. Therefore, the objective of this study was to assess the antibiotic resistance of airborne viable bacteria for different sizes (0.65-7 µm) in private-style and public-style neonatal intensive care units (NICU). Airborne bacteria concentrations were assessed by a six-stage Andersen impactor, operating at 28.3 L/min. Public-style NICU revealed higher concentrations of airborne viable bacteria (53.00 to 214.37 CFU/m3) than private-style NICU (151.94-466.43), indicating a possible threat to health. In the public-style NICU, Staphylococcus was the highest bacterial genera identified in the present study, were Staphylococcus saprophyticus and Staphylococcus epidermidis predominated, especially in the second bronchi and alveoli size ranges. Alloiococcus otitidis, Bacillus subtiles, Bacillus thuringiensis, Kocuria rosea, and Pseudomonas pseudoalcaligene, were identified in the alveoli size range. In NICU#2, eight species were identified in the alveoli size range: Bacillus cereus, Bacillus subtilis, Bacillus thuringiensis, Eikenella corrodens, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus gordoni. Multi-drug-resistant organisms (MDROs) were found in both of the NICUs. Bacillus cereus strains were resistant to Ampicillin, Cefoxitin, Ceftaroline, and Penicillin G. Staphylococcus cohnii ssp. cohnii was resistant in parallel to ampicillin and G penicillin. Staphylococcus saprophyticus strains were resistant to Ampicillin, Penicillin G, Oxaxilin, and Erythromycin. Results may indicate a potential threat to human health due to the airborne bacteria concentration and their antibiotic resistance ability. The results may provide evidence for the need of interventions to reduce indoor airborne particle concentrations and their transfer to premature infants with underdeveloped immune systems, even though protocols for visitors and cleaning are well-established.
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Affiliation(s)
- Wendy Beatriz Morgado-Gamero
- Department of Exact and Natural Sciences, Universidad de la Costa, Calle 58#55-66, Barranquilla 080002, Colombia.
| | - Martha Mendoza Hernandez
- Department of Civil and Environmental Engineering, Universidad del Norte, Km 5 Vía Puerto Colombia, Barranquilla 081007, Colombia.
| | | | - Jhorma Medina-Altahona
- Department of Exact and Natural Sciences, Universidad de la Costa, Calle 58#55-66, Barranquilla 080002, Colombia
| | - Stephanie De La Hoz
- Department of Exact and Natural Sciences, Universidad de la Costa, Calle 58#55-66, Barranquilla 080002, Colombia.
| | - Heidy Posso Mendoza
- Department of Bacteriology, Universidad Metropolitana, Calle 76 No. 42-78, Barranquilla 080020, Colombia.
| | - Alexander Parody
- Engineering Faculty, Universidad Libre Barranquilla, Carrera 46 No. 48-170, Barranquilla 080002, Colombia.
| | - Elba C Teixeira
- Postgraduate Program in Remote Sensing, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, Porto Alegre, RS 91501-970, Brazil.
| | - Dayana Milena Agudelo-Castañeda
- Department of Civil and Environmental Engineering, Universidad del Norte, Km 5 Vía Puerto Colombia, Barranquilla 081007, Colombia.
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Ballot DE, Bandini R, Nana T, Bosman N, Thomas T, Davies VA, Cooper PA, Mer M, Lipman J. A review of -multidrug-resistant Enterobacteriaceae in a neonatal unit in Johannesburg, South Africa. BMC Pediatr 2019; 19:320. [PMID: 31493789 PMCID: PMC6731552 DOI: 10.1186/s12887-019-1709-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/03/2019] [Indexed: 11/21/2022] Open
Abstract
Background Multi-drug resistant organisms are an increasingly important cause of neonatal sepsis. Aim This study aimed to review neonatal sepsis caused by multi-drug resistant Enterobacteriaceae (MDRE) in neonates in Johannesburg, South Africa. Methods This was a cross sectional retrospective review of MDRE in neonates admitted to a tertiary neonatal unit between 1 January 2013 and 31 December 2015. Results There were 465 infections in 291 neonates. 68.6% were very low birth weight (< 1500 g). The median age of infection was 14.0 days. Risk factors for MDRE included prematurity (p = 0.01), lower birth weight (p = 0.04), maternal HIV infection (p = 0.02) and oxygen on day 28 (p < 0.001). The most common isolate was Klebsiella pneumoniae (66.2%). Total MDRE isolates increased from 0.39 per 1000 neonatal admissions in 2013 to 1.4 per 1000 neonatal admissions in 2015 (p < 0.001). There was an increase in carbapenem-resistant Enterobacteriaceae (CRE) from 2.6% in 2013 to 8.9% in 2015 (p = 0.06). Most of the CRE were New Delhi metallo—β lactamase- (NDM) producers. The all-cause mortality rate was 33.3%. Birth weight (p = 0.003), necrotising enterocolitis (p < 0.001) and mechanical ventilation (p = 0.007) were significantly associated with mortality. Serratia marcescens was isolated in 55.2% of neonates that died. Conclusions There was a significant increase in MDRE in neonatal sepsis during the study period, with the emergence of CRE. This confirms the urgent need to intensify antimicrobial stewardship efforts and address infection control and prevention in neonatal units in LMICs. Overuse of broad- spectrum antibiotics should be prevented.
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Affiliation(s)
- Daynia E Ballot
- Neonatal Unit, Department of Paediatrics and Child Health, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa. .,Infection control, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, 2196, South Africa.
| | - Rosella Bandini
- Critical Care Infection Collaboration, Witwatersrand, South Africa
| | - Trusha Nana
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the National Health Laboratory Services and University of Witwatersrand, Witwatersrand, South Africa
| | - Noma Bosman
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the National Health Laboratory Services and University of Witwatersrand, Witwatersrand, South Africa
| | - Teena Thomas
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the National Health Laboratory Services and University of Witwatersrand, Witwatersrand, South Africa
| | - Victor A Davies
- Neonatal Unit, Department of Paediatrics and Child Health, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Peter A Cooper
- Neonatal Unit, Department of Paediatrics and Child Health, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Mervyn Mer
- Infection control, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, 2196, South Africa.,Department of Critical Care, University of the Witwatersrand, Witwatersrand, South Africa
| | - Jeffrey Lipman
- Infection control, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, 2196, South Africa.,The University of Queensland, Brisbane, Australia
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Hsu JF, Chen CL, Lee CC, Lien R, Chu SM, Fu RH, Chiang MC, Yang CY, Lai MY, Wu IH, Yen YS, Chiu CH. Characterization of group B Streptococcus colonization in full-term and Late-Preterm neonates in Taiwan. Pediatr Neonatol 2019; 60:311-317. [PMID: 30145107 DOI: 10.1016/j.pedneo.2018.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/26/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Group B streptococcus (GBS) infections can be life-threatening in newborns. This study aimed to analyze GBS carriage status and genotypic diversity in healthy neonates after implementation of intrapartum antibiotic prophylaxis (IAP) in Taiwan. METHODS Newborns carrying GBS were identified from a screen of 500 newborns and followed up until their cultures turned negative. Their mothers' GBS screening data were reviewed. Molecular methods, including capsular serotyping, multilocus sequence typing and pulsed-field gel electrophoresis (PFGE), were used to analyze GBS isolates. RESULTS GBS colonization was detected at either the nose or anus in 11 of 500 healthy neonates (2.2%). In this group of 11 neonates, 4 had GBS serotypes II and III for 4-6 months, 1 had serotype V for 2 months, 6 had serotypes Ia, II, V, and VI for less than 1 month, and 1 had 2 different serotypes (serotypes V and II) at different times. The most prevalent serotype was II (33.3%), followed by Ia (25.0%), III (16.7%), V (16.7%), and VI (8.3%). The main sequence type was ST1 (50.0%), followed by ST19 (16.7%), ST23 (8.3%), ST24 (8.3%), ST103 (8.3%), and ST 231 (8.3%). All isolates were grouped into 5 PFGE clusters F, G, J, X, and Y, and all were susceptible to β-lactam antimicrobial agents. CONCLUSIONS GBS was carried in 2.2% (11/500) healthy newborns and persisted for 6 months in 3 neonates. This study makes clearer our understanding of GBS colonization, serotype distribution, and genotype distribution in healthy neonates.
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Affiliation(s)
- Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Chung Lee
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Reyin Lien
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ren-Huei Fu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chang-Yo Yang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yin Lai
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - I-Hsyuan Wu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Shan Yen
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Escribano E, Saralegui C, Moles L, Montes MT, Alba C, Alarcón T, Lázaro-Perona F, Rodríguez JM, Sáenz de Pipaón M, Del Campo R. Influence of a Serratia marcescens outbreak on the gut microbiota establishment process in low-weight preterm neonates. PLoS One 2019; 14:e0216581. [PMID: 31112570 PMCID: PMC6529157 DOI: 10.1371/journal.pone.0216581] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/25/2019] [Indexed: 02/07/2023] Open
Abstract
Adequate gut microbiota establishment is important for lifelong health. The aim was to sequentially analyze the gut microbiota establishment in low-birth-weight preterm neonates admitted to a single neonatal intensive care unit during their first 3 weeks of life, comparing two epidemiological scenarios. Seven control infants were recruited, and another 12 during a severe S. marcescens outbreak. Meconium and feces from days 7, 14, and 21 of life were collected. Gut microbiota composition was determined by 16S rDNA massive sequencing. Cultivable isolates were genotyped by pulsed-field gel electrophoresis, with four S. marcescens submitted for whole-genome sequencing. The expected bacterial ecosystem expansion after birth is delayed, possibly related to antibiotic exposure. The Proteobacteria phylum dominates, although with marked interindividual variability. The outbreak group considerably differed from the control group, with higher densities of Escherichia coli and Serratia to the detriment of Enterococcus and other Firmicutes. Curiously, obligate predators were only detected in meconium and at very low concentrations. Genotyping of cultivable bacteria demonstrated the high bacterial horizontal transmission rate that was confirmed with whole-genome sequencing for S. marcescens. Preterm infants admitted at NICU are initially colonized by homogeneous microbial communities, most of them from the nosocomial environment, which subsequently evolve according to the individual conditions. Our results demonstrate the hospital epidemiology pressure, particularly during outbreak situations, on the gut microbiota establishing process.
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Affiliation(s)
- Esperanza Escribano
- Servicio de Neonatología, Hospital Universitario La Paz, and Universidad Autónoma de Madrid, Madrid, Spain
| | - Claudia Saralegui
- Servicio de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, and Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain
| | - Laura Moles
- Servicio de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, and Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain.,Departamento de Bromatología, Facultad de Veterinaria Nutrición y Ciencia de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain
| | - María Teresa Montes
- Servicio de Neonatología, Hospital Universitario La Paz, and Universidad Autónoma de Madrid, Madrid, Spain
| | - Claudio Alba
- Servicio de Microbiología, Hospital Universitario La Princesa, and Universidad Autónoma de Madrid, Madrid, Spain
| | - Teresa Alarcón
- Servicio de Microbiología, Hospital Universitario La Princesa, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Juan Miguel Rodríguez
- Departamento de Bromatología, Facultad de Veterinaria Nutrición y Ciencia de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain
| | - Miguel Sáenz de Pipaón
- Servicio de Neonatología, Hospital Universitario La Paz, and Universidad Autónoma de Madrid, Madrid, Spain.,Red de Salud Materno Infantil y del Desarrollo, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Del Campo
- Servicio de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, and Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain
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Clouse K, Shehabi A, Suleimat AM, Faouri S, Khuri-Bulos N, Al Jammal A, Chappell J, Fortner KB, Chamby AB, Randis TM, Ratner AJ, Aronoff DM, Halasa N. High prevalence of Group B Streptococcus colonization among pregnant women in Amman, Jordan. BMC Pregnancy Childbirth 2019; 19:177. [PMID: 31109301 PMCID: PMC6528311 DOI: 10.1186/s12884-019-2317-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background Little is known of the burden of Group B Streptococcus (GBS) colonization among pregnant women in Jordan. We conducted a pilot study to determine the prevalence of GBS among pregnant women in Amman, Jordan, where GBS testing is not routine. We also explored GBS serotypes and the performance of a rapid GBS antigen diagnostic test. Methods We collected vaginal-rectal swabs from women who presented for labor and delivery at Al-Bashir Hospital. Three methods were used to identify GBS: Strep B Rapid Test (Creative Diagnostics), blood agar media (Remel) with confirmed with BBL Streptocard acid latex test (Becton Dickinson), and CHROMagar StrepB (Remel). Results were read by a senior microbiologist. We defined our gold standard for GBS-positive as a positive blood agar culture confirmed by latex agglutination and positive CHROMagar. PCR testing determined serotype information. Demographic and clinical data were also collected. Results In April and May 2015, 200 women were enrolled with a median age of 27 years (IQR: 23–32); 89.0% were Jordanian nationals and 71.9% completed secondary school. Median gestational age was 38 weeks (IQR: 37–40); most women reported prenatal care (median 9 visits; IQR: 8–12). Median parity was 2 births (IQR: 1–3). Pre-pregnancy median BMI was 24.1 (IQR: 21.5–28.0) and 14.5% reported an underlying medical condition. Obstetric complications included gestational hypertension (9.5%), gestational diabetes (6.0%), and UTI (53.5%), of which 84.5% reported treatment. Overall, 39 (19.5%) of women were GBS-positive on blood agar media and CHROMagar, while 67 (33.5%) were positive by rapid test (36% sensitivity, 67% specificity). Serotype information was available for 25 (64%) isolates: III (48%), Ia (24%), II (20%), and V (8%). No demographic or clinical differences were noted between GBS+ and GBS-negative women. Conclusions Nearly one in five women presenting for labor in Jordan was colonized with GBS, with serotype group III as the most common. The rapid GBS antigen diagnostic had low sensitivity and specificity. These results support expanded research in the region, including defining GBS resistance patterns, serotyping information, and risk factors. It also emphasizes the need for routine GBS testing and improved rapid GBS diagnostics for developing world settings.
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Affiliation(s)
- Kate Clouse
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA. .,Vanderbilt Institute for Global Health, Nashville, TN, USA.
| | | | | | | | | | | | - James Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly B Fortner
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna B Chamby
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York, NY, USA
| | - Tara M Randis
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York, NY, USA
| | - Adam J Ratner
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York, NY, USA
| | - David M Aronoff
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natasha Halasa
- Vanderbilt Institute for Global Health, Nashville, TN, USA. .,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Li X, Ding X, Shi P, Zhu Y, Huang Y, Li Q, Lu J, Li Z, Zhu L. Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital, 2013 to 2017. Medicine (Baltimore) 2019; 98:e14686. [PMID: 30896617 PMCID: PMC6709008 DOI: 10.1097/md.0000000000014686] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Neonatal sepsis (NS) remains a major cause of morbidity and mortality in neonates, but data on the etiology and antibiotic susceptibility patterns of pathogens are limited. The aim of this study was to analyze the clinical characteristics, risk factors, and the antibiotic susceptibility patterns of pathogenic microbes associated with NS at a tertiary children's hospital in Shanghai, China.Episodes of blood culture-proven sepsis in the neonatal intensive care unit (NICU) of Children's Hospital of Fudan University from January 2013 to August 2017 were retrospectively reviewed. Collected data included demographics, perinatal risk factors, clinical symptoms, laboratory values, microbiology results and their antimicrobial susceptibility. Data for early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS) were compared.The 341 of 976 culture-positive cases were selected, including 161 EONS cases (47.21% of 341) and 180 LONS cases (52.79% of 341). 635 incomplete cases were excluded. There was significant difference in risk factors between the EONS group and LONS group including birth weight, gestational age, 1-minute Apgar score, respiratory support, and the use of peripherally insertion central catheter (PICC). Clinical symptoms such as fever, feeding intolerance, abdominal distension, and neonatal jaundice, and laboratory results such as hemoglobin and lymphocyte counts also showed between-group differences. Staphylococcus epidermidis (22.87%), Escherichia coli (9.68%), Alcaligenes xylosoxidans (9.38%) and Klebsiella pneumoniae (9.09%) remain the principal organisms responsible for neonatal sepsis. Most isolates of Gram-positive bacteria were sensitive to vancomycin, linezolid, minocycline and tigecycline, of which more than 90% were resistant to penicillin. Most isolates of Gram-negative bacteria were sensitive to amikacin and imipenem and resistant to ampicillin. Fungus was sensitive to antifungal agents. Better medical decisions, especially early detection and appropriate initial antimicrobial therapy can be made after understanding the different clinical features and pathogens of EONS and LONS.
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Affiliation(s)
| | | | - Peng Shi
- Department of Medical Statistics, Children's Hospital of Fudan University, Shanghai, China
| | | | | | - Qin Li
- Department of Clinical Pharmacy
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