scholarly journals Epidemiology of infections and antimicrobial use in Greek Neonatal Units

2018 ◽  
Vol 104 (3) ◽  
pp. F293-F297 ◽  
Author(s):  
Despoina Gkentzi ◽  
Christina Kortsalioudaki ◽  
Benjamin Campbell Cailes ◽  
Theoklis Zaoutis ◽  
John Kopsidas ◽  
...  
Keyword(s):  
Late Onset ◽  
Evidence Based ◽  
Antimicrobial Use ◽  
Neonatal Infections ◽  
Coagulase Negative Staphylococci ◽  
Surveillance Network ◽  
Prevalence Survey ◽  
Infection Surveillance ◽  
Late Onset Sepsis ◽  
Evidence Based Guidelines

ObjectiveTo describe the epidemiology of neonatal infections and of antimicrobial use in Greek Neonatal Units (NNUs) in order to develop national, evidence-based guidelines on empiric antimicrobial use for neonatal sepsis in Greece.DesignRetrospective analysis of prospectively collected infection surveillance data from 2012 to 2015, together with a Point Prevalence Survey (PPS) on antimicrobial use and the collection of data on local empiric antimicrobial policies.Setting16 NNUs in Greece participating in the neonIN infection surveillance networkPatientsNewborns in participating NNUs who had a positive blood, cerebrospinal fluid or urine culture and were treated with at least 5 days of antibiotics.Results459 episodes were recorded in 418 infants. The overall incidence of infection was 50/1000 NNU-admissions. The majority of episodes were late-onset sepsis (LOS) (413, 90%). Coagulase-negative Staphylococci (80%) were the most common Gram-positive organisms causing LOS and Klebsiella spp (39%) the most common Gram-negative. Nearly half (45%) of the Klebsiella spp were resistant to at least one aminoglycoside. The PPS revealed that 196 of 484 (40%) neonates were on antimicrobials. The survey revealed wide variation in empiric antimicrobial policies for LOS.ConclusionsThis is the largest collection of data on the epidemiology of neonatal infections in Greece and on neonatal antimicrobial use. It provides the background for the development of national evidence-based guidelines. Continuous surveillance, the introduction of antimicrobial stewardship interventions and evidence-based guidelines are urgently required.

scholarly journals Antimicrobial resistance in UK neonatal units: neonIN infection surveillance network

2017 ◽  
Vol 103 (5) ◽  
pp. F474-F478 ◽  
Author(s):  
Benjamin Cailes ◽  
Christina Kortsalioudaki ◽  
Jim Buttery ◽  
Santosh Pattnayak ◽  
Anne Greenough ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Late Onset ◽  
Future Research ◽  
Surveillance Network ◽  
Infection Surveillance ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
The Common ◽  
The Uk ◽  
Evidence Based Guidelines

ObjectiveTo define the susceptibilities of the common causative pathogens of neonatal sepsis in the UK.DesignRetrospective analysis of the prospectively collected neonIN infection surveillance network data between 2005 and 2014.Setting30 neonatal units in the UK.PatientsNewborns admitted to participating neonatal units who return a positive blood, cerebrospinal fluid or urine culture and are treated with at least 5 days of appropriate antibiotics.Results1568 isolates with recorded antimicrobial data were collected including 328 early-onset sepsis (EOS) isolates and 1240 late-onset sepsis (LOS) isolates. The majority of EOS pathogens (>92%) were susceptible to the four empirical commonly used antimicrobial combinations (eg, 93% for benzylpenicillin/gentamicin), while LOS pathogens demonstrated higher levels of resistance (eg, 89% for flucloxacillin/gentamicin). Among infants<1500 g and <32 weeks gestation, an amoxicillin/gentamicin combination demonstrated a trend towards improved coverage of EOS isolates than benzylpenicillin/gentamicin (93% vs 86%, p=0.211).ConclusionsThis analysis provides insights into the patterns of antimicrobial resistance among UK neonatal pathogens. These data will inform areas of future research and can be used to update national evidence-based guidelines on antimicrobial usage.

scholarly journals Gut Dysbiosis With Bacilli Dominance and Accumulation of Fermentation Products Precedes Late-onset Sepsis in Preterm Infants

2018 ◽  
Vol 69 (2) ◽  
pp. 268-277 ◽  
Author(s):  
S Graspeuntner ◽  
S Waschina ◽  
S Künzel ◽  
N Twisselmann ◽  
T K Rausch ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gut Microbiome ◽  
Late Onset ◽  
Anaerobic Bacteria ◽  
Gene Profiling ◽  
Rrna Gene ◽  
Coagulase Negative Staphylococci ◽  
Fermentation Products ◽  
Gut Dysbiosis ◽  
Late Onset Sepsis

Abstract Background Gut dysbiosis has been suggested as a major risk factor for the development of late-onset sepsis (LOS), a main cause of mortality and morbidity in preterm infants. We aimed to assess specific signatures of the gut microbiome, including metabolic profiles, in preterm infants <34 weeks of gestation preceding LOS. Methods In a single-center cohort, fecal samples from preterm infants were prospectively collected during the period of highest vulnerability for LOS (days 7, 14, and 21 of life). Following 16S rRNA gene profiling, we assessed microbial community function using microbial metabolic network modeling. Data were adjusted for gestational age and use of probiotics. Results We studied stool samples from 71 preterm infants with LOS and 164 unaffected controls (no LOS/necrotizing enterocolitis). In most cases, the bacteria isolated in diagnostic blood culture corresponded to the genera in the gut microbiome. LOS cases had a decelerated development of microbial diversity. Before onset of disease, LOS cases had specific gut microbiome signatures with higher abundance of Bacilli (specifically coagulase-negative Staphylococci) and a lack of anaerobic bacteria. In silico modeling of bacterial community metabolism suggested accumulation of the fermentation products ethanol and formic acid in LOS cases before the onset of disease. Conclusions Intestinal dysbiosis preceding LOS is characterized by an accumulation of Bacilli and their fermentation products and a paucity of anaerobic bacteria. Early microbiome and metabolic patterns may become a valuable biomarker to guide individualized prevention strategies of LOS in highly vulnerable populations.

scholarly journals Epidemiology and healthcare factors associated with neonatal enterococcal infections

2018 ◽  
Vol 104 (5) ◽  
pp. F480-F485 ◽  
Author(s):  
Joanna Wang ◽  
Christina Kortsalioudaki ◽  
Paul T Heath ◽  
Jim Buttery ◽  
Paul Clarke ◽  
...  
Keyword(s):  
Late Onset ◽  
Positive Culture ◽  
Neonatal Infection ◽  
Surveillance Network ◽  
Factors Associated ◽  
Staffing Ratios ◽  
Healthcare Data ◽  
High Dependency ◽  
Infection Surveillance ◽  
Enterococcal Infections

ObjectiveTo investigate the epidemiology and healthcare factors associated with late-onset neonatal enterococcal infections.DesignMulticentre, multinational retrospective cohort study using prospectively collected infection data from a neonatal infection surveillance network between 2004 and 2016; this was supplemented with healthcare data from a questionnaire distributed to participating neonatal units.SettingSixty neonatal units across Europe (UK, Greece, Estonia) and Australia.PatientsInfants admitted to participating neonatal units who had a positive culture of blood, cerebrospinal fluid or urine after 48 hours of life.ResultsIn total, 414 episodes of invasive Enterococcus spp infection were reported in 388 infants (10.1% of a total 4083 episodes in 3602 infants). Enterococcus spp were the second most common cause of late-onset infection after coagulase-negative Staphylococcus spp and were strongly associated with necrotising enterocolitis (NEC) (adjusted OR 1.44, 95% CI 1.02 to 2.03, p=0.038), total parenteral nutrition (TPN) (adjusted OR 1.34, 95% CI 1.06 to 1.70, p=0.016), increasing postnatal age (per 1-week increase: adjusted OR 1.04, 95% CI 1.02 to 1.06, p<0.001) and decreasing birth weight (per 1 kg increase: adjusted OR 0.85, 95% CI 0.74 to 0.97, p=0.017). There was no evidence that inadequate nurse to patient staffing ratios in high-dependency units were associated with a higher risk of enterococcal infections.ConclusionsEnterococcus spp were the second most frequent cause of late-onset infections. The association between enterococcal infections, NEC and TPN may inform empiric antimicrobial regimens in these contexts and provide insights into reducing these infections.

Rapid Clearance From the Bloodstream of Coagulase-Negative Staphylococci in Infants With Late-Onset Sepsis

2009 ◽  
Vol 28 (9) ◽  
pp. 853-854 ◽  
Author(s):  
Marieke A. C. Hemels ◽  
Malgorzata A. Verboon-Maciolek ◽  
Leo J. Gerards ◽  
Tannette G. Krediet ◽  
André Fleer
Keyword(s):  
Late Onset ◽  
Coagulase Negative Staphylococci ◽  
Late Onset Sepsis ◽  
Rapid Clearance

scholarly journals Epidemiology of Neonatal Sepsis and Implicated Pathogens: A Study from Egypt

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Eman M. Rabie Shehab El-Din ◽  
Mohamed M. Adel El-Sokkary ◽  
Mohamed Reda Bassiouny ◽  
Ramadan Hassan
Keyword(s):  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Laboratory Data ◽  
Total Mortality ◽  
Coagulase Negative Staphylococci ◽  
Suspected Sepsis ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Low Sensitivity

Prospective analytic study was conducted in NICUs of three Egyptian Neonatal Network (EGNN) participants in Mansoura Hospitals in Egypt over a period of 18 months from March 2011 to August 2012. By using EGNN 28-day discharge form, all demographic, clinical, and laboratory data were recorded and studied. During the study period, 357 neonates were diagnosed as suspected sepsis with an incidence of 45.9% (357/778) among the admitted neonates at the three neonatal intensive care units. 344 neonates (sex ratio = 1.3:1) were enrolled in the study in which 152 (44.2%) were classified as early onset sepsis EOS (≤72 hr) and 192 (55.8%) as late onset sepsis LOS (>72 hr). Among the LOS cases, 33.9% (65/192) were caused by nosocomial infections. In 40.7% (140/344), sepsis was confirmed by positive blood culture. The total mortality rate for the proven neonatal sepsis was 51% (25/49) and 42.9% (39/91) for EOS and LOS, respectively. Coagulase negative staphylococci were predominant isolates in both EOS and LOS, followed byKlebsiella pneumoniae. Most of the bacterial isolates had low sensitivity to the commonly used empiric antibiotics. However, 70.1% (89/127) exhibited multidrug resistance. Best sensitivities among Gram-positive isolates were found against imipenem, ciprofloxacin, vancomycin, and amikacin.

scholarly journals Epidemiology of UK neonatal infections: the neonIN infection surveillance network

2017 ◽  
Vol 103 (6) ◽  
pp. F547-F553 ◽  
Author(s):  
Benjamin Cailes ◽  
Christina Kortsalioudaki ◽  
Jim Buttery ◽  
Santosh Pattnayak ◽  
Anne Greenough ◽  
...  
Keyword(s):  
Late Onset ◽  
Guideline Development ◽  
Neonatal Infection ◽  
Future Research ◽  
Group B Streptococci ◽  
Surveillance Network ◽  
The Past ◽  
Infection Surveillance ◽  
Early Onset Sepsis ◽  
The Uk

ObjectiveTo describe the epidemiology of neonatal infection over the past decade in UK neonatal units.DesignRetrospective analysis of prospectively collected infection surveillance network data from 2005 to 2014.Setting30 neonatal units in the UK.PatientsNewborns on participating neonatal units who had a positive blood, cerebrospinal fluid or urine culture and were treated with at least 5 days of appropriate antibiotics.Results2171 episodes of neonatal infection in 1922 infants were recorded. The incidence of infection was 6.1/1000 live births and 48.8/1000 neonatal admissions (2.9 and 23.5 respectively if coagulase-negative staphylococci (CoNS) cultures excluded). The incidence of infection showed a statistically significant reduction over time with reductions in the rates of both early-onset sepsis (EOS) and late-onset sepsis (LOS).The majority of episodes (76%) represented LOS (diagnosed > 48 hours after birth), and infection was more common in premature (<37 weeks gestation) and low birth weight (<2500 g) neonates (84% and 81%, respectively). Commonly identified pathogens included group B streptococci (43%) and Escherichia coli (18%) for EOS, while E. coli (15%), Staphylococcus aureus (14%) and CoNS were prominent causes of LOS.ConclusionsThis paper describes the epidemiology of neonatal infection in the UK over the past decade. These data enable benchmarking of practice and inform areas of future research and guideline development. The results support the hypothesis that the introduction of infection prevention care bundles and antibiotic stewardship programmes in the UK has reduced the burden of LOS.

In vitrosynergy of oxacillin and gentamicin against coagulase-negative staphylococci from blood cultures of neonates with late-onset sepsis

Apmis ◽  
2013 ◽  
Vol 121 (9) ◽  
pp. 859-864 ◽  
Author(s):  
Tatjana Brilene ◽  
Hiie Soeorg ◽  
Merilin Kiis ◽  
Epp Sepp ◽  
Siiri Kõljalg ◽  
...  
Keyword(s):  
Late Onset ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci ◽  
Late Onset Sepsis

Late onset sepsis: comparison between coagulase-negative staphylococci and other bacteria in the neonatal intensive care unit

2018 ◽  
Vol 50 (10) ◽  
pp. 764-770 ◽  
Author(s):  
Neta Berlak ◽  
Eilon Shany ◽  
Shalom Ben-Shimol ◽  
Ilana Azulay Chertok ◽  
Gil Goldinger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Coagulase Negative Staphylococci ◽  
Late Onset Sepsis

P39 Continuous vancomycin dosing: an audit and evaluation

2018 ◽  
Vol 103 (2) ◽  
pp. e1.43-e1 ◽  
Author(s):  
Robertson Fiona ◽  
Walsh Rachel ◽  
Yeo Mildrid
Keyword(s):  
Adverse Effects ◽  
Continuous Infusion ◽  
Therapeutic Range ◽  
Late Onset ◽  
Therapeutic Drug ◽  
Coagulase Negative Staphylococci ◽  
Late Onset Sepsis ◽  
Resistance Patterns ◽  
Continuous Regime ◽  
Continuous Dosing

AimsLate onset sepsis is a major cause of morbidity and mortality within the field of neonatology, with coagulase- negative staphylococci being the most commonly reported pathogens. Due to staphylococcal resistance patterns vancomycin is an essential therapeutic agent. Its efficacy correlates directly with duration of bacterial exposure at therapeutic levels. Some studies have suggested that continuous infusion achieves quicker and more sustained therapeutic levels than traditional intermittent dosing. Continuous dosing was introduced in our neonatal units in September 2015. This piece of work audits adherence to local prescribing and monitoring guidance whilst assessing the effectiveness of the new continuous regimes.MethodAll infants commenced on continuous vancomycin over a six month period were included. Cases were identified via pharmacy records and data collected retrospectively and prospectively. Key areas were: loading and initial continuous doses, therapeutic drug monitoring (TDM), time spent in therapeutic range and the associated effects of gestation and baseline creatinine. Adverse effects were also considered. Data was analysed using Excel and Prism.Results45 treatment episodes were eligible for analysis. Corrected gestation ranged from 24+5 to 41+6. Mean weight was 1450 g and mean duration of therapy 6.5 days. Loading, initial continuous dosing and TDM were generally carried out in line with local guidelines. Regarding the first level measured after commencement of the continuous regime; 9% of levels with continuous infusion were subtherapeutic. A previous audit of intermittent vancomycin dosing showed that 50% of first levels were subtherapeutic. Statistically there was a weak correlation between creatinine level prior to commencement of continuous vancomycin and the first level. Of all 298 levels measured 56% were therapeutic, 19% were supratherapeutic and 25% subtherapeutic. Time spent in therapeutic range was comparable across the range of gestational groups.ConclusionContinuous vancomycin dosing showed promising results in this population. Adherence to local guidelines in terms of prescribing and monitoring was good. The time taken to reach therapeutic range was shorter than previously achieved with intermittent dosing. Maintaining levels with this therapeutic range was also seen to be favourable. More detailed analysis of our results suggests that our dosing guidance is adjusted correctly to take into account important variables in vancomycin pharmacokinetics such as corrected gestational age and renal function. No adverse effects specific to vancomycin were noted during the course of this work.

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