Pathogens distribution and antimicrobial resistance in bloodstream infections in twenty-five neonatal intensive care units in China, 2017–2019

Abstract Background Overcrowding, abuse of antibiotics and increasing antimicrobial resistance negatively affect neonatal survival rates in developing countries. We aimed to define pathogens and their antimicrobial resistance (AMR) of early-onset sepsis (EOS), hospital-acquired late-onset sepsis (HALOS) and community-acquired late-onset sepsis (CALOS) in 25 neonatal intensive care units (NICUs) in China. Study design This retrospective descriptive study included pathogens and their AMR from all neonates with bloodstream infections (BSIs) admitted to 25 tertiary hospitals in China from January 1, 2017, and December 31, 2019. We defined EOS as the occurrence of BSI at or before 72 h of life and late-onset sepsis (LOS) if BSI occurred after 72 h of life. LOS were classified as CALOS if occurrence of BSI was ≤ 48 h after admission, and HALOS, if occurrence was > 48 h after admission. Results We identified 1092 pathogens of BSIs in 1088 infants from 25 NICUs. Thirty-two percent of all pathogens were responsible for EOS, 64.3% HALOS, and 3.7% CALOS. Gram-negative (GN) bacteria accounted for a majority of pathogens in EOS (56.7%) and HALOS (62.2%). The most frequent pathogens causing EOS were Escherichia coli (27.2%) and group B streptococcus (GBS; 14.6%) whereas in CALOS they were GBS (46.3%) and Staphylococcus aureus (41.5%). Klebsiella pneumoniae (27.9%), Escherichia coli (15.7%) and Fungi (12.8%) were the top three isolates in HALOS. Third-generation cephalosporin resistance rates in GN bacteria ranged from 9.7 to 55.6% in EOS and 26% to 63.3% in HALOS. Carbapenem resistance rates in GN bacteria ranged from 2.7 to 31.3% in HALOS and only six isolates in EOS were carbapenem resistant. High rates of multidrug resistance were observed in Klebsiella pneumoniae (60.7%) in HALOS and in Escherichia coli (44.4%) in EOS. All gram-positive bacteria were susceptible to vancomycin except for three Enterococcus faecalis in HALOS. All-cause mortality was higher among neonates with EOS than HALOS (7.4% VS 4.4%, [OR] 0.577, 95% CI 0.337–0.989; P = 0.045). Conclusions Escherichia coli, Klebsiella pneumoniae and GBS were the leading pathogens in EOS, HALOS and CALOS, respectively. The high proportion of pathogens and high degree of antimicrobial resistance in HALOS underscore understanding of the pathogenesis and emphasise the need to devise effective interventions in developing countries.

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Pathogens Distribution and Antimicrobial Resistance in Bloodstream Infections in Twenty-Five Neonatal Intensive Care Units in China, 2017-2019

10.21203/rs.3.rs-145861/v1 ◽

2021 ◽

Author(s):

Jing Liu ◽

Zengyu Fang ◽

Yonghui Yu ◽

Yanjie Ding ◽

Zhijie Liu ◽

...

Keyword(s):

Escherichia Coli ◽

Intensive Care ◽

Antimicrobial Resistance ◽

Neonatal Intensive Care ◽

Late Onset ◽

Bloodstream Infections ◽

Neonatal Intensive Care Units ◽

Klebsiella Pneumonia ◽

Late Onset Sepsis ◽

Resistance Rates

Abstract BackgroundOvercrowding, abuse of antibiotics and increase of antimicrobial resistance negatively affect neonatal survival rates in developing countries. We aimed to define pathogens and their antimicrobial resistance (AMR) of early-onset sepsis (EOS), hospital-acquired late-onset sepsis (HALOS) and community-acquired late-onset sepsis (CALOS) in 25 neonatal intensive care units (NICUs) in China.Study designThis retrospective descriptive study included pathogens and their AMR from all neonates with bloodstream infections (BSIs) admitted to 25 tertiary hospitals in China from January 1, 2017, and December 31, 2019. We defined EOS as the occurrence of BSI at or before 72 hours of life and late-onset sepsis (LOS) if BSI occurred after 72 hours of life. LOS were classified as CALOS if occurrence of BSI was ≤ 48 hours after admission, and HALOS, if occurrence was > 48 hours after admission.Results1092 pathogens of BSIs collected from 25 NICUs including 349 EOS isolates, 702 HALOS isolates and 41 CALOS isolates. Gram-negative bacteria (GNB) dominated in EOS (56.7%) and HALOS (62.2%). The most frequent pathogens causing EOS were Escherichia coli (27.2%) and group B streptococcus (GBS; 14.6%) whereas in CALOS they were GBS (46.3%) and Staphylococcus aureus (41.5%). Klebsiella pneumonia (27.9%), Escherichia coli (15.7%) and fungi (12.8%) were the top three isolates in HALOS. Third-generation cephalosporin resistance rates in GNB ranged from 9.7–55.6% in EOS and 26–63.3% in HALOS. Carbapenem resistance rates in GNB ranged from 2.7–31.3% in HALOS and only six isolates in EOS were carbapenem resistant. High rates of multidrug resistance were observed in Klebsiella pneumonia (60.7%) in HALOS and in Escherichia coli (44.4%) in EOS. All gram-positive bacteria were susceptible to vancomycin except for three Enterococcus faecalis in HALOS. The adverse outcome rates in HALOS were high, ranging from 4.6–16.2%.ConclusionsEscherichia coli, Klebsiella pneumonia and GBS were the leading pathogens in EOS, HALOS and CALOS, respectively. The high proportion of pathogens, high degree of antimicrobial resistance and high proportion of adverse outcomes in HALOS underscore understanding of the pathogenesis and devise effective interventions in developing countries.

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Risk factors for late-onset health care–associated bloodstream infections in patients in neonatal intensive care units

American Journal of Infection Control ◽

10.1016/j.ajic.2006.01.002 ◽

2007 ◽

Vol 35 (3) ◽

pp. 177-182 ◽

Cited By ~ 78

Author(s):

Sharon E. Perlman ◽

Lisa Saiman ◽

Elaine L. Larson

Keyword(s):

Risk Factors ◽

Health Care ◽

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Late Onset ◽

Bloodstream Infections ◽

Neonatal Intensive Care Units

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High Burden of Bloodstream Infections Associated With Antimicrobial Resistance and Mortality in the Neonatal Intensive Care Unit in Pune, India

Clinical Infectious Diseases ◽

10.1093/cid/ciaa554 ◽

2020 ◽

Cited By ~ 1

Author(s):

Julia Johnson ◽

Matthew L Robinson ◽

Uday C Rajput ◽

Chhaya Valvi ◽

Aarti Kinikar ◽

...

Keyword(s):

Intensive Care ◽

Antimicrobial Resistance ◽

Early Onset ◽

Neonatal Intensive Care ◽

Late Onset ◽

Bloodstream Infections ◽

Middle Income ◽

Middle Income Countries ◽

Effective Interventions ◽

High Prevalence

Abstract Background Antimicrobial resistance (AMR) is a growing threat to newborns in low- and middle-income countries (LMIC). Methods We performed a prospective cohort study in 3 tertiary neonatal intensive care units (NICUs) in Pune, India, to describe the epidemiology of neonatal bloodstream infections (BSIs). All neonates admitted to the NICU were enrolled. The primary outcome was BSI, defined as positive blood culture. Early-onset BSI was defined as BSI on day of life (DOL) 0–2 and late-onset BSI on DOL 3 or later. Results From 1 May 2017 until 30 April 2018, 4073 neonates were enrolled. Among at-risk neonates, 55 (1.6%) developed early-onset BSI and 176 (5.5%) developed late-onset BSI. The majority of BSIs were caused by gram-negative bacteria (GNB; 58%); among GNB, 61 (45%) were resistant to carbapenems. Klebsiella spp. (n = 53, 23%) were the most common cause of BSI. Compared with neonates without BSI, all-cause mortality was higher among neonates with early-onset BSI (31% vs 10%, P < .001) and late-onset BSI (24% vs 7%, P < .001). Non–low-birth-weight neonates with late-onset BSI had the greatest excess in mortality (22% vs 3%, P < .001). Conclusions In our cohort, neonatal BSIs were most commonly caused by GNB, with a high prevalence of AMR, and were associated with high mortality, even in term neonates. Effective interventions are urgently needed to reduce the burden of BSI and death due to AMR GNB in hospitalized neonates in LMIC.

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An outbreak of Klebsiella pneumoniae late-onset sepsis in a neonatal intensive care unit in Guatemala

American Journal of Infection Control ◽

10.1016/j.ajic.2012.02.031 ◽

2012 ◽

Vol 40 (6) ◽

pp. 516-520 ◽

Cited By ~ 16

Author(s):

Jennifer Gray ◽

Wences Arvelo ◽

John McCracken ◽

Beatriz Lopez ◽

Fernanda C. Lessa ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Late Onset ◽

Late Onset Sepsis

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Antibiotics Prescriptions in the Neonatal Intensive Care Unit: How to Overcome Everyday Challenges

American Journal of Perinatology ◽

10.1055/s-0037-1602426 ◽

2017 ◽

Vol 34 (12) ◽

pp. 1169-1177 ◽

Cited By ~ 4

Author(s):

E. Mozzo ◽

V. Mardegan ◽

U. Trafojer ◽

P. Lago ◽

S. Salvadori ◽

...

Keyword(s):

Intensive Care ◽

Neonatal Intensive Care ◽

Late Onset ◽

Clinical Pathways ◽

Neonatal Intensive Care Units ◽

Current Review ◽

Late Onset Sepsis ◽

Excellent Starting Point ◽

Starting Point ◽

Formulary Restriction

AbstractAntimicrobial prescriptions in neonatal intensive care units (NICUs) represent a point of concern for the emergence of MDROs and for morbidity associated with prolonged antibiotic exposure (e.g., invasive candidiasis, necrotizing enterocolitis, and late-onset sepsis). Antimicrobial stewardship programs (ASPs) have shown to be a valuable tool for the prevention of resistance with the goals of optimizing clinical outcomes while decreasing unnecessary prescribing. The most frequent ASP strategies include the correct collection and interpretation of microbiological specimens, prescription of the narrowest-spectrum antibiotic appropriate for a particular case, and de-escalation or discontinuation of therapy in defined situations. A robust ASP requires everyday multidisciplinary collaboration between ID physicians, neonatologist, clinical pharmacists, clinical microbiologists, infection control professionals, hospital epidemiologists, and information services specialists. Education and clinical pathways (e.g., sepsis or surgical prophylaxis pathways) are an excellent starting point if followed by proactive interventions such as prospective audits and feedback and formulary restriction with prior antimicrobial authorization. The current review outlines the problems faced in NICU antimicrobial prescribing and presents various solutions from the literature.

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Mucosal surveillance cultures in predicting Gram-negative late-onset sepsis in neonatal intensive care units

Journal of Hospital Infection ◽

10.1016/j.jhin.2011.03.025 ◽

2011 ◽

Vol 78 (4) ◽

pp. 327-332 ◽

Cited By ~ 25

Author(s):

Ü. Parm ◽

T. Metsvaht ◽

E. Sepp ◽

M.-L. Ilmoja ◽

H. Pisarev ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Late Onset ◽

Neonatal Intensive Care Units ◽

Gram Negative ◽

Surveillance Cultures ◽

Late Onset Sepsis

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Staphylococcus capitis isolated from bloodstream infections: a nationwide 3-month survey in 38 neonatal intensive care units

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-020-03925-5 ◽

2020 ◽

Vol 39 (11) ◽

pp. 2185-2194

Author(s):

Marie Decalonne ◽

Sandra Dos Santos ◽

Rémi Gimenes ◽

Florent Goube ◽

Géraldine Abadie ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Late Onset ◽

Bloodstream Infections ◽

Neonatal Intensive Care Units ◽

Staphylococcus Capitis ◽

Clone Evolution ◽

Preterm Babies ◽

Median Birth Weight

Abstract To increase the knowledge about S. capitis in the neonatal setting, we conducted a nationwide 3-month survey in 38 neonatal intensive care units (NICUs) covering 56.6% of French NICU beds. We demonstrated 14.2% of S. capitis BSI (S.capBSI) among nosocomial BSIs. S.capBSI incidence rate was 0.59 per 1000 patient-days. A total of 55.0% of the S.capBSIs were late onset catheter-related BSIs. The S. capitis strains infected preterm babies (median gestational age 26 weeks, median birth weight 855 g). They were resistant to methicillin and aminoglycosides and belonged to the NRCS-A clone. Evolution was favorable in all but one case, following vancomycin treatment.

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