Multidrug resistance in the neonatal unit and its therapeutic implications

Background Neonatal septicemia constitutes an important causeof morbidity and mortality among neonates in Indonesia. The ex-cessive use of antibiotics may cause antibiotic resistant bacteriaand may cause neonatal fungal infection.Objective To investigate the spectrum of organisms which causeneonatal sepsis and assess their sensitivity to various groups ofdrugs in the neonatal unit.Methods A prospective study conducted on newborn babies de-livered in Cipto Mangunkusumo Hospital, Jakarta from July 2004-May 2005 who presented clinical signs of septicemia were sub-jected for blood culture. Those sensitive to antibiotics for 7 daysyet showed no clinical improvement were also cultured for fungi.Results A total of 499 blood cultures were taken, 320 were posi-tive for bacteria (positivity rate was 65.3%). There were 192 samplescultured for fungi, and the positivity rate was 64% (all for Candidasp). Acinetobacter calcoaceticus was the most common bacteriafound (35.7%), followed by Enterobacter sp (7.0%), and Staphylo-coccus sp (6.8%). Most bacteria showed high degrees of resis-tance to commonly used antibiotics (ampicillin and gentamicin).There were also high degrees of resistance to cephalosporins byboth Gram negative and Gram positive organisms. Only 61.7% ofA. calcoaceticus, and 45.7% of Enterobacter sp were sensitive toceftazidime. Gram negative organisms were also highly resistantto amikacin, but Staphylococcus sp was only moderately resis-tant. Resistance to carbapenem (meropenem and imipenem) var-ied from moderate to low. Drugs which were not used for newbornbabies (quinolones/ciprofloxacin and chloramphenicol) varied frommoderate to high resistance.Conclusion Neonatal sepsis remains one of the major causes ofmortality in our neonatal unit. Most organisms have developedmultidrug resistance, and management of patients infected withthese organisms and especially those with fungi infection are be-coming a problem in developing countries

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Emergence of multidrug-resistant gram-negative organisms in a neonatal unit and the therapeutic implications

Journal of Tropical Pediatrics ◽

10.1093/tropej/46.2.86 ◽

2000 ◽

Vol 46 (2) ◽

pp. 86-91 ◽

Cited By ~ 32

Author(s):

R. Musoke

Keyword(s):

Multidrug Resistant ◽

Neonatal Unit ◽

Gram Negative ◽

Therapeutic Implications ◽

Gram Negative Organisms

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Nosocomial acquisition and transmission of antibiotic-resistant Gram-negative organisms in the pediatric intensive care unit

The Pediatric Infectious Disease Journal ◽

10.1097/00006454-200106000-00013 ◽

2001 ◽

Vol 20 (6) ◽

pp. 612-618 ◽

Cited By ~ 14

Author(s):

PHILIP TOLTZIS ◽

JEFFREY L. BLUMER

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Antibiotic Resistant ◽

Gram Negative ◽

Gram Negative Organisms

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Factors influencing colonisation with gentamicin resistant gram negative organisms in the neonatal unit.

Archives of Disease in Childhood ◽

10.1136/adc.63.5.533 ◽

1988 ◽

Vol 63 (5) ◽

pp. 533-535 ◽

Cited By ~ 19

Author(s):

D Isaacs ◽

J Catterson ◽

P L Hope ◽

E R Moxon ◽

A R Wilkinson

Keyword(s):

Neonatal Unit ◽

Gram Negative ◽

Factors Influencing ◽

Gram Negative Organisms

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Effect of Antibiotic Heterogeneity on the Development of Infections with Antibiotic-resistant Gram-negative Organisms in a Non-intensive Care Unit Surgical Ward

World Journal of Surgery ◽

10.1007/s00268-005-0781-7 ◽

2006 ◽

Vol 30 (7) ◽

pp. 1269-1276 ◽

Cited By ~ 9

Author(s):

Yoshio Takesue ◽

Hiroki Ohge ◽

Mitsuru Sakashita ◽

Takeshi Sudo ◽

Yoshiaki Murakami ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antibiotic Resistant ◽

Gram Negative ◽

Surgical Ward ◽

Gram Negative Organisms

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Patients’ Bath Basins as Potential Sources of Infection: A Multicenter Sampling Study

American Journal of Critical Care ◽

10.4037/ajcc2009968 ◽

2009 ◽

Vol 18 (1) ◽

pp. 31-40 ◽

Cited By ~ 45

Author(s):

Debra Johnson ◽

Lauri Lineweaver ◽

Lenora M. Maze

Keyword(s):

Bacterial Colonization ◽

Gram Negative ◽

Sterile Culture ◽

Hospital Acquired Infections ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Gram Negative Organisms ◽

A Prospective Study ◽

Hospital Acquired ◽

Rates Of Growth

Background Nosocomial infections are a marked burden on the US health care system and are linked to a high number of patient deaths. Objective To identify and quantify bacteria in patients’ bath basins and evaluate the basins as a possible reservoir for bacterial colonization and a risk factor for subsequent hospital-acquired infection. Methods In a prospective study at 3 acute care hospitals, 92 bath basins, including basins from 3 intensive care units, were evaluated. Sterile culture sponges were used to obtain samples from the basins. The culture sponges were sent to an outside laboratory, and qualitative and quantitative microbial tests were conducted and the results reported. Results Some form of bacteria grew in 98% of the samples (90 sponges), either by plating or on enrichment (95% confidence interval, 92%–99.7%). The organisms with the highest positive rates of growth on enrichment were enterococci (54%), gram-negative organisms (32%), Staphylococcus aureus (23%), vancomycin-resistant enterococci (13%), methicillin-resistant S aureus (8%), Pseudomonas aeruginosa (5%), Candida albicans (3%), and Escherichia coli (2%). Mean plate counts, in colony-forming units, were 10 187 for gram-negative organisms, 99 for E coli, 30 for P aeruginosa, 86 for S aureus, 207 for enterococci, and 31 for vancomycin-resistant enterococci. Conclusions Bath basins are a reservoir for bacteria and may be a source of transmission of hospital-acquired infections. Increased awareness of bath basins as a possible source of transmission of hospital-acquired infections is needed, particularly for high-risk patients.

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Antibiotic-Resistant Gram-Negative Organisms in Pediatric Chronic-Care Facilities

Clinical Infectious Diseases ◽

10.1086/338957 ◽

2002 ◽

Vol 34 (6) ◽

pp. 760-766 ◽

Cited By ~ 17

Author(s):

Karen Lidsky ◽

Claudia Hoyen ◽

Ann Salvator ◽

Louis B. Rice ◽

Philip Toltzis

Keyword(s):

Chronic Care ◽

Antibiotic Resistant ◽

Gram Negative ◽

Care Facilities ◽

Gram Negative Organisms

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Pivmecillinam in the Treatment of Childhood Pyelonephritis

Journal of International Medical Research ◽

10.1177/030006058301100209 ◽

1983 ◽

Vol 11 (2) ◽

pp. 113-115 ◽

Cited By ~ 1

Author(s):

Ingemar Helin

Keyword(s):

Urinary Tract Infection ◽

Body Weight ◽

Urinary Tract ◽

Upper Urinary Tract ◽

Gram Positive ◽

Gram Negative ◽

E Coli ◽

Gram Negative Organisms ◽

A Prospective Study ◽

Klebsiella Spp

In a prospective study, twenty children with a mean age of 4 years were treated with pivmecillinam, 25 mg to 40 mg per kilogram body-weight and day, for acute pyelonephritis. Urine cultures yielded growth of E. coli in sixteen instances, Klebsiella spp. in two, S. saprophyticus in one and a mixed Gram-positive flora in one patient. All children fulfilled the diagnostic criteria for upper urinary tract infection. In all cases where Gram-negative pathogens were responsible, the infections were eradicated. One reinfection was registered in a child with a concomitantly discovered congenital urological malformation. Pivmecillinam also cured one patient infected with S. saprophyticus but was ineffective in the case of mixed Gram-positive flora. It is concluded that pivmecillinam is a valuable new drug for the management of pyelonephritis in children, as most of these infections are caused by Gram-negative organisms.

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Catheter-related blood stream infections in hemodialysis patients

Journal of Renal Injury Prevention ◽

10.34172/jrip.2020.34 ◽

2020 ◽

Vol 9 (4) ◽

pp. e34-e34

Author(s):

Babak Hadian ◽

Azita Zafarmohtashami ◽

Mahdi Razani

Keyword(s):

Staphylococcus Aureus ◽

Clinical Signs ◽

Blood Stream ◽

Multidrug Resistant ◽

Hemodialysis Patients ◽

Empirical Treatment ◽

Gram Positive ◽

Gram Negative ◽

Gram Negative Organisms ◽

Clinical Records

Introduction: Proper care of vascular access in hemodialysis patients is important. Catheter-related bloodstream infection (CRBSI), is a life-threatening complication of hemodialysis. Objectives: Sufficient data about microorganisms and their susceptibility to antibiotics in hemodialysis patients is necessary for handling of CRBSI; therefore, this study performed for better management of patients. Patients and Methods: All hemodialysis patients from March 2015 to March 2018 who had cultures of catheter and blood samples were studied. Clinical records of 122 patients were reviewed for variables such as catheter and blood culture microorganism types, antibiotic resistance, age, gender, site, comorbidities, and various clinical signs. Results: Eighty-four cases of catheter cultures were positive for bacteria. Staphylococcus epidermidis was the most common organism (36%) since Staphylococcus aureus was the second one (28%). In some cases, multidrug resistant organisms such as Enterobacter baumannii or methicillin-resistant Staphylococcus aureus (MRSA) organisms were grown. Twenty-one percent of S. aureus organisms were MRSA. No significant association between important diagnostic data (fever, chills or WBC count) and bacteremia were shown. Gender of patients had a significant statistical association with CRBSI. Conclusion: Given the necessity of proper management, physicians must empirically initiate antibiotic therapy as soon as possible, until receiving definite culture results, in hemodialysis patients suspected of bacteremia. In our study, both gram-positive and gram-negative organisms were common. Hence, when initial empirical treatment is indicated, the coverage of both gram positive and gram negative organisms must be considered. Vancomycin or other antibiotics that are effective on MRSA must be included in empirical treatment.

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2297. Epidemiology of Antibiotic-resistant Pathogens and Empiric Treatment Patterns in Community-Onset Sepsis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1975 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S787-S787

Author(s):

Chanu Rhee ◽

Sameer S Kadri ◽

John P Dekker ◽

Robert L Danner ◽

Huai-Chun Chen ◽

...

Keyword(s):

Empiric Therapy ◽

Treatment Patterns ◽

Antibiotic Resistant ◽

Gram Negative ◽

Empiric Treatment ◽

Extended Spectrum ◽

Gram Negative Organisms ◽

Inappropriate Empiric Therapy ◽

Culture Positive ◽

Community Onset

Abstract Background Guidelines recommend immediate empiric broad-spectrum antibiotics for all patients with suspected sepsis. Understanding the epidemiology of antibiotic-resistant pathogens and empiric treatment patterns in sepsis could inform improvements in antibiotic utilization and outcomes. Methods We identified adults admitted during 2009–2015 to 104 US hospitals in the Cerner HealthFacts dataset who met CDC Adult Sepsis Event criteria and had positive clinical cultures within 2 days of admission. We characterized prevalence and empiric treatment rates for methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococcus (VRE), ceftriaxone-resistant Gram-negative organisms (CRO) (including P. aeruginosa), and extended-spectrum β-lactamase Gram-negative organisms (ESBL). We evaluated associations between in-hospital mortality and either inappropriate empiric therapy (antibiotics inactive against any isolated pathogen) or excessively broad therapy (empiric MRSA or VRE coverage, extended spectrum β-lactam, or carbapenem therapy when targeted organisms were absent), adjusting for baseline characteristics and severity-of-illness. Results The cohort included 17,962 patients with culture-positive sepsis; 2,965 (16.5%) died in-hospital. The most common culture-positive sites were urine (51.2%), blood (41.8%), and respiratory (16.5%). The most common pathogens were E. coli (33.0%), S. aureus (20.9%), and Streptococcus (13.2%) (Figure 1). Most (81.6%) patients received empiric antibiotics active against all isolated pathogens. Empiric therapy was directed at resistant organisms in 67.5% of cases (primarily vancomycin and extended spectrum β-lactams, Figure 2), but resistant organisms were isolated in only 25.2% (MRSA 11.5%, CRO 12.9%, VRE 2.0%, ESBL 0.8%). Both inappropriate empiric therapy and excessively broad empiric therapy were associated with higher mortality on multivariate analysis (OR 1.30, 95% CI 1.14–1.48 and OR 1.20, 95% CI 1.05–1.38, respectively). Conclusion Most patients with community-onset sepsis do not have resistant pathogens, yet empiric broad-spectrum antibiotics are frequently prescribed. Both inappropriate empiric therapy and excessively broad therapy are associated with worse outcomes. Disclosures All authors: No reported disclosures.

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