Antibiotic Resistance Patterns of Bacterial Isolates from Neonatal Sepsis Patients at University Hospital of Leipzig, Germany

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.

Teicoplanin Resistance in Gram-Positive Bacterial Isolate: An Emerging Threat

“…Gram-negative bacteria were tremendous (83.3%) in the present study which was similar to Vaghela et al [15], Paul et al [16], and Santwana Pandey et al [17]. However, this contrasts with other studies where Gram-positive organisms were predominant like Belay et al [18], Muley et al [19], Pan et al [20], and Sorsa et al [21]. This variation of blood culture isolates may be due to various factors such as geographical location, seasonal variation, and endemicity of etiological agents.…”

Gram-negative bacteria isolates and their antibiotic-resistance patterns among pediatrics patients in Ethiopia: A systematic review

“…The results were closed similarly with studies done in University Hospital of Leipzig, Germany, and Nepal. 45 , 46 This might be due to the proximity of the anal opening to the urethra as E.coli resides as commensals in the gastrointestinal tract. In contrast, a study conducted in Iran explained that the most common isolated bacteria were Acinetobacter species and E.coli , each account for 5.9%, isolated gram-negative bacteria.…”

Alarming level of single or multidrug resistance in poultry environments‐associated extraintestinal pathogenic Escherichia coli pathotypes with potential to affect the One Health

“…Additionally, increased infections associated with drug-resistant ExPEC strains especially strains resistant to multiple drugs such as UPEC pose a severe threat to global health (Iqbal et al, 2016;Walker et al, 2016;Gandra et al, 2019). Over the past few years, a growing body of evidence has been established that extensive and routine use of antimicrobials in animal production, especially, in poultry is contributing to the overall burden of the effectiveness of antimicrobials (Chantziaras et al, 2014;Van Boeckel et al, 2014;Van Boeckel et al, 2015;Brower et al, 2017;van Boeckel et al, 2020). Studies conducted in a few regions of the world have reported the presence of antimicrobial resistance (AMR) in ExPEC associated with poultry (Cortés et al, 2010;Johnson et al, 2012;Sary et al, 2019;Zou et al, 2021).…”

“…In most developing countries, including India, antimicrobials are extensively used in animal production, especially in poultry (Van Boeckel et al, 2015). Recently, a study indicated a strong correlation between the unregulated uses of antimicrobials in broiler/layer farms of India and the emergence of AMR in E. coli (van Boeckel et al, 2020). However, with some exceptions (Kar et al, 2015;Hussain et al, 2017) in India, little is known about the presence of AMR in poultry environments-sourced ExPEC strains, especially no information available on ExPEC pathotypes.…”