Antimicrobial-resistant Gram-negative infections in neonates: burden of disease and challenges in treatment

Folgori, Laura; Bielicki, Julia; Heath, Paul T; Sharland, Mike

doi:10.1097/qco.0000000000000371

Cited by 72 publications

(71 citation statements)

References 45 publications

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“…These resistance markers can be acquired either by chromosomal mutations or horizontal gene transfer [41][42]. Neonatal infection with P. aeruginosa is mostly acquired due to their underdeveloped immune system, especially when these infants are catheterized with intravascular catheters/devices and/or receiving parenteral nutrition, [43][44]. Almost all P. aeruginosa isolates in this study were resistant for one or more commonly used antibiotics in treatment of Pseudomonas infections, especially to carbapenems (meropenem and impenem) ( Table 3).…”

Section: Discussionmentioning

confidence: 89%

Intestinal colonization of infants with multidrug resistant Pseudomonas aeruginos in tertiary care center in Jordan

Shehabi¹,

Shishtawi²,

Al-lawama³

2019

int. arab. j antimicrob. agents

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Background: Pseudomonas.aeruginosa is among the most common opportunistic hospital pathogens, which exhibit an innate resistance and has developed increasing resistance to many useful antimicrobial agents over the last decades. This study investigated the occurrence of important types of ESBLs and MBLs in association with potential important virulence factors among P. aeruginosa isolates from feces of Jordanian infants. Methods: A total of 302 feces samples were obtained randamely from neonates and infants admitted to Pediatric Clinic and the Neonate Intensive Care Unit (NICU)/Jordan University Hospital (JUH), over a 9-months period(2016- 2017). Fecal samples were cultured for P.aeruginosa and their growth was identified and tested using microbiological and antibiotic susceptibility methods. Additionly, virulence factors, antimicrobial resistance genes and genotypes were detected using Polymerase Chain Reaction (PCR). Results: A total of 16/302 (5.3%) of P. aeruginosa isolates were recovered from feces samples. Antimicrobial susceptibility of the isolates ranged between the lowest 18.75% to meropenem and highest of 87.5% to azetreonam among 9 tested drugs. The percentage of specific genes of ESBLs and MBLs in 16 P.aeruginosa isolates were the following: blaOXA-50, blaTEM, blaCTX-M , blaVIM ,blaKPC , blaSHV ,blaGES, and blaVEB were detected at the rate of 13(81.2%), 13(81.2%), 12(75%), 12(75%), 11(68.7%), 10(62.5%), 2(12.5),1(6.2%), respectively. The percentage of the potential virulence genes in the same isolates were detected as follow: lasB, algD , toxA, exo S and exo U at the rate of 100%, 87.5% , 81.2%, 81.2%,31.2, respectively. All P.aeruginosa isolates observed to develop beta-hemolysis on both human and sheep blood agar, and to produce either pyoverdin ((56.3%) or pyocyanin (43.7%). Conclusions: The present study demonstrates high occurrence of multidrug resistant P.aeruginosa isolates in infant feces which carried high rates of important genes of ESBLs and MBLs and potential virulence factors.

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Section: Discussionmentioning

confidence: 89%

Intestinal colonization of infants with multidrug resistant Pseudomonas aeruginos in tertiary care center in Jordan

Shehabi¹,

Shishtawi²,

Al-lawama³

2019

int. arab. j antimicrob. agents

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“…Infections are one of the most common complications in the NICU; they lead to an increase in morbidity and mortality, an extended length of stay, and higher hospital costs, especially in the case of multidrug resistant microorganisms. 1 Although, in general, the most common microorganisms observed in the NICU are Gram-positive cocci, the incidence of Gramnegative infections and multidrug resistant microorganisms has increased in recent years. 4 The emergence of MDRGN bacilli, especially those resistant to carbapenems, is a diagnostic and therapeutic challenge in the neonatal population because the evidence is limited to case series or small outbreaks, in addition to the scarce availability of treatments with proven effectiveness and safety, as well as the multiple hurdles caused by the implementation of adequate isolation measures at the NICU.…”

Section: Discussionmentioning

confidence: 99%

“…Increasing antibiotic resistance, together with restrictions in new drug development, especially in the neonatal population, makes multidrug resistant bacterial infections an ongoing problem that increases the risk for morbidity and mortality. 1 An adequate empirical therapy for severe bacterial infections is critically relevant to reduce mortality, and carbapenems are still the initial treatment of choice for hospitalacquired infections in most neonatal intensive care units (NICUs).…”

Section: Introductionmentioning

confidence: 99%

Multidrug resistant Gram-negative infections in neonatology

et al. 2019

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Introduction. Multidrug resistant Gramnegative (MDRGN) infections are an increasing problem in neonatal intensive care units. The objective of this study was to establish the epidemiological, clinical, microbiological, and evolutionary characteristics of carbapenemresistant MDRGN infections and the risk factors for them at the Division of Neonatology of a tertiary care hospital. Population and method. A retrospective cohort study was done in this Division in patients with a documented MDRGN infection between 4/24/2013 and 4/29/2015. Results. Twenty-one patients were included. Their median gestational age and birth weight were 35 weeks and 2070 g, respectively. Eighteen patients (86 %) had a positive blood culture; the most commonly isolated microorganism was Acinetobacter baumannii (17 patients, 81 %), followed by carbapenemase-producing Klebsiella pneumoniae (3 patients, 14 %) and Enterobacter cloacae (1 patient, 5 %). The median age at diagnosis was 28 days and all patients had risk factors for infection, including surgery, assisted mechanical ventilation, parenteral nutrition, central venous line, and antibiotics. The definite antibiotic therapy included colistin in all cases; in combination, in 84 %. Five patients (24 %) died due to the infection. Prematurity and a birth weight < 2000 g were statistically significant risk factors associated with mortality (p = 0.03 and 0.01, respectively). Conclusion. MDRGN infections were observed in patients with predisposing factors. Acinetobacter baumannii was the main etiologic agent. Mortality was high and related to prematurity and a low birth weight.

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“…Las infecciones son una de las complicaciones más frecuentes en las UCIN, que provocan un aumento en la morbimortalidad, así como la prolongación del tiempo de internación y mayores gastos hospitalarios, más aún en las infecciones por organismos multirresistentes. 1 A pesar de que los patógenos más frecuentes en las UCIN, en general, son los cocos Grampositivos, las infecciones por BGN han ido aumentando su incidencia en los últimos años, así como los organismos multirresistentes. 4 La emergencia de BGN-MR, en especial, resistentes a carbapenemes, representa un desafío diagnóstico y terapéutico en la población neonatal, ya que la evidencia se limita a reportes de series de casos o pequeños brotes, sumado a la escasa disponibilidad de tratamientos de probada eficacia y seguridad, así como las múltiples dificultades que genera la implementación de medidas adecuadas de aislamiento en las UCIN.…”

Section: Discussionunclassified

“…La resistencia creciente contra los antibióticos, junto con la limitación en el desarrollo de nuevas drogas, en especial, en la población neonatal, hacen que el manejo de las infecciones por bacterias multirresistentes sea un problema progresivo, que aumenta el riesgo de morbimortalidad. 1 El tratamiento empírico adecuado en las infecciones bacterianas graves tiene una importancia crucial en la reducción de la mortalidad, y los carbapenemes continúan siendo de elección para el tratamiento inicial de infecciones hospitalarias en gran parte de las unidades de cuidados intensivos neonatales (UCIN).…”

Section: Introductionunclassified

Infecciones por bacilos Gram-negativos multirresistentes en neonatología

2019

Arch Argent Pediat

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RESUMEN Introducción. Las infecciones por bacilosGram-negativos multirresistentes (BGN-MR) constituyen un problema creciente en las unidades de cuidado intensivo neonatal. El objetivo del estudio fue conocer las características epidemiológicas, clínicas, microbiológicas, evolutivas y los factores de riesgo de infección por BGN-MR resistentes a carbapenemes en el Servicio de Neonatología de un hospital de alta complejidad. Población y método. Se realizó un estudio de cohorte retrospectivo en dicho Servicio, donde se incluyeron los pacientes con infección documentada por BGN-MR del 24/4/2013 al 29/4/2015. Resultados. Se incluyeron 21 pacientes. La mediana de edad gestacional y peso de nacimiento fue 35 semanas y 2070 gramos, respectivamente. Dieciocho pacientes (86 %) tuvieron hemocultivos positivos y el aislamiento microbiológico más frecuente fue Acinetobacter baumannii (17 pacientes, 81 %), seguido por Klebsiella pneumoniae productora de carbapenemasa (3 pacientes, 14 %) y Enterobacter cloacae (1 paciente, 5 %). La mediana de edad al momento del diagnóstico fue de 28 días y todos tenían factores de riesgo para la infección, como cirugía, asistencia respiratoria mecánica, nutrición parenteral, catéter central y antibióticos. El tratamiento antibiótico definitivo fue colistina en todos los casos, combinado en el 84 %. Cinco pacientes (24 %) fallecieron por la infección. La prematurez y el peso < 2000 g fueron factores de riesgo estadísticamente significativos asociados a la mortalidad (p = 0,03 y 0,01, respectivamente). Conclusión. Las infecciones por BGN-MR se presentaron en pacientes con factores predisponentes. Acinetobacter baumannii fue el primer agente etiológico. La mortalidad fue elevada y relacionada con prematurez y bajo peso al nacer. Palabras clave: farmacorresistencia bacteriana múltiple, bacterias Gram-negativas, recién nacido.

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Antimicrobial-resistant Gram-negative infections in neonates: burden of disease and challenges in treatment

Cited by 72 publications

References 45 publications

Intestinal colonization of infants with multidrug resistant Pseudomonas aeruginos in tertiary care center in Jordan

Intestinal colonization of infants with multidrug resistant Pseudomonas aeruginos in tertiary care center in Jordan

Multidrug resistant Gram-negative infections in neonatology

Infecciones por bacilos Gram-negativos multirresistentes en neonatología

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