Clinical outcome of neonates with Carbapenem-resistant Enterobacteriaceae infections at the King Edward VIII Hospital’s neonatal unit, Durban, South Africa

Mzimela, Bongani W; Nkwanyana, None Ntombifikile M.; Singh, Rachna

doi:10.4102/sajid.v36i1.223

Cited by 6 publications

(12 citation statements)

References 14 publications

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“…Patient demographics for the cohort were similar to those described in the literature: prematurity, low birthweight, previous NICU admission and the need for invasive and/or non-invasive ventilation. 7 , 27 , 28 …”

Section: Discussionmentioning

confidence: 99%

“…Median age of presentation was 14 days in a Gauteng neonatal unit looking at multidrug-resistant Enterobacterales (MDRE), including CRE and 10.5 days in a KwaZulu-Natal study on CRE-infected neonates. 7 , 27 Carbapenem-resistant Enterobacterales infection should therefore be considered in at-risk neonates with long hospital stays and among those with HAI episodes not responding to initial antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

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Colistin use in a carbapenem-resistant Enterobacterales outbreak at a South African neonatal unit

Abrahams

Dramowski

Moloto

et al. 2023

Southern African Journal of Infectious Diseases

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Background: Colistin is increasingly prescribed for neonates with carbapenem-resistant Enterobacterales (CRE) infections.Objectives: We described patient demographics, infection episodes, treatment and clinical outcomes, colistin related adverse events and relatedness of isolates in neonates with clinically confirmed or clinically suspected CRE infections.Method: The authors retrospectively reviewed culture-confirmed and clinically suspected culture-negative CRE infections at a South African neonatal unit during a CRE outbreak.Results: Fifty-three neonates (median gestational age 29 weeks and birth weight 1185 g) were included. Twenty-three of 53 neonates (43%) had culture-confirmed CRE (17 received colistin; 6 died without receiving colistin) and 30 (57%) received colistin for clinically suspected CRE infection but were ultimately culture-negative. Prior respiratory support and surgical conditions were present in 37/53 (70%) and 19/53 (36%) neonates, respectively. Crude mortality was high (20/53; 38%) with no significant difference between culture-confirmed CRE versus clinically suspected culture-negative CRE groups (10/23 [44%] vs 10/30 [33%]; p = 0.45). Hypomagnesaemia (10/38; 26%) and hypokalaemia (15/38; 40%) were frequent; acute kidney injury was rare (1/44; 2%). Three CRE infection clusters were identified by genotypic analysis of 20 available isolates (18 [90%] blaNDM-1 [New Delhi metallo-beta-lactamase], 2 [10%] blaOXA [oxacillinase]-48).Conclusion: Neonates receiving colistin therapy were predominantly preterm, with multiple risk factors for infection. Colistin-associated electrolyte derangement was frequent. Over one-third of neonates died. BlaNDM-1 was the most frequent carbapenemase gene identified in the outbreak isolates.Contribution: Colistin was safely used during an Enterobacterales outbreak in predominantly premature and surgical neonates. The mortality was high.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Colistin use in a carbapenem-resistant Enterobacterales outbreak at a South African neonatal unit

Abrahams

Dramowski

Moloto

et al. 2023

Southern African Journal of Infectious Diseases

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“…E. coli, K. pneumoniae , and Enterobacter cloacae are the major isolates of carbapenem-resistant Enterobacterales (CRE), which cause high morbidity and mortality rates and exhibit worldwide prevalence. 31 , 32 In K. pneumoniae , the rates of resistance to ertapenem and imipenem were severe, at 37.9% and 39.4%, respectively. However, it is encouraging to note that E. coli and Enterobacter cloacae remained highly susceptible to carbapenems.…”

Section: Discussionmentioning

confidence: 99%

Clinical Laboratory Features of Microbes That Cause Neonatal Sepsis: An 8-Year Retrospective Study

Jin

Wang

et al. 2022

IDR

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“…Shaw et al revealed that isolated Staphylococcus and Klebsiella were the most frequently involved pathogens [37]. There are other studies with similar positive blood culture reports [38][39][40]. Some studies mentioned above, however, showed a higher incidence of the gram-negative organism [38,[40][41][42].…”

Section: Discussionmentioning

confidence: 99%

The Role of C-reactive Protein Estimation in Determining the Duration of Antibiotic Therapy in Neonatal Sepsis

Chaudhuri¹,

Ghosh²,

Sinha³

et al. 2022

Cureus

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Introduction: Septicemia is globally considered the most important cause of neonatal morbidity and fatality. Serum C-Reactive Protein (CRP) is an acute phase reactant, which is brought out in response to the inflammatory reaction. It is prophesied to drop down speedily after the coherent weeding out of microbial incitation due to the short half-life of CRP. CRP levels reflect the individual's association between microbial infection and defensive mechanisms. Methods: This hospital-based cross-sectional study included 150 admitted patients with suspected sepsis in the Department of Pediatrics, Rajendra Institute Medical Sciences (RIMS), Ranchi, India, over a study period of one year (2020 to 2021). CRP was estimated on the day of admission and repeated after 72 hours, on the fifth day, and on the seventh day for serial values of CRP, and the findings were compared by making three groups. Further, the research participants were designated to three different groups according to the CRP estimation levels. Results: Out of the 150 assumed neonatal septicemia patients, antibiotics were paused in 42 neonates (28%) within 72 hours. In group 2, 8% of neonates’ antibiotics were stopped in five days, and a total of 102 neonates (68%) could be discharged on the seventh day of antibiotic therapy as their CRPs became negative on the third day and seventh day consecutively, along with negative blood culture reports. In group 3, antibiotics of 48 neonates (32%) were continued beyond seven days. Conclusion: CRP has a skyscraping specificity and negative predictive values (NPV); thus, by estimating serial CRPs, the antibiotic therapy duration can be determined, which further helps determine the period of hospitalization.

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Clinical outcome of neonates with Carbapenem-resistant Enterobacteriaceae infections at the King Edward VIII Hospital’s neonatal unit, Durban, South Africa

Cited by 6 publications

References 14 publications

Colistin use in a carbapenem-resistant Enterobacterales outbreak at a South African neonatal unit

Colistin use in a carbapenem-resistant Enterobacterales outbreak at a South African neonatal unit

Clinical Laboratory Features of Microbes That Cause Neonatal Sepsis: An 8-Year Retrospective Study

The Role of C-reactive Protein Estimation in Determining the Duration of Antibiotic Therapy in Neonatal Sepsis

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