Colonization with Multidrug-Resistant Bacteria in the First Week of Life among Hospitalized Preterm Neonates in Serbia: Risk Factors and Outcomes

Abstract

The aim of this prospective cohort study was to determine the prevalence of gut colonization with multidrug-resistant (MDR) bacteria, risk factors for colonization, infection risk, and outcomes among preterm neonates hospitalized at a tertiary-care center in Serbia. During the period from December 2017 to April 2018, 103 neonates were screened for rectal carriage at admission and on the seventh day of life. Characterization of MDR strains was done by conventional microbiology and molecular methods. Out of 61 (59.2%) colonized neonates, 12 (11.6%) were found colonized at admission, while 49 (47.6%) became colonized at the study site. Among a total of 72 MDR isolates, extended-spectrum beta-lactamase (ESBL)-producing enterobacteria prevailed (56/72, 77%), followed by Acinetobacter baumannii (14/72, 19%). The majority of ESBL-producing strains carried multiple genes (blaTEM/blaCTX-M-15 or blaTEM/blaSHV). Longer previous hospitalization and delivery by cesarean section were associated with MDR colonization, while mechanical ventilation was a risk factor for colonization at the study site. Infections due to MDR bacteria were more frequent among colonized than non-colonized neonates, but not significantly, and mortality was low (1%) in the studied neonates. These results indicate that hospitalized preterm neonates in Serbia are rapidly colonized with a diversity of MDR species and resistance phenotypes/genotypes.

Multi-resistant Bacteria to Antibiotics in Hospitals: The Case of Neonatology Services of the University Hospitals Centers of Abidjan, Côte d'Ivoire

“…Our results agree with those of Teklu et al, 2019 and Kagia et al, 2019 who also noted a high prevalence of the same germ [21,26]. Indeed, K. pneumoniae and E. coli are the Enterobacteriaceae frequently associated with the production of Beta-Lactamases although this resistance mechanism is also described in the genera Pseudomonas, Proteus, Citrobacter, Morganella, Salmonella [27]. In our study, more than 45% of E-ESBL were isolated from neonatal rectal carriage.…”

“…Studies conducted in Morocco have shown prevalence of 22.4% at the time of admission of newborns to the neonatal unit and 92.4% during their stay in the unit [13]. Other authors have reported a rate of 77% of rectal carriage E-ESBL in this age group [27]. In addition to the production of ESBLs in Enterobacteriaceae, the predominance of methicillin resistance was noted in 75.6% of Staphylococcus strains, including 61.3% of S. aureus.…”

Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers

“…In Tanzania (2017-2018), Tunisia (2015), Gabon (2010-2011), and Cambodia (2012), 56%, 28.6%, 45%, and 55% of the hospitalized children were carriers of ESBL-Ent, respectively [64][65][66][67]. In Serbia (2017-2018), gut carriage with ESBL-producing Kp (ESBL-Kp) or ESBL-producing Ec (ESBL-Ec) was recorded in 59% of the hospitalized pre-term neonates; previous hospitalization, delivery by cesarean section, and mechanical ventilation were associated with colonization [68]. In a study from Morocco (2013Morocco ( -2015, up to 59.4% and 12.5% of the neonatal ICU (NICU)-patients were colonized with ESBL-Ent and CPE, respectively [69].…”

Therapeutic Options and Outcomes for the Treatment of Neonates and Preterms with Gram-Negative Multidrug-Resistant Bacteria: A Systematic Review

“…ESBL-producing bacteria are the most widespread MDROs, with 10% of colonized neonates becoming infected [ 42 ]. Further, in addition to cephalosporins, different Enterobacterales species can also share some genetic elements with different patterns susceptible to other antibiotics [ 43 , 44 ].…”