Correlation of Bacterial Type and Antibiotic Sensitivity with Maternal Antibiotic Exposure in Early-Onset Neonatal Sepsis

Bromiker, Ruben; Ernest, Netanela; Meir, Maskit Bar; Kaplan, Michael; Hammerman, Cathy; Schimmel, Michael S.; Schlesinger, Yechiel

doi:10.1159/000342215

Cited by 17 publications

(12 citation statements)

References 29 publications

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“…Previous studies demonstrated the importance of considering these aspects of antenatal antimicrobial exposure. 7,16,19 Comprehensive antimicrobial resistance profiles were not captured within the dataset. Ampicillin resistance secondary to narrow spectrum beta-lactamases does not reliably predict resistance to first-generation cephalosporins.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Escherichia coli Bloodstream Infections

Bergin¹,

Thaden²,

Ericson³

et al. 2015

Pediatric Infectious Disease Journal

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Background Escherichia coli is a common cause of bloodstream infections (BSI) in infants and is associated with high mortality and morbidity among survivors. The clinical significance of antibiotic resistance and timing of appropriate antimicrobial therapy in this population is poorly understood. Methods We identified all infants with E. coli BSIs discharged from 77 neonatal intensive care units managed by the Pediatrix Medical Group in 2012. We used multivariable logistic regression to evaluate the association between 30-day mortality and ampicillin-resistant E. coli BSI, as well as the number of active empiric antimicrobial agents administered, controlling for gestational age, small-for-gestational age status, early- versus late-onset BSI, oxygen requirement, ventilator support, and inotropic support on the day of the first positive blood culture. Results We identified 258 episodes of E. coli BSI, including 123 (48%) ampicillin-resistant isolates. Unadjusted 30-day mortality did not significantly differ between infants with ampicillin-resistant vs. -susceptible E. coli BSI (11/123 [9%] vs. 7/135 [5%]; p=0.33; adjusted odds ratio=1.37 [95% confidence interval 0.39, 4.77]). Among ampicillin-resistant E. coli BSIs, 30-day mortality was not significantly lower for infants treated with at least one empiric antimicrobial active against ampicillin-resistant E. coli vs. infants receiving no active empiric agent (adjusted odds ratio=1.50 [0.07, 33.6]). Conclusions In this population of infants with E. coli BSI, ampicillin resistance was not associated with significantly increased mortality. Among the subset of infants with ampicillin-resistant E. coli, appropriate empirical antibiotic therapy was not associated with lower mortality.

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Section: Discussionmentioning

confidence: 99%

Neonatal Escherichia coli Bloodstream Infections

Bergin¹,

Thaden²,

Ericson³

et al. 2015

Pediatric Infectious Disease Journal

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“…Host factors could specifically predispose a newborn to infections by antibiotic-resistant GNB. Several studies have reported an increased risk of neonatal infections by antibiotic-resistant pathogens with intrapartum exposure to ampicillin [34][35][36][37][38]. Penicillins are typically the recommended intrapartum antibiotic given to women with group B Streptococci (GBS) colonization to reduce the risk of early neonatal sepsis [39].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors for antimicrobial resistance among newborns with gram-negative sepsis

et al. 2021

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Introduction Newborn sepsis accounts for more than a third of neonatal deaths globally and one in five neonatal deaths in Ethiopia. The first-line treatment recommended by WHO is the combination of gentamicin with ampicillin or benzylpenicillin. Gram-negative bacteria (GNB) are increasingly resistant to previously effective antibiotics. Objectives Our goal was to estimate the prevalence of antibiotic-resistant gram-negative bacteremia and identify risk factors for antibiotic resistance, among newborns with GNB sepsis. Methods At a tertiary hospital in Ethiopia, we enrolled a cohort pregnant women and their newborns, between March and December 2017. Newborns who were followed up until 60 days of life for clinical signs of sepsis. Among the newborns with clinical signs of sepsis, blood samples were cultured; bacterial species were identified and tested for antibiotic susceptibility. We described the prevalence of antibiotic resistance, identified newborn, maternal, and environmental factors associated with multidrug resistance (MDR), and combined resistance to ampicillin and gentamicin (AmpGen), using multivariable regression. Results Of the 119 newborns with gram-negative bacteremia, 80 (67%) were born preterm and 82 (70%) had early-onset sepsis. The most prevalent gram-negative species were Klebsiella pneumoniae 94 (79%) followed by Escherichia coli 10 (8%). Ampicillin resistance was found in 113 cases (95%), cefotaxime 104 (87%), gentamicin 101 (85%), AmpGen 101 (85%), piperacillin-tazobactam 47 (39%), amikacin 10 (8.4%), and Imipenem 1 (0.8%). Prevalence of MDR was 88% (n = 105). Low birthweight and late-onset sepsis (LOS) were associated with higher risks of AmpGen-resistant infections. All-cause mortality was higher among newborns treated with ineffective antibiotics. Conclusion There was significant resistance to current first-line antibiotics and cephalosporins. Additional data are needed from primary care and community settings. Amikacin and piperacillin-tazobactam had lower rates of resistance; however, context-specific assessments of their potential adverse effects, their local availability, and cost-effectiveness would be necessary before selecting a new first-line regimen to help guide clinical decision-making.

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“…In the current study, we found that antibiotic use during delivery and artificial rupture of the membrane were statistically significant higher among the carrier neonates compared to all non-carrier neonates and compared to non-carrier neonates born to a carrier mother. ESBL and MRSA carriage rates among newborns were previously associated with antibiotic use [14,[40][41][42]. Antibiotic use during delivery may contribute to the development or survival of resistant bacteria in the pregnant mother that may transmit to the neonate while passing through the birth canal.…”

Section: Risk Factors For Neonatal Colonizationmentioning

confidence: 99%

Mother-to-Neonate Transmission of Antibiotic-Resistant Bacteria: A Cross-Sectional Study

et al. 2021

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We evaluated carriage rates of extended spectrum β-lactam-producing Enterobacterales (ESBL-E), Carbapeneme-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) among pregnant women and determined the maternal-to-neonate transmission rates of these antibiotic-resistant bacteria (ARB). Pregnant women provided rectal and vaginal samples, proximal to delivery. Stool samples were collected from newborns within 48 h of birth. All samples were cultured on selective media for ARB identification. Clinical and demographic data were collected from the participants’ medical files. We performed molecular and phenotypic characterization of the different resistance mechanisms, and determined the isolates’ antibiotic susceptibility and biofilm-forming ability. The prevalence of ESBL-E, MRSA and VRE among pregnant women were 16%, 6% and 1%, respectively. The prevalence of ESBL-E and MRSA among neonates were 7.6% and 1.6%, respectively. Maternal-to-neonate transmission rates of ESBL-E and MRSA were 48% and 27.8%, respectively. Maternal and neonatal isolates shared similar characteristics. Maternal-to-neonate transmission of ARB plays an important role in bacterial colonization in newborns. Future studies should investigate the outcomes of the high ESBL-E transmission rate. The biofilm-forming ability of ARB was found to affect transmission. Additional factors should be investigated in order to understand the differences between transmitted and non-transmitted bacteria.

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Correlation of Bacterial Type and Antibiotic Sensitivity with Maternal Antibiotic Exposure in Early-Onset Neonatal Sepsis

Cited by 17 publications

References 29 publications

Neonatal Escherichia coli Bloodstream Infections

Neonatal Escherichia coli Bloodstream Infections

Prevalence and risk factors for antimicrobial resistance among newborns with gram-negative sepsis

Mother-to-Neonate Transmission of Antibiotic-Resistant Bacteria: A Cross-Sectional Study

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