Multidrug resistant Gram-negative infections in neonatology

Berberián, Griselda; Brizuela, Martín; Rosanova, María Teresa; Travaglianti, Mónica; Mastroiani, Alejandra; Reijtman, Vanesa; Fiorili, Graciela; Cruz, Dora Santa; Castro, Graciela

doi:10.5546/aap.2019.eng.6

Cited by 6 publications

(2 citation statements)

References 23 publications

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“…According to a Peruvian study, the incidence of LOS was high in very LBW infants, reaching 36.2% and even higher in extremely LBW infants (40.7%) ( 33 ). Further, LBW (< 2,000 g) was an important risk factor affecting the mortality of sick newborns with multidrug resistant gram-negative infections ( 34 ). On the contrary, birth weight ≥2,500 g was a significant protective factor against infection and death caused by drug-resistant strains.…”

Section: Discussionmentioning

confidence: 99%

Carbapenem-resistant Pseudomonas aeruginosa infections in critically ill children: Prevalence, risk factors, and impact on outcome in a large tertiary pediatric hospital of China

Huang

Wei²,

Xu³

et al. 2023

Front. Public Health

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Background and aimsCarbapenem-resistant Pseudomonas aeruginosa (CRPA) is a major cause of healthcare-associated infections worldwide, but comprehensive study of clinical characteristics for CRPA infections among critically ill children remains limited in China. The objective of this study was to determine the epidemiology, risk factors, and clinical outcomes of CRPA infections among critically ill pediatric patients in a large tertiary pediatric hospital in China.MethodsA retrospective case-control study of patients with P. aeruginosa infections was conducted in the three intensive care units (ICUs) of Shanghai Children's Medical Center from January 2016 to December 2021. All patients with CRPA infection in the ICUs were enrolled as case patients. Patients with carbapenem-susceptible P. aeruginosa (CSPA) infection were randomly selected as control patients in a ratio of 1:1. Clinical characteristics of those inpatients were reviewed through the hospital information system. Univariate and multivariate analyses were performed to evaluate risk factors associated with the development of CRPA infections and mortality of P. aeruginosa infections.ResultsA total of 528 cases of P. aeruginosa infection in the ICUs were enrolled in the 6-year study. The prevalence of CRPA and MDRPA (multidrug-resistance P. aeruginosa) was 18.4 and 25.6%, respectively. Significant risk factors related to CRPA infection were the length of hospitalization >28 days (OR = 3.241, 95% CI 1.622–6.473, p = 0.001), receiving invasive operations (OR = 2.393, 95% CI 1.196–4.788, p = 0.014) and a blood transfusion (OR = 7.003, 95% CI 2.416–20.297, p < 0.001) within 30 days before infection. Conversely, birth weight ≥2,500 g (OR = 0.278, 95% CI 0.122–0.635, p = 0.001) and breast nursing (OR = 0.362, 95% CI 0.168–0.777, p = 0.009) were significant protective factors against CRPA infections. The in-hospital mortality rate was 14.2%, and no difference in mortality was observed between patients with CRPA and CSPA infections. Platelet < 100 × 109/L (OR = 5.729, 95% CI 1.048–31.308, p = 0.044) and serum urea <3.2 mmol/L (OR = 5.173, 95% CI 1.215–22.023, p = 0.026) were independent predictors for the mortality due to P. aeruginosa infection.ConclusionsOur findings provide insights into CRPA infections among critically ill children in China. They provide guidance in identifying patients that may be at high risk for a resistant infection and emphasize the importance of antimicrobial stewardship and infection control in hospitals.

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Section: Discussionmentioning

confidence: 99%

Carbapenem-resistant Pseudomonas aeruginosa infections in critically ill children: Prevalence, risk factors, and impact on outcome in a large tertiary pediatric hospital of China

Huang

Wei²,

Xu³

et al. 2023

Front. Public Health

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“…CRKP is a serious threat in paediatric patients, particularly newborns, due to limited therapeutic options. 26,27 This pathogen is now considered as a reservoir for virulent and resistant genes, due to the acquisition of β-lactamase (carbapenemase and ESBLs) and the recently reported colistin resistance mcr-1 encoding genes; which make it a serious threat to human and animal. [28][29][30] These data revealed for the first time that NDM carbapenemase is widely spread among CRKP, while CTX-M and SHV were the most prevalent βlactamase in same isolates in Shenzhen's children Hospital, China.…”

Section: Discussionmentioning

confidence: 99%

Emergence of Klebsiella pneumoniae ST307 Co-Producing CTX-M with SHV and KPC from Paediatric Patients at Shenzhen Children’s Hospital, China

Patil

Chen

Guo

et al. 2021

IDR

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Aim:We investigated the clonal diversity of carbapenemase-producing Klebsiella pneumoniae isolates from the Shenzhen Children's Hospital, China, and drew conclusions on the clinical and public health impact of these isolates as multidrug-resistant. Methods: From January 2014 to December 2018, a total number of 36 unique carbapenemase-producing clinical isolates of Klebsiella pneumoniae were collected out of 900 clinical isolates in paediatric patients from the Shenzhen Children's Hospital, China. After carbapenemase production confirmation, antimicrobial susceptibility, resistance determinants and phylogenetic relationship were determined. Results: The isolates showed resistance to ceftazidime, ertapenem, ampicillin, cefazolin, ceftriaxone, cefotetan, ticarcillin, cefaclor, cefpodoxime, azlocillin, cefcapene, mezlocillin and ampicillin-sulbactam. Of the 36 Klebsiella pneumoniae carbapenemase genes coding isolates, bla NDM was the mostly detected 50% (n=18) followed by bla KPC and bla IMP 19% (n=7), bla VIM 17% (n=6), bla OXA-48-like 8% (n=3) and bla SME 5% (n=2), whereas extended-spectrum β-lactamase (bla SHV ) was predominantly detected 92% (n=33) followed by bla CTX-M 53% (n=19) and bla CMY 28% (n=10). Pulsed-field gel electrophoresis typing showed eight different patterns, and twenty-five distinct sequences types were observed with ST307 being predominantly identified 11% (n=4), followed by ST2407 8% (n=3). Plasmid replicon typing results indicated that IncFIS, IncHI2, IncFIC and IncFIA plasmids carry bla CTX-M, bla SHV and bla NDM genes. Conclusion:This study reports on the occurrence and spread of carbapenemase and extended-spectrum β-lactamase encoding genes co-existence in sporadic Klebsiella pneumoniae ST307 in paediatric patients from the Shenzhen Children's Hospital, China.

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Neonatal multidrug-resistant gram-negative infection: epidemiology, mechanisms of resistance, and management

et al. 2021

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Infants admitted to the neonatal intensive care unit, particularly those born preterm, are at high risk for infection due to the combination of an immature immune system, prolonged hospitalization, and frequent use of invasive devices. Emerging evidence suggests that multidrug resistant gram-negative (MDR-GN) infections are increasing in neonatal settings, which directly threatens recent and ongoing advances in contemporary neonatal care. A rising prevalence of antibiotic resistance among common neonatal pathogens compounds the challenge of optimal management of suspected and confirmed neonatal infection. We review the epidemiology of MDR-GN infections in neonates in the United States and internationally, with a focus on extended-spectrum β-lactamase (ESBL)-producing Enterobacterales and carbapenem-resistant Enterobacterales (CRE). We include published single center studies, neonatal collaborative reports, and national surveillance data. Risk factors for and mechanisms of resistance are discussed. Additionally, we discuss current recommendations for empiric antibiotic therapy for suspected infections, as well as definitive treatment options for key multidrug resistant organisms. Finally, we review best practices for prevention and identify current knowledge gaps and areas for future research.

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Multidrug resistant Gram-negative infections in neonatology

Cited by 6 publications

References 23 publications

Carbapenem-resistant Pseudomonas aeruginosa infections in critically ill children: Prevalence, risk factors, and impact on outcome in a large tertiary pediatric hospital of China

Carbapenem-resistant Pseudomonas aeruginosa infections in critically ill children: Prevalence, risk factors, and impact on outcome in a large tertiary pediatric hospital of China

Emergence of Klebsiella pneumoniae ST307 Co-Producing CTX-M with SHV and KPC from Paediatric Patients at Shenzhen Children’s Hospital, China

Neonatal multidrug-resistant gram-negative infection: epidemiology, mechanisms of resistance, and management

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