Outbreak of Extended Spectrum Beta Lactamase Producing Klebsiella Species Causing Neonatal Sepsis at Patan Hospital in Nepal

Amatya, Puja; Joshi, Suchita; Shrestha, Shrijana

doi:10.3126/jpahs.v1i1.13011

Cited by 3 publications

(2 citation statements)

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“…Among all isolates, Klebsiella pneumonia was the most common isolate, similar to observations in other NICUs [18,19]. In fact, this bacteria has been a predominantly persisting etiologic agent of sepsis outbreaks in Patan hospital NICU requiring intermittent shut down of the unit [21,22]. Increasing AMR of clinical Enterobacteriaceae isolates is a global public health threat [23].…”

Section: Discussionsupporting

confidence: 56%

Risk factors for the development of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal

Manandhar

Amatya

Ansari

et al. 2020

Preprint

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Background: Sepsis is an overwhelming and life-threatening response to bacteria in bloodstream and a major cause of neonatal morbidity and mortality. Understanding the etiology and potential risk factors for neonatal sepsis is urgently required, particularly in low-income countries where burden of pathogens is high and epidemiology is poorly understood.Methods: A prospective observational cohort study was conducted between April 2016 and October 2017 in a level three NICU of a tertiary care hospital in Nepal to determine the bacterial etiology and potential risk factors for neonatal sepsis.Results: Among 142 NICU admitted neonates, 15% (21/142) and 32% (46/142) developed blood culture-positive and -negative neonatal sepsis respectively. Klebsiella pneumoniae (34%, 15/44) and Enterobacter spp. (25%, 11/44) were the most common isolates. The antimicrobial resistance of isolates to ampicillin (100%, 43/43), cefotaxime (74%, 31/42) and ampicillin-sulbactam (55%, 21/38) were the highest with blaTEM (53%, 18/34) and blaKPC (46%, 13/28) being the commonest ESBL and carbapenemase genes. In univariate logistic regression, various potential neonatal, maternal, environmental and laboratory parameters were tested. Of these, the odds of sepsis increased with each additional day of use of invasive procedures such as mechanical ventilation (OR 1.086, 95% CI 1.008–1.170), umbilical artery catheter (OR 1.375, 95% CI 1.049–1.803), intravenous cannula (OR 1.140, 95% CI 1.062–1.225); blood transfusion events (OR 3.084, 95% CI 1.407–6.760); NICU stay (OR 1.109, 95% CI 1.040–1.182); failure to breast feed (OR 1.130, 95% CI 1.060–1.205); leukopenia (OR 1.790, 95% CI 1.04–3.082),thrombocytopenia (OR 0.992, 95% CI 0.989–0.994) and increase in C-reactive protein (OR 1.028, 95% CI 1.016–1.040). In multivariate analysis, increase in IV cannula insertion days (OR 1.140, 95% CI 1.024–1.269) and CRP level (OR 1.021, 95% CI 1.003–1.040) increased the odds of sepsis.Conclusions: Our study indicated various nosocomial risk factors and underscored the need to improve local infection control measures so as to reduce the existing burden of sepsis. We have highlighted certain sepsis associated laboratory parameters along with identification of antimicrobial resistance genes, which can guide for early and better therapeutic management of sepsis. These findings could be extrapolated to other low-income settings within the region.

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Section: Discussionsupporting

confidence: 56%

Risk factors for the development of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal

Manandhar

Amatya

Ansari

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Among all isolates, Klebsiella pneumonia was the most common isolate, similar to observations in other NICUs [ 25 , 26 ]. In fact, this bacteria has been a predominantly persisting etiologic agent of sepsis outbreaks in Patan hospital NICU requiring intermittent shut down of the unit [ 28 , 29 ]. Increasing AMR of clinical Enterobacteriaceae isolates is a global public health threat [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for the development of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal

et al. 2021

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Background Sepsis is an overwhelming and life-threatening response to bacteria in bloodstream and a major cause of neonatal morbidity and mortality. Understanding the etiology and potential risk factors for neonatal sepsis is urgently required, particularly in low-income countries where burden of infection is high and its epidemiology is poorly understood. Methods A prospective observational cohort study was conducted between April 2016 and October 2017 in a level three NICU at a tertiary care hospital in Nepal to determine the bacterial etiology and potential risk factors for neonatal sepsis. Results Among 142 NICU admitted neonates, 15% (21/142) and 32% (46/142) developed blood culture-positive and -negative neonatal sepsis respectively. Klebsiella pneumoniae (34%, 15/44) and Enterobacter spp. (25%, 11/44) were the most common isolates. The antimicrobial resistance of isolates to ampicillin (100%, 43/43), cefotaxime (74%, 31/42) and ampicillin-sulbactam (55%, 21/38) were the highest. BlaTEM (53%, 18/34) and blaKPC (46%, 13/28) were the commonest ESBL and carbapenemase genes respectively. In univariate logistic regression, the odds of sepsis increased with each additional day of use of invasive procedures such as mechanical ventilation (OR 1.086, 95% CI 1.008–1.170), umbilical artery catheter (OR 1.375, 95% CI 1.049–1.803), intravenous cannula (OR 1.140, 95% CI 1.062–1.225); blood transfusion events (OR 3.084, 95% CI 1.407–6.760); NICU stay (OR 1.109, 95% CI 1.040–1.182) and failure to breast feed (OR 1.130, 95% CI 1.060–1.205). Sepsis odds also increased with leukopenia (OR 1.790, 95% CI 1.04–3.082), increase in C-reactive protein (OR 1.028, 95% CI 1.016–1.040) and decrease in platelets count (OR 0.992, 95% CI 0.989–0.994). In multivariate analysis, increase in IV cannula insertion days (OR 1.147, 95% CI 1.039–1.267) and CRP level (OR 1.028, 95% CI 1.008–1.049) increased the odds of sepsis. Conclusions Our study indicated various nosocomial risk factors and underscored the need to improve local infection control measures so as to reduce the existing burden of sepsis. We have highlighted certain sepsis associated laboratory parameters along with identification of antimicrobial resistance genes, which can guide for early and better therapeutic management of sepsis. These findings could be extrapolated to other low-income settings within the region.

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A fatal outbreak of neonatal sepsis caused by mcr-10-carrying Enterobacter kobei in a tertiary care hospital in Nepal

Manandhar

Nguyen

Thanh

et al. 2022

Journal of Hospital Infection

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Outbreak of Extended Spectrum Beta Lactamase Producing Klebsiella Species Causing Neonatal Sepsis at Patan Hospital in Nepal

Cited by 3 publications

References 22 publications

Risk factors for the development of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal

Risk factors for the development of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal

Risk factors for the development of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal

A fatal outbreak of neonatal sepsis caused by mcr-10-carrying Enterobacter kobei in a tertiary care hospital in Nepal

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