×
Home Current Archive Editorial board
News Contact
Review paper

Epidemiology of neonatal sepsis caused by multidrug resistant pathogens in a neonatal intensive care unit level 3

By
Devleta Hadžić Orcid logo ,
Devleta Hadžić
Contact Devleta Hadžić

Paediatric Clinic, University Clinical Centre of Tuzla , Tuzla , Bosnia and Herzegovina

Fahrija Skokić ,
Fahrija Skokić

Paediatric Clinic, University Clinical Centre of Tuzla , Tuzla , Bosnia and Herzegovina

Selmira Brkić ,
Selmira Brkić

School of Medicine University of Tuzla , Tuzla , Bosnia and Herzegovina

Amina Saračević ,
Amina Saračević

Paediatric Clinic, University Clinical Centre of Tuzla , Tuzla , Bosnia and Herzegovina

Delila Softić ,
Delila Softić

School of Medicine University of Tuzla , Tuzla , Bosnia and Herzegovina

Dženana Softić
Dženana Softić

Paediatric Clinic, University Clinical Centre of Tuzla , Tuzla , Bosnia and Herzegovina

Abstract

Aim
Steady progress in intensive treatment worldwide has increased the survival of immature neonates, but with multiple invasive procedures, which have increased the risk of infection, thus the bacterial resistance to antibiotics. The aim of this study was to analyse the epidemiology of multidrug resistance pathogens as causative agents of neonatal sepsis in the neonatal intensive care unit.
Methods
A retrospective cohort study conducted at the Intensive care unit of the Paediatric Clinic of Tuzla over a three-year period (2016-2018) analysed epidemiology of neonatal sepsis caused by multidrug resistance pathogens. Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution.
Results
Of the total of 921 treated neonates, multidrug resistance (MDR) pathogens among causative agents of neonatal sepsis were found in 22 neonates (2.38%) with no gender difference. Prematurity and low birth weight were confirmed as the most significant risk factors. From the maternal risk factors a significant difference was found in the first birth and in vitro fertilization. Clinically, MDR sepsis manifested frequently as late onset sepsis, with longer hospital stay and higher mortality. The findings of leukopenia, thrombocytopenia and coagulation disorders were significant. Gram negative bacteria were frequently isolated, in particular Acinetobacter, which showed the greatest resistance to antibiotics.
Conclusion
Neonatal MDR sepsis is a threat to life, it complicates the treatment, increases costs and mortality. Outcomes can be improved by preventive strategies, earlier and more accurate diagnosis and rational use of antibiotics.

References

1
Black C, Tavares L, Stachel A, Ratner A, Randis T. Distribution of late-onset neonatal sepsis pathogens differs in inpatient and outpatient settings. Am J Perinatol 2018:38–43.
2
Gkentzi D, Kortsalioudaki C, Cailes B, Zaoutis T, Kopsidas J, Tsolia M, et al. Neonatal infection surveillance network in Greece. Epidemiology of infections and antimicrobial use in Greek neonatal units. Arch Dis Child Fetal Neonatal Ed 2019:293–7.
3
Perrone S, Lotti F, Longini M, Rossetti A, Bindi I, Bazzini F, et al. C reactive protein in healthy term newborns during the first 48 hours of life. Arch Dis Child Fetal Neonatal Ed 2018:163–6.
4
Vecchio D, A. Evaluation and management of thrombocytopenic neonates in the intensive care unit. Early Hum Dev 2014:51–5.
5
Hornik C, Benjamin D, Becker K, Benjamin D, Jr, Li J, et al. Use of the complete blood cell count in late-onset neonatal sepsis. Pediatr Infect Dis J 2012:803–7.
6
Yusef D, Shalakhti T, Awad S, Algharaibeh H. Khasawneh W. Clinical characteristics and epidemiology of sepsis in the neonatal intensive care unit in the era of multi-drug resistant organisms: A retrospective review. Pediatr Neonatol 2018:35–41.
7
Verstraete E, De Coen K, Vogelaers D, Blot S. Risk factors for health care-associated sepsis in critically Ill neonates stratified by birth weight. Pediatr Infect Dis J 2015:1180–6.
8
Garcia H, Torres-Gutierrez J, Peregrino-Bejarano L, Ma C-C. Risk factors for nosocomial infection in a level III neonatal intensive care unit. Gac Med Mex 2015:711–9.
9
Jajoo M, Manchanda V, Chaurasia S, Sankar M, Gautam H, Agarwal R, et al. Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India. PLoS One 2018:180705.
10
Nour I, Eldegla H, Nasef N, Shouman B, Hady A, Shabaan H, et al. Risk factors and clinical outcomes for carbapenem-resistant Gram-negative late-onset sepsis in a neonatal intensive care unit. J Hosp Infect 2017:52–8.
11
Tsai M, Chu S, Hsu J, Huang L, Chiang H, Fu M, et al. Risk factors and outcomes for multidrug-resistant Gram-negative bacteremia in the NICU. Pediatrics 2014:322–9.
12
Roy P, Kumar A, Kaur I, Faridi M. Gender differences in outcomes of low birth weight and preterm neonates: the male disadvantage. J Trop Pediatr 2014:480–5.
13
Townsel C, Emmer S, Campbell W, Hussain N. Gender differences in respiratory morbidity and mortality of preterm neonates. Front Pediatr 2017:6.
14
Klingenberg C, Kornelisse R, Buonocore G, Maier R, Stocker M. Culture-negative early-onset neonatal sepsis -at the crossroad between efficient sepsis care and antimicrobial stewardship. Front Pediatr 2018:285.
15
Ozkan H, Cetinkaya M, Koksal N, Celebi S, Hacimustafaoglu M. Culture-proven neonatal sepsis in preterm infants in a neonatal intensive care unit over a 7 year period: coagulase-negative Staphylococcus as the predominant pathogen. Pediatrics International 2014:60–6.
16
Rhodesa, Evans L, Alhazzani W, Levy M, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock. Intensive Care Med 2016:304–77.
17
Cailes B, Kortsalioudaki C, Buttery J, Pattnayak S, Greenough A, Matthes J, et al. Antimicrobial resistance in UK neonatal units: neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed 2018:474–8.
18
Afonso E, Blot S. Effect of gestational age on the epidemiology of late-onset sepsis in neonatal intensive care units -a review. Expert Rev Anti Infect Ther 2017:917–24.
19
Dorling J, Field D, Manktelow B. Neonatal disease severity scoring systems. Arch Dis Child Fetal Neonatal Ed 2005:11–6.
20
Behmadi H, Borji A, Taghavi-Rad A, Soghandi L, Behmadi R. Prevalence and antibiotic resistance of neonatal sepsis pathogen in Neyshabour, Iran. Arch Pediatr Dis 2016:33818.
21
Shane A, Sanchez P, Stoll B. Neonatal sepsis. Lancet 2017:1770–80.
22
Mcpherson C, Liviskie C, Zeller B, Nelson M, Newland J. Antimicrobial stewardship in neonates: challenges and opportunities. Neonatal Netw 2018:116–23.
23
Raymond S, Stortz J, Mira J, Larson S, Wynn J, Moldawer L. Immunological defects in neonatal sepsis and potential therapeutic approaches. Front Pediatr 2017:14.
24
Bandyopadhyay T, Kumar A, Saili A, Randhawa V. Distribution, antimicrobial resistance and predictors of mortality in neonatal sepsis. J Neonatal Perinatal Med 2018:145–53.
25
Laxminarayan R, Matsoso P, Pant S, Brower C, Rottingen J, Klugman K, et al. Access to effective antimicrobials: a worldwide challenge. Lancet 2016:168–75.
26
Combating antibiotic-resistant bacteria. Federal Register 13676:56931–5.
27
Graham C. The global threat of antibiotic resistance: what can be done? JoGHR 2017.
28
Laxminarayan R, Duse A, Wattal C, Zaidi A, Wertheim H, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. Lancet 2013:1057–98.
29
Blair J, Webber M, Baylay A, Ogbolu D, Piddock L. Molecular mechanisms of antibiotic resistance. Nat Rev Microbiol 2015:42–51.

Citation

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.