Antimicrobial Resistance Patterns Among Neonates Referred to Pediatric Emergency in North India: A Prospective Cohort Study.
Journal
The Pediatric infectious disease journal
ISSN: 1532-0987
Titre abrégé: Pediatr Infect Dis J
Pays: United States
ID NLM: 8701858
Informations de publication
Date de publication:
01 Nov 2023
01 Nov 2023
Historique:
pubmed:
31
7
2023
medline:
31
7
2023
entrez:
31
7
2023
Statut:
ppublish
Résumé
Sepsis is a leading cause of neonatal mortality worldwide, with a disproportionately high burden in low-income and middle-income countries. There is limited prospective data on microorganism profiles and antimicrobial resistance (AMR) in outborn newborns referred to pediatric emergency in developing countries. We aimed to assess the pathogen profile and AMR patterns in outborn neonates referred to the pediatric emergency at a tertiary care center. In this prospective cohort study, we enrolled neonates with suspected sepsis and sent blood or cerebrospinal fluid cultures. Neonates were followed up daily until discharge or death. The isolated organisms were identified and tested for antimicrobial susceptibility. Standard definitions were used to define multidrug resistance. Between January 1, 2020, and December 31, 2020, 1072 outborn neonates with suspected sepsis were enrolled. The rate of proven sepsis was 223.6 (95% CI:198.7-248.4) per 1000 infants. Gram-negative sepsis was the most common (n = 107,10%), followed by gram-positive sepsis (n = 81,7.6%) and fungal sepsis (n = 67,6.3%). Coagulase-negative staphylococci (n = 69), Candida spp. (n = 68), Klebsiella spp. (n = 55), Acinetobacter spp . (n = 31) and Escherichia coli (n = 9) were the most common pathogens. Over two-thirds (68.6%) of pathogens were multidrug resistance, with an alarming prevalence in Klebsiella spp. (33/53, 62%), Acinetobacter spp. (25/30, 83%) and coagulase-negative staphylococci (54/66, 82%). In total, 124 (11.6%) neonates died in the hospital (13.3% of proven cases and 11.1% of culture-negative sepsis cases). High sepsis burden and alarming AMR among neonates referred to tertiary care centers warrant urgent attention toward coordinated implementation of rigorous sepsis prevention measures and antimicrobial stewardship across all healthcare levels.
Sections du résumé
BACKGROUND
BACKGROUND
Sepsis is a leading cause of neonatal mortality worldwide, with a disproportionately high burden in low-income and middle-income countries. There is limited prospective data on microorganism profiles and antimicrobial resistance (AMR) in outborn newborns referred to pediatric emergency in developing countries. We aimed to assess the pathogen profile and AMR patterns in outborn neonates referred to the pediatric emergency at a tertiary care center.
METHODS
METHODS
In this prospective cohort study, we enrolled neonates with suspected sepsis and sent blood or cerebrospinal fluid cultures. Neonates were followed up daily until discharge or death. The isolated organisms were identified and tested for antimicrobial susceptibility. Standard definitions were used to define multidrug resistance.
RESULTS
RESULTS
Between January 1, 2020, and December 31, 2020, 1072 outborn neonates with suspected sepsis were enrolled. The rate of proven sepsis was 223.6 (95% CI:198.7-248.4) per 1000 infants. Gram-negative sepsis was the most common (n = 107,10%), followed by gram-positive sepsis (n = 81,7.6%) and fungal sepsis (n = 67,6.3%). Coagulase-negative staphylococci (n = 69), Candida spp. (n = 68), Klebsiella spp. (n = 55), Acinetobacter spp . (n = 31) and Escherichia coli (n = 9) were the most common pathogens. Over two-thirds (68.6%) of pathogens were multidrug resistance, with an alarming prevalence in Klebsiella spp. (33/53, 62%), Acinetobacter spp. (25/30, 83%) and coagulase-negative staphylococci (54/66, 82%). In total, 124 (11.6%) neonates died in the hospital (13.3% of proven cases and 11.1% of culture-negative sepsis cases).
CONCLUSIONS
CONCLUSIONS
High sepsis burden and alarming AMR among neonates referred to tertiary care centers warrant urgent attention toward coordinated implementation of rigorous sepsis prevention measures and antimicrobial stewardship across all healthcare levels.
Identifiants
pubmed: 37523584
doi: 10.1097/INF.0000000000004056
pii: 00006454-990000000-00535
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1007-1011Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no funding or conflicts of interest to disclose.
Références
Fleischmann C, Reichert F, Cassini A, et al. Global incidence and mortality of neonatal sepsis: a systematic review and meta-analysis. Arch Dis Child. 2021;106:745–752.
Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, et al. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018;6:223–230.
Chaurasia S, Sivanandan S, Agarwal R, et al. Neonatal sepsis in South Asia: huge burden and spiralling antimicrobial resistance. BMJ. 2019;364:k5314.
Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet Lond Engl. 2022;399:629–655.
Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study. Lancet Glob Health. 2016;4:e752–e760.
Jajoo M, Manchanda V, Chaurasia S, et al.; Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration, New Delhi, India. Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India. PLoS One. 2018;13:e0180705.
Weinstein MP, Lewis JS. The clinical and laboratory standards institute subcommittee on antimicrobial susceptibility testing: background, organization, functions, and processes. J Clin Microbiol. 2020;58:e01864–e01819.
M23Ed5. In Vitro Susceptibility Testing Criteria & QC. Clinical & Laboratory Standards Institute. Available at: https://clsi.org/standards/products/microbiology/documents/m23/ . Accessed October 6, 2022.
Magiorakos A-P, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–281.
EUCAST: Clinical breakpoints and dosing of antibiotics. Available at: https://www.eucast.org/clinical_breakpoints . Accessed October 17, 2022.
World Health Organization. The WHO AWaRe (Access, Watch, Reserve) antibiotic book - Infographics. World Health Organization. Available at: https://www.who.int/publications-detail-redirect/WHO-MHP-HPS-EML-2022.02 . Published December 9, 2022. Accessed June 12, 2023.
Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev. 2004;17:638–680, table of contents.
Hsieh E, Smith PB, Jacqz-Aigrain E, et al. Neonatal fungal infections: when to treat? Early Hum Dev. 2012;88:S6–S10.
Sousa RA, Oliveira Diniz LM, Lapa Marinho FE, et al. Risk factors for candidemia in neonates: systematic review and meta-analysis. J Neonatal Nurs. 2022;28:83–92.
Greenberg RG, Benjamin DK. Neonatal candidiasis: diagnosis, prevention, and treatment. J Infect. 2014;69:S19–S22.
Barton M, O’Brien K, Robinson JL, et al. Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls. BMC Infect Dis. 2014;14:327.
Stoll BJ, Hansen NI, Sánchez PJ, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011;127:817–826.
Sundaram V, Kumar P, Dutta S, et al. Blood culture confirmed bacterial sepsis in neonates in a North Indian tertiary care center: changes over the last decade. Jpn J Infect Dis. 2009;62:46–50.
Laxminarayan R, Chaudhury RR. Antibiotic Resistance in India: drivers and opportunities for action. PLoS Med. 2016;13:e1001974.
Wolfensberger A, Kuster SP, Marchesi M, et al. The effect of varying multidrug-resistence (MDR) definitions on rates of MDR gram-negative rods. Antimicrob Resist Infect Control. 2019;8:193.
Li L, Xu L, Zhu R, et al. Effect of prior receipt of antibiotics on the pathogen distribution: a retrospective observational cohort study on 27,792 patients. BMC Infect Dis. 2020;20:8.
Harris AM, Bramley AM, Jain S, et al. Influence of antibiotics on the detection of bacteria by culture-based and culture-independent diagnostic tests in patients hospitalized with community-acquired pneumonia. Open Forum Infect Dis. 2017;4:ofx014.
Williams PC, Qazi SA, Agarwal R, et al. Antibiotics needed to treat multidrug-resistant infections in neonates. Bull World Health Organ. 2022;100:797–807.