A review of -multidrug-resistant Enterobacteriaceae in a neonatal unit in Johannesburg, South Africa

Abstract

Background Multi-drug resistant organisms are an increasingly important cause of neonatal sepsis. Aim This study aimed to review neonatal sepsis caused by multi-drug resistant Enterobacteriaceae (MDRE) in neonates in Johannesburg, South Africa. Methods This was a cross sectional retrospective review of MDRE in neonates admitted to a tertiary neonatal unit between 1 January 2013 and 31 December 2015. Results There were 465 infections in 291 neonates. 68.6% were very low birth weight (< 1500 g). The median age of infection was 14.0 days. Risk factors for MDRE included prematurity ( p = 0.01), lower birth weight ( p = 0.04), maternal HIV infection ( p = 0.02) and oxygen on day 28 ( p < 0.001). The most common isolate was Klebsiella pneumoniae (66.2%). Total MDRE isolates increased from 0.39 per 1000 neonatal admissions in 2013 to 1.4 per 1000 neonatal admissions in 2015 ( p < 0.001). There was an increase in carbapenem-resistant Enterobacteriaceae (CRE) from 2.6% in 2013 to 8.9% in 2015 ( p = 0.06). Most of the CRE were New Delhi metallo—β lactamase- (NDM) producers. The all-cause mortality rate was 33.3%. Birth weight ( p = 0.003), necrotising enterocolitis ( p < 0.001) and mechanical ventilation ( p = 0.007) were significantly associated with mortality. Serratia marcescens was isolated in 55.2% of neonates that died. Conclusions There was a significant increase in MDRE in neonatal sepsis during the study period, with the emergence of CRE. This confirms the urgent need to intensify antimicrobial stewardship efforts and address infection control and prevention in neonatal units in LMICs. Overuse of broad- spectrum antibiotics should be prevented.

<p>Carbapenem-Resistant <em>Enterobacter cloacae</em> Causing Nosocomial Infections in Southwestern China: Molecular Epidemiology, Risk Factors, and Predictors of Mortality</p>

“…Bacteria belonging to Enterobacterales, such as Escherichia coli, Klebsiella pneumoniae, Enterobacter, Citrobacter, Serratia, Proteus, and Morganella, often cause nosocomial infections. 1,2 During the last decade, the emergence of carbapenem-resistant Enterobacteriaceae (CRE), which led to limited treatment options, has become the main cause of clinical anti-infective treatment failure. 3,4 It is worth noting that carbapenem-resistant Enterobacter cloacae (CR-ECL), which is one of the most common species that has been focused on in studies of a single species of Enterobacterales, 5 has been reported in many countries such as Korea, the United States, India, and China.…”

Epidemiology of Clinically Suspected and Laboratory-Confirmed Bloodstream Infections at A South African Neonatal Unit

“…Despite NICU admission and maximal organ support, neonates with proven BSI experienced high crude mortality rates (27%), comparable to that reported from other African country cohorts with similar proportions of preterm neonates. 20,21,30,31 Notably, most patients with proven BSI demised soon after blood culture collection (BSI-attributable mortality), highlighting the rapid clinical progression of bacteraemia, particularly in preterm neonates. Infection due to a Gram-negative pathogen was the single most important factor predicting neonatal mortality on multivariate analysis.…”

“…17 In some African neonatal units, carbapenem-resistant Acinetobacter baumannii and Enterobacterales (CRE) are now leading causes of neonatal infectious deaths, especially in preterm infants. [18][19][20][21] In this paper we characterise the epidemiology of clinically suspected and laboratory-con rmed bloodstream infections at a large academic neonatal unit in South Africa, with analysis of factors associated with mortality in proven infections.…”

Successful control of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae ST307 outbreak in a neonatal intensive care unit

“…The mortality and morbidity rates due to healthcareassociated infections (HAIs) are high in neonates who require intensive care because of their low immunity. In South Africa, the mortality from neonatal sepsis due to multi-drug resistant Enterobacteriaceae was reported to be 33.3% [1].…”