Changing of bloodstream infections in a medical center neonatal intensive care unit

Chen, I‐Ling; Chiu, Nan-Chang; Chi, Hsin; Hsu, Chyong-Hsin; Chang, Jui‐Hsing; Huang, Daniel Tsung-Ning; Huang, Fu‐Yuan

doi:10.1016/j.jmii.2015.08.023

Cited by 29 publications

(26 citation statements)

References 20 publications

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“…ESKAPE organisms, E. coli and Streptococci spp. were the most isolated pathogens, again similar to a number of other studies [32,33,36,[61][62][63]. Recently the protocol for the treatment of neonatal infections were reviewed to reduce the use of third-generation cephalosporins to help reduce Enterococci, and Acinetobacter spp.…”

Section: Discussionsupporting

confidence: 62%

“…This is also a priority area across countries with up to ten million neonates worldwide dying within 5 days of birth, and most of these in LMICs due to BSIs [32,33]. Overall, up to 71% of neonates are prone to BSIs during intensive care, with neonatal infections contributing substantially to the morbidity and mortality of infants [34][35][36]. This is due to risk factors such as low birth weight, gestational age, administration of parenteral nutrition as well as the use of invasive devices and procedures [37].…”

Section: Introductionmentioning

confidence: 99%

“…Indiscriminate antibiotic use, coupled with poor IPC practices, leads to high infection rates and emergence of AMR [38]. However, screening for Group B Streptococcus (GBS) among mothers can avoid early onset of GBS among infants and help reduce mortality alongside considering intrapartum antibiotic prophylaxis [36,39,40]. Currently, the trends in the prevalence of neonatal BSI and the current antibiotic sensitivities are unknown in this hospital and wider to inform future IPC initiatives as well as any ASPs.…”

Section: Introductionmentioning

confidence: 99%

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Healthcare-associated infections including neonatal bloodstream infections in a leading tertiary hospital in Botswana

et al. 2019

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Background: Healthcare-associated infections (HAIs) increase morbidity, mortality, length of hospital stay and costs, and should be prevented where possible. In addition, up to 71% of neonates are prone to bloodstream infections (BSI) during intensive care due to a variety of factors. Consequently, the objectives of this study were to estimate the burden of HAIs and possible risk factors in a tertiary hospital in Botswana as well as describe current trends in bacterial isolates from neonatal blood specimen and their antibiotic resistance patterns. Methods: Point Prevalence Survey (PPS) in all hospital wards and a retrospective cross-sectional review of neonatal blood culture and sensitivity test results, with data abstracted from the hospital laboratory database. Results: 13.54% (n = 47) of patients had HAIs, with 48.9% (n = 23) of them lab-confirmed. The highest prevalence of HAIs was in the adult intensive care unit (100%n = 5), the nephrology unit (50%n = 4), and the neonatal intensive care unit (41.9%n = 13). One-fourth of HAIs were site unspecific, 19.1% (n = 9) had surgical site infections (SSIs), 17% (n = 8) ventilator-associated pneumonia/complications, and 10.6% (n = 5) were decubitus ulcer infections. There were concerns with overcrowding in some wards and the lack of aseptic practices and hygiene. These issues are now being addressed through a number of initiatives. Coagulase Negative Staphylococci (CoNS) was the commonest organism (31.97%) isolated followed by Enterococci spp. (18.03%) among neonates. Prescribing of third-generation cephalosporins is being monitored to reduce Enterococci, Pseudomonas and Acinetobacter spp. infections. Conclusions: There were concerns with the rate of HAIs and BSIs. A number of initiatives are now in place in the hospital to reduce these including promoting improved infection prevention and control (IPC) practices and use of antibiotics via focal persons of the multidisciplinary IPC committee. These will be followed up and reported on. ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Healthcare-associated infections including neonatal bloodstream infections in a leading tertiary hospital in Botswana

et al. 2019

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“…17 Synergistic effects of tacrolimus in combination with azoles have been detected in all tested azole-resistant Candida strains, demonstrating that efflux pumps contribute to antifungal drug resistance in this genus. 17 The antifungal activities of MCZ and tacrolimus, alone and in combination, were tested in the three MCZ-tolerant strains, and results revealed that the combination of MCZ and tacrolimus exerted an indifferent effect against our MCZ-tolerant strains. Therefore, it is presumed that ATP-dependent efflux pumps were not the mediators of antifungal tolerance in these strains, implying the presence of other antifungal-tolerance mutations.…”

Section: Discussionmentioning

confidence: 91%

“…Tacrolimus previously was shown to reverse multidrug resistance in multiple types of eukaryotic cells, an effect mediated via blockade of ATP‐dependent efflux pumps, including human P‐glycoprotein, in C. glabrata . Synergistic effects of tacrolimus in combination with azoles have been detected in all tested azole‐resistant Candida strains, demonstrating that efflux pumps contribute to antifungal drug resistance in this genus . The antifungal activities of MCZ and tacrolimus, alone and in combination, were tested in the three MCZ‐tolerant strains, and results revealed that the combination of MCZ and tacrolimus exerted an indifferent effect against our MCZ‐tolerant strains.…”

Section: Discussionmentioning

confidence: 97%

Miconazole‐tolerant strains of Malassezia pachydermatis generated by culture in medium containing miconazole

Kano

Kamata

2019

Veterinary Dermatology

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Background Tolerance of Malassezia pachydermatis to azole drugs has been reported worldwide, from strains isolated from dogs. Canine Malassezia dermatitis often is treated with shampoos containing 2% miconazole (MCZ) or other topical MCZ products. Objectives In the in vitro study herein, it was investigated whether MCZ‐induced amino acid substitutions in the lanosterol 14‐alpha‐demethylase (ERG11) gene 1 lead to azole tolerance in M. pachydermatis. Methods and materials Toleranced to MCZ was induced in an azole‐susceptible strain of M. pachydermatis (CBS1879T) by culture in medium containing MCZ. Antifungal susceptibility to MCZ, clotrimazole (CTZ) and itraconazole (ITZ) was assessed using the modified broth microdilution (BM) method. To assess the potential mechanism of tolerance in the three MCZ‐resistant strains, ERG11 was sequenced. The interaction between the calcineurin inhibitor tacrolimus and MCZ in the azole‐tolerant isolates also was examined. Results Three strains (NUBS19001 to NUBS19003) from CBS1879T cultured in medium containing MCZ exhibited minimum inhibitory concentrations (MICs) of 40 mg/L to MCZ, 5 mg/L to ITZ and >32 mg/L to CTZ, meaning that the isolates were tolerant. The combination of MCZ and tacrolimus exerted an indifferent effect against the MCZ‐tolerant strain. BLAST analysis using the NCBI database showed mutations in the cytochrome p450 encoded by ERG11 in the MCZ‐tolerant strains. Conclusions In the present in vitro study, it was shown that MCZ exposure can induce amino acid substitutions in ERG11 and subsequent tolerance of M. pachydermatis to several azoles. Whether topical therapy with azole‐containing products can exert a similar effect in vivo is a question that requires further research.

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Group B Streptococcus causes severe sepsis in term neonates: 8 years experience of a major Chinese neonatal unit

et al. 2017

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GBS as a pathogen for neonatal sepsis has been receiving little attention in China. Our data demonstrated that GBS sepsis was likely to be fulminant. Early recognition followed by antibiotics and adequate supportive therapies was critical for successful treatment. Chinese clinicians should be aware of GBS infection when treating neonatal sepsis, especially in the absence of universal maternal GBS screening.

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Changing of bloodstream infections in a medical center neonatal intensive care unit

Cited by 29 publications

References 20 publications

Healthcare-associated infections including neonatal bloodstream infections in a leading tertiary hospital in Botswana

Healthcare-associated infections including neonatal bloodstream infections in a leading tertiary hospital in Botswana

Miconazole‐tolerant strains of Malassezia pachydermatis generated by culture in medium containing miconazole

Group B Streptococcus causes severe sepsis in term neonates: 8 years experience of a major Chinese neonatal unit

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