Extended-spectrum beta-lactamase (ESBL) producing Enterobacterales in stool surveillance cultures of preterm infants are no risk factor for necrotizing enterocolitis: a retrospective case–control study over 12 years

Abstract

Purpose Microbial dysbiosis has been found preceding necrotizing enterocolitis (NEC) in preterm infants; thus, we aimed to investigate whether there is evidence that neonates with extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) positive stool cultures are at higher risk for NEC at the NICU. Methods We included very preterm inborn infants of ≤ 32 weeks of gestational age being fecal carriers of ESBL-E and compared them with 1:1 matched (gestational age, birth weight, gender and year) controls tested negative for ESBL-E in the stool between 2005 and 2016. An association with NEC was defined as the first detection of ESBL-E before or at the time of definite diagnosis of NEC. Results During the study period, we diagnosed 217 infants with a total of 270 ESBL-E. We identified ten different species with ESBL-producing Klebsiella oxytoca being the most common one (46%) followed by Klebsiella pneumoniae (19%), and Citrobacter freundii (17%). Ten out of 217 infants had any kind of NEC in the case group compared to two of the controls (p < 0.01), but only four cases with predefined criteria were associated with NEC ≥ stage IIa (1.8 vs. 0.5%, p = 0.089, OR 4.1, CI95% 0.45–36.6). NEC mortality rate was 2/8 (25%). Conclusions We observed a threefold increase of ESBL-E in stool surveillance cultures during study time and germs were dominated by ESBL-producing Klebsiella spp. There was no evidence that preterm infants colonized with ESBL-E in the stool were at higher risk for definite NEC.

Intestinal colonization with ESBL-producing Klebsiella pneumoniae in healthy rural villager: A genomic surveillance study in China, 2015-2017

“…Aminoglycoside resistance genes were commonly detected, and 252 isolates (95.5%) carried at least one aminoglycoside resistance gene. The most common were aac ( 3 ) -IId (150, 56.8%), followed by aac(6')-Ib-cr (113, 42.8%), aph(3')-Ib (68, 25.8%), aadA16 (107, 40.5%), and aph(3')-Ia (69, 26.1%). Notably, the linked strA-strB genes, which confer streptomycin resistance in at least 17 genera of gram-negative bacteria, were detected in 51 isolates (19.3%).…”

“…ESBL-KP is one of the most common multi-drug resistant groups of Enterobacteriaceae worldwide ( 1 ). As an essential nosocomial pathogen, its invasive infection recently resulted in high mortality rates ( 2 , 3 ). Acquired drug resistance in human commensal bacteria such as Escherichia coli and K. pneumoniae has become a widespread threat to public health ( 4 ).…”

Long-term Follow-up of Preterm Infants Having Been Colonized With Extended Spectrum Beta-lactamase–producing Enterobacterales Over the First 6 Years of Life

“…The control group was matched by 1:1 according to year of birth, gestational age, birth weight and gender (control infants ≤32 weeks without ESBL colonization) as published recently. 7 The local ethics committee of the Medical University of Graz, Austria (number 32-052 ex 19/20), provided ethical approval of this retrospective case-control cohort study. We collected the total number of outpatient visits and inpatient hospital stays regarding bacterial and viral infections including ESBL-E bacteremias of both groups, number of children with febrile seizures, appendicitis, ileus, volvulus, gastritis, enteritis/diarrhea and gastroesophageal reflux disease and number of children with neurodevelopmental impairment.…”

“…In a previously published retrospective case-control study, we were able to demonstrate that ESBL-E colonization of preterm infants ≤32 weeks of gestation (from stool surveillance cultures) at the neonatal intensive care unit (NICU) was not associated with an increased risk of necrotizing enterocolitis. 7 From this cohort, we extracted a matched case-control group and retrospectively followed them over the first 6 years of life with focus on gastrointestinal diseases, infections and neurodevelopmental impairment. We hypothesized that the case group might have more gastrointestinal diseases or infections compared with controls without neonatal ESBL-E colonization of the gut.…”

Toxin‐Producing Klebsiella oxytoca in Healthy Infants

“…Furthermore, K oxytoca often plays an important role in Klebsiella spp. outbreaks on neonatology wards, leading to increased morbidity and mortality among preterm infants (8)(9)(10). K oxytoca colonization rates in healthy adults are low and have been reported between 1.6% and 9% (1,(11)(12)(13).…”