Impact of Empiric Antibiotic Use on Development of Infections caused by Extended-Spectrum β-Lactamase Bacteria in a Neonatal Intensive Care Unit

Lê, Jennifer; Nguyen, Thong; Okamoto, Mark P.; McKamy, Susan; Lieberman, Jay M.

doi:10.1097/inf.0b013e3181606850

Cited by 45 publications

(34 citation statements)

References 18 publications

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“…These diverse results can be explained by the different definitions of a resistant GNB isolate, [24][25][26][27] different study designs, 24,25 different empirical antibiotic policies, and different inclusion criteria (nosocomial infection instead of bacteremia in the other studies). 24,25,27 Previous antibiotic therapy has been recognized to be significantly related to bacterial resistance development, [24][25][26][27][28] but all issues regarding appropriate control group selection, case definition, description of previous antibiotic exposure, and adjustment for confounding factors should be refined. Therefore, a prospective study should be conducted to investigate the impact of specific antibiotic type, treatment duration or total dosage in grams, and interval on the development of neonatal MDR GNB and the colonization and risk of subsequent bacteremia.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:There is a perception that Gram-negative bacilli (GNB) bloodstream infection is increasing in the NICU, and those infections caused by a multidrug-resistant (MDR) strain are a growing threat to hospitalized patients. WHAT THIS STUDY ADDS:Exposure to broad-spectrum antibiotics is the most important risk factor for MDR GNB bacteremia, which is associated with higher mortality. Neonates with risk factors for bacteremia caused by a MDR GNB strain may benefit from empirical antimicrobial therapy with carbapenem. abstract OBJECTIVES: To assess the risk factors antibiotic therapy and outcomes of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bacteremia in NICU patients. METHODS:Episodes of MDR GNB bacteremia were compared with a non-MDR GNB bacteremia group in an 8-year cohort study. RESULTS:Of 1106 bacteremias, 393 (35.5%) were caused by GNB. Seventy (18.6%) were caused by an MDR strain. The most frequent mechanism of resistance was extended-spectrum b-lactamase production (67.1%), mainly by Klebsiella pneumoniae (59.6%). Previous antibiotic exposure to third-generation cephalosporin (odds ratio [OR]: 5.97; 95% confidence interval [CI]: 2.37-15.08; P , .001) and carbapenem (OR: 3.60; 95% CI: 1.26-10.29; P = .017) and underlying renal disease (OR: 7.08; 95% CI: 1.74-28.83; P = .006) were identified as independent risk factors for MDR GNB acquisition. Patients with MDR GNB bacteremia more likely received inadequate initial antibiotic therapy (72.9% vs 7.8%; P , .001) had higher rates of infectious complication (21.4% vs 10.5%; P = .011) and overall case fatality 1rate (28.6% vs 10.5%; P , .001). Independent risk factors for overall mortality were presence of infectious complications after bacteremia (OR: 3.16; 95% CI: 1.41-7.08; P = .005) and underlying secondary pulmonary hypertension with or without cor pulmonale (OR: 6.19; 95% CI: 1.88-20.31; P = .003).CONCLUSIONS: MDR GNB accounted for 18.6% of all neonatal GNB bacteremia in the NICU, especially in those with previous broad-spectrum antibiotic therapy and underlying renal disease. The most frequent mechanism of resistance was extended-spectrum b-lactamase (ESBL) production. Neonates with MDR GNB were more likely to develop infectious complications, which were independently associated with a higher overall case-fatality rate. Pediatrics 2014;133:e322-e329

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Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

et al. 2014

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“…Arslan et al [23] stellten im Verlauf des Ausbruchs ihr empirisches Therapieregime zur Therapie der "Late-onset"-Sepsis um und etablierten ein "Antibiotic Stewardship" Team. Es gibt noch zahlreiche weitere Studien, die auf einen kausalen Zusammenhang zwischen dem Einsatz bestimmter Breitspektrumantibiotika (insbesondere von Cephalosporinen der Gruppe III) und der Prä-valenz von MRGN in der jeweiligen NI-CU hinweisen [13,[60][61][62]. Auch NICUs benötigen zur langfristigen Kontrolle von MRGN nicht nur eine gute Praxis der Krankenhaushygiene sondern auch ein "Antibiotic Stewardship" Programm [11,63].…”

Section: Ausbruchsuntersuchung Und Maßnahmen Zur Ausbruchskontrolleunclassified

Literatur-Update zu Ausbrüchen auf neonatologischen Intensivpflegestationen – Serratia marcescens, Klebsiella pneumoniae, Acinetobacter baumannii und Pseudomonas aeruginosa

Kraus-Haas

Mielke

Simon

2015

Bundesgesundheitsbl.

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Häufungen von Infektionen mit einem (vermeintlich) einheitlichen Erreger in neonatologischen Intensivpflegestationen (NICUs) sind unerwünschte Ereignisse, durch die die Sicherheit der Patienten und ein günstiger Ausgang der Intensivtherapie gefährdet wird [1]. Mitunter sterben die Kinder an unmittelbaren Komplikationen bzw. langfristigen Folgen dieser "Late-onset"-Infektionen oder ihre psychomotorischen und mentalen Entwicklungsoptionen werden durch diese Ereignisse nachhaltig beeinträchtigt [2]. Ausbrüche bedingen zudem erhebliche Mehrbelastungen des Behandlungsteams (zu dem wir auch das Hygienefachpersonal zählen) [3] und können zur vorüber-gehenden oder dauerhaften Schließung einer Abteilung führen [4][5][6][7][8]. Aufgrund der besonderen Infektionsgefährdung der Patienten, der strukturell-organisatorischen Besonderheiten der Intensivtherapie in NICUs, des initial sehr uncharakteristischen klinischen Bildes und aufgrund des speziellen Erregerspektrums (z. B. Serratia marcescens) müssen Ausbrüche auf NICUs separat von anderen Ausbrüchen betrachtet werden [1].Die

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“…However, both the epidemiology and the approach to neonatal infection are subject to changes over time and differ regionally. [10][11][12] Therefore, the Swiss Society of Neonatology conducted a Neonatal Infection Surveillance for preterm infants born earlier than 28 weeks' gestational age between January 1, 2000, and December 31,2007. The aim of the present study was to describe the effect of proven or suspected sepsis on neurodevelopmental outcomes at 2 years of age in this recent national cohort of extremely premature infants.…”

mentioning

confidence: 99%

Impact of Sepsis on Neurodevelopmental Outcome in a Swiss National Cohort of Extremely Premature Infants

Schlapbach

Aebischer²,

Adams³

et al. 2011

Pediatrics

311

257

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Impact of Empiric Antibiotic Use on Development of Infections caused by Extended-Spectrum β-Lactamase Bacteria in a Neonatal Intensive Care Unit

Abstract: The change from empiric use of CEF to TOB was associated with a significant decrease in the incidence of ESBL infections.

Cited by 45 publications

References 18 publications

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

Literatur-Update zu Ausbrüchen auf neonatologischen Intensivpflegestationen – Serratia marcescens, Klebsiella pneumoniae, Acinetobacter baumannii und Pseudomonas aeruginosa

Impact of Sepsis on Neurodevelopmental Outcome in a Swiss National Cohort of Extremely Premature Infants

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