<p>Multi-Drug Resistant <em>Escherichia coli</em> Causing Early-Onset Neonatal Sepsis – a Single Center Experience from China</p>

Abstract

Background and objectiveInfections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) have raised public-health concerns and are becoming a global health challenge. This study aimed to investigate changes in antimicrobial resistance of E. coli responsible for early-onset sepsis (EOS) in a perinatal center in eastern China.MethodsTwo periods, 2002 to 2008 and 2012 to 2018, were investigated. EOS was defined as the presence of a single potentially pathogenic bacterium grown from blood or cerebrospinal fluid in cultures drawn in any newborn infant within 72 hrs of birth. The changes in antimicrobial resistance of E. coli were analyzed.ResultsA total of 163 cases of EOS were identified, and E. coli continued to be the leading pathogen in our neonatal intensive care unit (NICU). Overall resistance of E. coli to third-generation cephalosporins increased from 14.3% in 2002–2008 to 46.7% in 2012–2018 (p<0.05). This resistance pattern closely parallels ESBL production. Compared to that from term infants, E. coli isolated from preterm infants had a significantly higher rate of resistance to ampicillin (93.3% vs 48.4%, p<0.01) and gentamicin (60.0% vs 9.4%, p<0.01), as well as a higher rate of ESBL production (66.7% vs 15.6%, p<0.01).ConclusionWe conclude that ESBL-producing multi-drug resistant E. coli has emerged as the major pathogen responsible for early-onset neonatal sepsis, particularly in preterm infants. Clinicians should consider this trend and attempt to select proper effective antibiotics as the empirical treatment for early-onset neonatal sepsis.

Antimicrobial Resistance Analysis of Clinical Escherichia coli Isolates in Neonatal Ward

“…The incidence of E. coli early-onset sepsis in very low birth weight infants was estimated at 1.04%, reaching a mortality rate of 35.3% (10). A recent meta-analysis based on a systematic review of published studies in the Chinese literature demonstrated that, among the newborn infants hospitalized in Chinese NICUs, ∼50% of all E. coli bloodstream isolates (independently of being early or late onset) were multi-drug resistant due to extendedspectrum beta-lactamase (ESBL) production (11,12). Emerging antibiotic resistance is currently acknowledged as one of the most significant public health problems with high mortality rates associated with multidrug-resistant bacterial infections.…”

Global emerging resistance in pediatric infections with TB, HIV, and gram-negative pathogens

“…In a study at a children's hospital in China, ~72% of gram-negative bacilli were found to be MDR, with ESBLs being most prevalent [72]. Other studies have demonstrated similar findings [73]. In Ethiopia, all isolates of Acinetobacter baumanni and Pseudomonas aeruginosa were resistant to three-to-six antibiotics from different classes.…”

Enteral broad-spectrum antibiotics antagonize the effect of fecal microbiota transplantation in preterm pigs

“…These bacteria are clinically challenging to manage and pose a serious threat to compromised patients such as preterm infants. 29 Interestingly, FMT treatment reduced levels of cefotaxime resistance after AB treatment, which warrants further investigation. On the other hand, FMT is also capable of transmitting AB resistance genes to recipients, and likely to a greater degree if the recipient microbiota is naïve or dysbiotic, emphasizing the need for rigorous screening of donor stool.…”