Multidrug resistant Klebsiella pneumoniae in NICU – what next? Trend of antibiotic resistance

Tagare, Amit; Vaidya, Umesh; Deodhar, Jayant; Pandit, Anand

doi:10.3233/jpi-2010-0245

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…27 A similar resistance pattern was reported by Tagare et al The latter group reported 100% resistance to ampicillin and third-generation cephalosporins, almost 90% resistance to piperacillin and 40% resistance to carbapenems. 9 In the present study, overall the isolates had better susceptibility to piperacillin with tazobactam, amikacin, and ciprofloxacin. Nevertheless, it would seem inappropriate to use higher-generation broad-spectrum antibiotics in suspected sepsis cases that are not critically ill.…”

Section: Discussionsupporting

confidence: 50%

“…An earlier report from western India also showed a similar pattern with gram-negative organisms accounting for more than 75% of the isolates. 9 Data from developing countries are more or less similar with K. pneumoniae as the major pathogen. 4 S. aureus emerged as the second most common organism.…”

Section: Discussionmentioning

confidence: 99%

“…High resistance to first-line antibiotics such as ampicillin and gentamicin and third-generation cephalosporins as observed in the present study has been reported from India, Pakistan, and Eygpt. 9,10,25,26 making them less suitable for empiric therapy. Issacs (2005) reported 100% resistance to ampicillin in Indian NICUs.…”

Section: Discussionmentioning

confidence: 99%

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Pattern and Antimicrobial Susceptibility of Neonatal Sepsis at a Tertiary Care Center in Western India

Dhanawade

Tagare

Gadre

et al. 2016

J Pediatr Infect Dis

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Changing trends in neonatal sepsis is documented worldwide. We reviewed blood culture reports over a 3-year period. Out of 1,020 blood cultures sent from 620 neonates with suspected sepsis, 127 (12.4%) were positive. Gram-negative and gram-positive pathogens constituted 68.2% and 31.78%, respectively. Klebsiella was the most common organism (37/127) followed by Staphylococcus aureus (25/127), Acinetobacter (18/127), Escherichia coli (18/127), and Enterococci spp. (12/127). Gram-negative organisms were highly resistant to ampicillin (84.8%), gentamicin (81.3%), and cefotaxime (71.3%). Carbapenem resistance was observed in 26.6% of gram-negative pathogens. Vancomycin resistance among enterococci was 40%, and 12% of S. aureus strains were methicillin resistant. Mortality rate was 29.13% and was highest (44.44%) in Acinetobacter sepsis.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

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Pattern and Antimicrobial Susceptibility of Neonatal Sepsis at a Tertiary Care Center in Western India

Dhanawade

Tagare

Gadre

et al. 2016

J Pediatr Infect Dis

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“…Finally, 128 articles at the time of writing, none of which were preprints, were analyzed ( S1 Dataset ). The 128 articles comprised a total study population of 127,583 neonates in 30 countries of Africa ( n = 10; Algeria [ 27 ], Egypt [ 28 , 29 ], Ghana [ 30 ], Guinea [ 31 ], Morocco [ 32 , 33 ], Nigeria [ 34 – 37 ], South Africa [ 38 – 45 ], Tanzania [ 46 ], Tunisia [ 47 ], and Zambia [ 48 ]), Asia ( n = 10; Bangladesh [ 34 , 49 ], China [ 50 – 92 ], India [ 34 , 93 – 113 ], Iran [ 114 ], Israel [ 115 ], Japan [ 116 ], Nepal [ 117 ], Pakistan [ 34 , 118 – 122 ], Saudi Arabia [ 123 , 124 ], and Vietnam [ 125 – 128 ]), Europe ( n = 8; France [ 129 ], Greece [ 130 ], Hungary [ 131 ], Italy [ 132 – 142 ], Portugal [ 143 ], Russia [ 144 ], Turkey [ 145 – 147 ], and the United Kingdom [ 148 ]), and South America (Colombia [ 149 – 152 ] and Venezuela [ 153 ]) ( Fig 2 ). Among the ...…”

Section: Resultsmentioning

confidence: 99%

Prevalence and clonal diversity of carbapenem-resistant Klebsiella pneumoniae causing neonatal infections: A systematic review of 128 articles across 30 countries

Yang

Feng

et al. 2023

PLoS Med

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Background Klebsiella pneumoniae is the most common pathogen causing neonatal infections, leading to high mortality worldwide. Along with increasing antimicrobial use in neonates, carbapenem-resistant K. pneumoniae (CRKP) has emerged as a severe challenge for infection control and treatment. However, no comprehensive systematic review is available to describe the global epidemiology of neonatal CRKP infections. We therefore performed a systematic review of available data worldwide and combined a genome-based analysis to address the prevalence, clonal diversity, and carbapenem resistance genes of CRKP causing neonatal infections. Methods and findings We performed a systematic review of studies reporting population-based neonatal infections caused by CRKP in combination with a genome-based analysis of all publicly available CRKP genomes with neonatal origins. We searched multiple databases (PubMed, Web of Science, Embase, Ovid MEDLINE, Cochrane, bioRxiv, and medRxiv) to identify studies that have reported data of neonatal CRKP infections up to June 30, 2022. We included studies addressing the prevalence of CRKP infections and colonization in neonates but excluded studies lacking the numbers of neonates, the geographical location, or independent data on Klebsiella or CRKP isolates. We used narrative synthesis for pooling data with JMP statistical software. We identified 8,558 articles and excluding those that did not meet inclusion criteria. We included 128 studies, none of which were preprints, comprising 127,583 neonates in 30 countries including 21 low- and middle-income countries (LMICs) for analysis. We found that bloodstream infection is the most common infection type in reported data. We estimated that the pooled global prevalence of CRKP infections in hospitalized neonates was 0.3% (95% confidence interval [CI], 0.2% to 0.3%). Based on 21 studies reporting patient outcomes, we found that the pooled mortality of neonatal CRKP infections was 22.9% (95% CI, 13.0% to 32.9%). A total of 535 neonatal CRKP genomes were identified from GenBank including Sequence Read Archive, of which 204 were not linked to any publications. We incorporated the 204 genomes with a literature review for understanding the species distribution, clonal diversity, and carbapenemase types. We identified 146 sequence types (STs) for neonatal CRKP strains and found that ST17, ST11, and ST15 were the 3 most common lineages. In particular, ST17 CRKP has been seen in neonates in 8 countries across 4 continents. The vast majority (75.3%) of the 1,592 neonatal CRKP strains available for analyzing carbapenemase have genes encoding metallo-β-lactamases and NDM (New Delhi metallo-β-lactamase) appeared to be the most common carbapenemase (64.3%). The main limitation of this study is the absence or scarcity of data from North America, South America, and Oceania. Conclusions CRKP contributes to a considerable number of neonatal infections and leads to significant neonatal mortality. Neonatal CRKP strains are highly diverse, while ST17 is globally prevalent and merits early detection for treatment and prevention. The dominance of blaNDM carbapenemase genes imposes challenges on therapeutic options in neonates and supports the continued inhibitor-related drug discovery.

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“…Compounding the difficulty and complexity of treating neonatal sepsis is antimicrobial resistance (AMR); as antibiotic use has increased and broader spectrum antibiotics are used more frequently, AMR has risen (4). Previously published longitudinal data from our neonatal intensive care unit (NICU) in western India from 2006 to 2008 already showed a worrying increase in multidrug-resistant (MDR) infection over the 2-year study period as well as persistently high rates of cephalosporin and carbapenem resistance (5). A more recent systematic review from 2019 on AMR in neonatal sepsis in South Asia (including 69 studies from India) shows that these challenges are ongoing and more widespread (6).…”

Section: Introductionmentioning

confidence: 99%

Emerging Antibiotic Resistance Patterns in a Neonatal Intensive Care Unit in Pune, India: A 2-Year Retrospective Study

et al. 2022

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Objective:Treating neonatal bloodstream infections and meningitis in South Asia remains difficult given high rates of antimicrobial resistance (AMR). To evaluate changing epidemiology of neonatal infections, we assessed pathogen-specific and clinical features of culture-proven infections in neonates admitted to a neonatal intensive care unit (NICU) in Pune, India.Materials and MethodsThis retrospective cohort study was performed in the King Edward Memorial Hospital and Research Center NICU over 2 years between January 1, 2017 and December 31, 2018. We included all neonates admitted to the NICU with positive blood or cerebrospinal fluid cultures. Demographic, clinical, and microbiologic data were collected from the medical record. We reviewed antimicrobial susceptibility testing (AST) of all isolates.ResultsThere were 93 culture-positive infections in 83 neonates, including 11 cases of meningitis. Fifteen (18%) neonates died. Gram-negative pathogens predominated (85%) and AST showed 74% resistance to aminoglycosides, 95% resistance to third/fourth generation cephalosporins, and 56% resistance to carbapenems. Resistance to colistin was present in 30% of Klebsiella pneumoniae isolates. Birth weight <1,000 g [odds ratio (OR) 6.0, p < 0.002], invasive respiratory support (OR 7.7, p = 0.001), and antibiotics at the time of culture (OR 4.2, p = 0.019) were associated with increased risk of mortality. Rates of AMR to all major antibiotic classes were similar between early onset and late onset infections. There was no association between carbapenem resistance and mortality.ConclusionIn our NICU in India, there are high rates of AMR among Gram-negative pathogens that are predominantly responsible for infections. Given higher colistin resistance in this cohort than previously reported, hospitals should consider routinely testing for colistin resistance.

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Multidrug resistant Klebsiella pneumoniae in NICU – what next? Trend of antibiotic resistance

Cited by 5 publications

References 23 publications

Pattern and Antimicrobial Susceptibility of Neonatal Sepsis at a Tertiary Care Center in Western India

Pattern and Antimicrobial Susceptibility of Neonatal Sepsis at a Tertiary Care Center in Western India

Prevalence and clonal diversity of carbapenem-resistant Klebsiella pneumoniae causing neonatal infections: A systematic review of 128 articles across 30 countries

Emerging Antibiotic Resistance Patterns in a Neonatal Intensive Care Unit in Pune, India: A 2-Year Retrospective Study

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