Multidrug-resistant organisms in neonatal sepsis in two tertiary neonatal ICUs, Egypt

Awad, H.H.; Mohamed, Maha H.; Badran, Nabil F.; Mohsen, Manal; Abd-Elrhman, Al-Sayed A.

doi:10.1097/01.epx.0000482038.76692.3

Cited by 36 publications

(53 citation statements)

References 23 publications

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“…Our study showed a high percentage of MDRGNB episodes of sepsis (64.2%, 174/271). However, this incidence was lower than a study from Egypt (83.4%) but the data in that study were not clear because there was no clear definition of MDR sepsis [28]. The data from studies in Taiwan (18.6%) [4] and Hungary (including both neonatal and pediatric ICUs, 33.6%) [29] were much lower compared to our study.…”

Section: Discussioncontrasting

confidence: 97%

Multidrug-resistant Gram-negative bacilli sepsis from a neonatal intensive care unit: a case-case-control study

Thatrimontrichai

Premprat

Janjindamai

et al. 2019

J Infect Dev Ctries

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Introduction: To identify the risks and outcomes for multidrug-resistant Gram-negative bacilli (MDRGNB) sepsis in neonates. Methodology: This was a retrospective case-case-control study between 1991 and 2016. The control group was selected from the same source records of all neonates with clinical or suspected sepsis but not culture-proven. Results: The numbers of patients in the MDRGNB sepsis, non-MDRGNB sepsis, and control groups were 157, 88, and 218, respectively. MDRGNB sepsis was significantly associated with outborn infants [adjusted odds ratio (aOR) 2.08; p = 0.003] and infants who had a neurologic sequela (aOR 11.58; p = 0.04), lower gestational age (p = 0.03) or previous aminoglycoside use (aOR 2.43; p < 0.001) compared with the control group. Non-MDRGNB sepsis was associated with outborn infants (aOR 2.63; p < 0.001), and infants who had neurologic sequelae (aOR 48.25; p = 0.001) and previous cephalosporin use (aOR 6.28; p < 0.001) or cefoperazone plus sulbactam use (aOR 6.48; p = 0.02) compared with the control group. Case fatality (OR 3.63; p < 0.001) and septic shock (OR 12.81; p < 0.001) rates, length of stay (p < 0.001), and daily hospital costs (p = 0.01) were higher in the MDRGNB sepsis group than in the control group. Conclusions: Smaller preterm neonate with previous aminoglycoside use had a higher MDRGNB than non-MDRGNB sepsis compared with the control group. Intervention to reduce MDRGNB sepsis in the NICU is cost-effective.

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Section: Discussioncontrasting

confidence: 97%

Multidrug-resistant Gram-negative bacilli sepsis from a neonatal intensive care unit: a case-case-control study

Thatrimontrichai

Premprat

Janjindamai

et al. 2019

J Infect Dev Ctries

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“…A previous study from India stated that multidrug resistant organisms were leading causes of early as well as late onset sepsis [17]. Even studies from Egypt addressing this problem studied multi drug resistance either collectively [18] or in relation to late onset sepsis only [19]. The worrisome rise in levels of antimicrobial resistance among pathogens retrieved from NICUs highlight the needs for better understanding of the problem of early onset sepsis and implementing strategies to combat, especially in countries with limited resources [20].…”

Section: Discussionmentioning

confidence: 99%

Emerging antimicrobial resistance in early and late-onset neonatal sepsis

Mohsen

Ramy

Saied

et al. 2017

Antimicrob Resist Infect Control

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BackgroundCompared to developed countries, the use of antimicrobials in Egypt is less regulated and is available over the counter without the need for prescriptions. The impact of such policy on antimicrobial resistance has not been studied. This study aimed to determine the prevalence of early and late onset sepsis, and the frequency of antimicrobial resistance in a major referral neonatal intensive care unit (NICU).MethodsThe study included all neonates admitted to the NICU over a 12-month period. Prospectively collected clinical and laboratory data were retrieved, including blood cultures and endotracheal aspirate cultures if performed.ResultsA total of 953 neonates were admitted, of them 314 neonates were diagnosed with sepsis; 123 with early onset sepsis (EOS) and 191 with late onset sepsis (LOS). A total of 388 blood cultures were obtained, with 166 positive results. Total endotracheal aspirate samples were 127; of them 79 were culture-positive. The most frequently isolated organisms in blood were Klebsiella pneumoniae (42%) and Coagulase negative staphylococcus (19%) whereas in endotracheal cultures were Klebsiella pneumoniae (41%) and Pseudomonas aeruginosa (19%). Gram negative organisms were most resistant to ampicillins (100%), cephalosporins (93%–100%) and piperacillin-tazobactam (99%) with less resistance to aminoglycosides (36%–52%). Gram positive isolates were least resistant to vancomycin (18%). Multidrug resistance was detected in 92 (38%) cultures, mainly among gram negative isolates (78/92).ConclusionsAntibiotic resistance constitutes a challenge to the management of neonatal sepsis in Egypt. Resistance was predominant in both early and late onset sepsis. This study supports the need to implement policies that prohibits the non-prescription community use of antibiotics.

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“…Also, E. cloacae is located under category “B” and these two organisms have been associated with neonatal infections, including necrotizing enterocolitis, which is the most common important gastrointestinal illness in the newborn (Iversen & Forsythe, ). Furthermore, K. pneumoniae , E. coli, and E. cloacae cause neonatal sepsis (Nour et al, ), which is an important challenge for clinicians, accounting for approximately 22% of the global annual neonatal deaths (Awad, Mohamed, Badran, Mohsen, & Abd‐Elrhman, ). One of the most competitive issues associated with the genus Enterobacter is the disability to characterize the exact species of 2 isolates of this genera which turned out to be E. hormaechei that belongs to “ E. cloacae complex”.…”

Section: Discussionmentioning

confidence: 99%

Molecular detection of Enterobacter spp. and other related species in powdered milk infant formula and milk powder

El‐Zamkan

Mohamed

2018

Journal of Food Safety

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A total of 60 powdered milk infant formula and milk powder samples were obtained from different localities in Qena Governorate, Egypt, to be evaluated for presence of Enterobacter and closely related species using FDA procedure. Ten out of 60 samples were contaminated with Enterobacter spp. and other Enterobacteriaceae. The obtained isolates were biochemically identified as Enterobacter spp., Klebsiella pneumoniae, Escherichia coli, Citrobacter spp. Further characterization was performed using 16S rRNA sequence analysis; it was a pivotal to confirm the identity of the isolates especially in imprecise identification of phenotypic method in some isolates like Enterobacter hormaechei, Klebsiella quasipneumoniae, and Acinetobacter vivianii. Results revealed the contamination of powdered milk infant formula with E. hormaechei which makes it a matter of concern. According to the best of our knowledge, Enterobacter hormaechei and Klebsiella quasipneumonia were isolated for the first time in Egypt. The phylogenetic analysis proved the close relation between our isolates in amplification of partial 16S rRNA gene. Practical applications As many neonates depend on powdered infant formula in their feeding as well as milk powder is a fundamental component of many infants diet, our study evaluated these products for the presence of pathogens of safety concern. This study focused on Enterobacteriaceae family members other than Salmonella and Cronobacter sakazakii using 16S rRNA gene for identification and differentiation of the closely related species.

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Multidrug-resistant organisms in neonatal sepsis in two tertiary neonatal ICUs, Egypt

Cited by 36 publications

References 23 publications

Multidrug-resistant Gram-negative bacilli sepsis from a neonatal intensive care unit: a case-case-control study

Multidrug-resistant Gram-negative bacilli sepsis from a neonatal intensive care unit: a case-case-control study

Emerging antimicrobial resistance in early and late-onset neonatal sepsis

Molecular detection of Enterobacter spp. and other related species in powdered milk infant formula and milk powder

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