Predictors for gut colonization of carbapenem-resistant Enterobacteriaceae in neonates in a neonatal intensive care unit

Singh, Narendra; Choudhury, Debapriya Das; Gupta, Kanupriya; Rai, Sumit; Batra, Prerna; Manchanda, Vikas; Saha, Rituparna; Kaur, Ishminder

doi:10.1016/j.ajic.2018.01.007

Cited by 19 publications

(17 citation statements)

References 15 publications

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“…During this study, the overall resistance to ESBLwas 68% and that to CRO was 5%. A recent study done in the northern part of India has reported carbapenem-resistant Enterobacteriaceae gut colonization in neonates as 8.7%,[ 5 ] whereas a study done in Germany has shown ESBL Enterobacteriaceae colonization rate in preterm infants to be 5.7%. [ 15 ] In an Italian study, the ESBL colonization rate was found to be 27.1%,[ 16 ] whereas a study done in Cambodia showed colonization by a CRO in 7.5% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are only a few studies on the prevalence of CROs colonization in the gut of preterm babies. [ 5 ] Hence, this study was done to (i) determine neonatal and maternal colonization with these organisms, (ii) identify risk factors associated with colonization, and (iii) look for the association between colonization and late-onset sepsis.…”

Section: Introductionmentioning

confidence: 99%

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Colonization of the preterm neonatal gut with carbapenem-resistant Enterobacteriaceae and its association with neonatal sepsis and maternal gut flora

Smith

Anandan

Veeraraghavan

et al. 2020

J Global Infect Dis

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Background: Multidrug-resistant Gram-negative neonatal sepsis is associated with high mortality and morbidity. Mucosal colonization with these organisms in hospitals may predispose neonates to septicemia. Aims: The aim of the study was to determine the prevalence and pattern of colonization of neonatal preterm gut with carbapenem-resistant Enterobacteriaceae and identify risk factors associated with colonization. Settings and Design: The study was a prospective observational study done in a Level 3 neonatal unit of a tertiary care hospital. Methods: Stool samples from preterm babies were collected soon after birth and at 1 and 3 weeks of age after consent. Maternal stool sample was collected within 48 h after the delivery. Predetermined antenatal, neonatal, and environmental risk factors were recorded. Isolation and identification of organisms was done in a standardized manner; antibiotic susceptibility was done by the Kirby–Bauer method and results interpreted according to the Clinical and Laboratory Standards Institute guidelines. Results: Seventy-one percent of the babies were colonized by Gram-negative bacteria (GNB) at birth, and 100% were colonized by the end of the 1 st week. The organisms commonly isolated were Escherichia coli , Klebsiella , NFGNB (Nonfermenting Gram-Negative Bacilli), Pseudomonas , and Enterobacter . Sixty-eight percent of the babies were colonized with extended-spectrum beta-lactamase-producing organisms, and 5% of the babies were colonized with carbapenem-resistant organisms (CROs). In the babies who developed culture-positive sepsis, 21% had concordance of strains in the gut and blood. There was no association between maternal and neonatal colonization. Conclusions: The results show that neonatal gut is colonized by GNB from birth onward. However, the rate of colonization with CRO is low. An association was also observed between colonization and late-onset sepsis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Colonization of the preterm neonatal gut with carbapenem-resistant Enterobacteriaceae and its association with neonatal sepsis and maternal gut flora

Smith

Anandan

Veeraraghavan

et al. 2020

J Global Infect Dis

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“…Adequate attention must be given to prevent the spread of CRE for children patients in each region hospitals. One study by Millar et al on predictors for gut colonization of CRE in a NICU showed active surveillance of cultures from hospitalized patients and implementation of preventive efforts can reduce the risk of CRE [7]. Therefore, the future controlled studies are necessary to assess risk factors and antibiotic policies in hospital to ensure the appropriate therapeutic selection in children.…”

Section: Discussionmentioning

confidence: 99%

“…In East Delhi of India, a study demonstrated that 8.7% CRE gut colonization in neonates. The risk factors for CRE gut colonization were duration of hospitalization, nasogastric (NG) tube, NG feeding, lack of breastfeeding, top feeding, ventilation, and antibiotics administration [7]. Three carbapenem-resistant Klebsiella pneumoniae isolates recovered from pediatric patients at a single U.S. health care facility, and no patients with these CRE isolates had a history of international travel.…”

Section: Introductionmentioning

confidence: 99%

The characteristics of antimicrobial resistance and treatment of carbapenem-resistant Enterobacteriaceae infections in children from 2013 to 2018 in a chinese tertiary hospital

Jia¹,

Pan²,

Luo³

et al. 2019

Preprint

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Background The aim of this study was to performe a retrospective analysis of prevalence and treatment of carbapenem-resistant Enterobacteriaceae (CRE) infections in children in a tertiary hospital. Methods The non-repeat clinical isolates of CRE in children were collected in Liaocheng People's Hospital from January, 2013 to December, 2018. The bacterial identification and antibiotic susceptibility was performed according to the standard methods. The isolated strains will be detected carbapenemases genotypes and homology analysis. All data on the culture-positive strains and associated clinical infection from different pediatric wards were reviewed. Results A total of 20 CRE strains isolated from pediatric patients, which derived from different infection sites and present a classification of multiple species of Enterobacteriaceae. And the production of IMP-type carbapenemase in these strains is the main reason of antimicrobial resistance. Most of the infected patients have severe comorbidities and invasive procedures, and use insensitive drugs due to the high resistance rates and medication restrictions. Nevertheless, most infected children have been treated despite the resistance of pathogens to multiple antimicrobial agents. In our follow-up survey, most children received adjuvant therapy such as human intravenous immunoglobulin, which may be an important factor in helping patients defeat pathogenic bacteria. Conclusions This study demonstrates a high prevalence of IMP-mediated CRE infection in pediatric patients with severe comorbidities and invasive procedures. Most children have been cured, which may be related to application of adjuvant therapy and weaker pathogenicity of the IMP-type Enterobacteriaceae.

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“…Neonatal risk factors for intestinal CPE colonization and infection have been inconsistently described in the literature, and these are mainly derived from adult studies [1]. Features reported include low gestational age, low birth weight, intensive care unit stay, prolonged hospitalization, prior exposure to antibiotics (especially carbapenems), invasive medical procedures or devices, history of surgery, congenital/syndromic conditions leading to impaired functional status and/or immunosuppression, lack of breastfeeding, maternal-to-neonatal transmission, and travel from endemic regions [1,6,[9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Carbapenemase-Producing Enterobacteriaceae (CPE) Newborn Colonization in a Portuguese Neonatal Intensive Care Unit (NICU): Epidemiology and Infection Prevention and Control Measures

Almeida

Mendo

Costa

et al. 2021

Infectious Disease Reports

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Infections due to carbapenemase-producing Enterobacterales (CPE) are increasing worldwide and are especially concerning in a neonatal intensive care unit (NICU). Risk factors for CPE gut colonization in neonates need to be clarified. In this work, we describe the epidemiological and clinical features of CPE-colonized newborns and the infection control measures in a Portuguese NICU. We performed a prospective, observational, longitudinal, cohort study for surveillance of CPE colonization. Maternal and neonatal features of colonized newborns and surveillance strategy were described. A statistical analysis was performed with SPSS23.0, and significance was indicated by p-value ≤ 0.05. Between March and November 2019, CPE was isolated in 5.8% of 173 admitted neonates. Carbapenemase-producing Klebsiella pneumoniae were the most frequently isolated. There was no associated infection. Birth weight, gestational age, length of stay, and days of central line were the identified risk factors for CPE colonization (bivariate analysis with Student’s t-test or Mann–Whitney U test, according to normality). No independent risk factors for CPE colonization were identified in the logistic regression analysis. CPE colonization risk factors are still to be determined accurately in the neonatal population. Active surveillance and continuous infection control measures restrained the current cluster of colonized newborns and helped to prevent infection and future outbreaks.

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Predictors for gut colonization of carbapenem-resistant Enterobacteriaceae in neonates in a neonatal intensive care unit

Cited by 19 publications

References 15 publications

Colonization of the preterm neonatal gut with carbapenem-resistant Enterobacteriaceae and its association with neonatal sepsis and maternal gut flora

Colonization of the preterm neonatal gut with carbapenem-resistant Enterobacteriaceae and its association with neonatal sepsis and maternal gut flora

The characteristics of antimicrobial resistance and treatment of carbapenem-resistant Enterobacteriaceae infections in children from 2013 to 2018 in a chinese tertiary hospital

Carbapenemase-Producing Enterobacteriaceae (CPE) Newborn Colonization in a Portuguese Neonatal Intensive Care Unit (NICU): Epidemiology and Infection Prevention and Control Measures

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