Risk Factors for 30-Day Mortality in Neonates With Carbapenem-resistant A. baumannii Sepsis

Abstract

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) sepsis is becoming an extreme threat caused by high-case fatality rates and poor prevention and control in ICUs worldwide. However, the risk of mortality among neonatal CRAB sepsis is still unclear. Methods: A retrospective medical records review study, which aimed to identify the risk factors of mortality in neonates with CRAB sepsis (including both bacteremia and/or meningitis) in Thailand from 1996 to 2019. All cases featuring positive blood and cerebrospinal fluid cultures for CRAB were reviewed. A multivariable logistic regression model was analyzed for nonsurvivors and survivors of neonatal CRAB sepsis. Results: In a 24-year period, 47 of these were identified with CRAB sepsis. The median (interquartile range) gestational age and birth weight were 30 (28–35) weeks and 1500 (933–2482) g, respectively. The 30-day case fatality rate was 55% (26/47). In multivariable analysis, nonsurvivors of neonatal CRAB sepsis were associated with congenital heart disease (adjusted odds ratio [OR] = 1.33; 95% CI 1.06–1.66, P = 0.02), CRIB II score ≥9 (adjusted OR = 1.65; 95% CI: 1.20–2.27, P = 0.004), severe thrombocytopenia (adjusted OR = 1.45; 95% CI: 1.09–1.94, P = 0.02), and septic shock (adjusted OR = 1.62; 95% CI: 1.33–1.99, P <0.001). Conclusion: The risk factors of mortality in neonates with CRAB sepsis are associated with congenital heart disease, CRIB II score ≥9, shock, and severe thrombocytopenia.

Differential Abundances of Bdellovibrio and Rheinheimera in the Oral Microbiota of Neonates With and Without Clinical Sepsis

“…Further, this group had higher doses and days of antibiotic exposure (both P < 0.001) than neonates without clinical sepsis (Table 1). The median (IQR) time interval between sepsis occurrence and oral collection was 20 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) days. Six neonates with clinical sepsis had culture-proven LOS (2 cases of Acinetobacter baumannii, and 1 case each of Acinetobacter baylyi, Klebsiella pneumoniae, Staphylococcus epidermidis and Staphylococcus capitis).…”

“…Notably, this study is the first to show an increased abundance of Bdellovibrio in neonates without clinical sepsis. A predatory renaissance, the first step for new strategies of preventive and therapeutic sepsis as well as multidrug-and extensively drugresistant human pathogens [31][32][33] in the postantibiotic era, aims to restore a balance in the intestinal ecosystem, especially Bdellovibrio as a dual probiotic and living antibiotic. However, this study had several limitations that should be mentioned.…”