Risk Factors of Nosocomial Infection with Extended-Spectrum Beta-Lactamase-Producing Bacteria in a Neonatal Intensive Care Unit in China

Huang, Yuefang; Zhuang, Shihao; Du, Mingmei

doi:10.1007/s15010-007-6356-9

Cited by 54 publications

(57 citation statements)

References 32 publications

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“…Previous reports indicated conflicting findings in different settings. 25,26 Our understanding is that central venous catheter by itself is not a risk for ESBL, but the care and handling of central venous catheter is a key for the prevention of ESBL and for sepsis in general.…”

Section: Discussionmentioning

confidence: 99%

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RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

et al. 2008

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Objectives: Extended-spectrum beta-lactamase producing (ESBL) Klebsiella pneumoniae is an important cause of nosocomial infections in neonatal intensive care units (NICUs). Our objectives were to determine (1) the incidence of ESBL K. pneumoniae in our NICU, (2) the frequency of SHV-1 and SHV-2 gene acquisition among ESBL K. pneumoniae isolates, (3) the risk factors associated with ESBL K. pneumoniae infection and (4) the clinical outcomes of infected infants.Study Design: We conducted a prospective surveillance study in our NICU over a period of 1 year on all neonates admitted without evidence of early sepsis. We collected specimens from blood, urine, cerebrospinal fluid, swabs from wounds and throat and endotracheal tube aspirates of infants whenever sepsis was suspected. Bacterial isolates were identified via clinical morphology, Gram stain and standard biochemical tests. Antimicrobial susceptibility was determined by disc diffusion method, and phenotypic confirmation of ESBL production was done by the double-disc synergy test and Etest. Genetic detection of SHV-1 and SHV-2 genes in ESBL K. pneumoniae isolates was done by polymerase chain reaction (PCR) and restriction fragment length polymorphisms. Risk factors associated with ESBL K. pneumoniae infection were analysed by both univariate and multiple logistic regression methods.Results: A total of 980 cultures were obtained from 380 neonates, and 372 screening cultures were collected from the environment. K. pneumoniae was cultured from 27 (7%) infants (3.8/1000 patient-days); of them, 18 (67%) were ESBL producers. PCR amplicons revealed the presence of SHV-2 in all 18 isolates (100%), and SHV-1 gene in 8 isolates (44%). Independent risk factors for ESBL K. pneumoniae infection were mechanical ventilation (OR: 4.2, confidence interval (CI): 1.6-11.0); birth weight <1500 g (OR: 3.2, CI: 1.2-8.3) ); duration of hospitalization >15 days (OR: 4

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Section: Discussionmentioning

confidence: 99%

“…25,26 Antibiotic restriction policy can significantly reduce antimicrobial consumption and antimicrobial resistance rates. 27 We have demonstrated that neonates with infections due to ESBL K. pneumoniae had a significantly higher mortality than those without ESBL K. pneumoniae infection.…”

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

et al. 2008

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Section: Discussioncontrasting

confidence: 54%

“…[24][25][26][27] However, some of these associations were not observed in this study, and we further identified antibiotic exposure of third-generation cephalosporin and carbapenem within 1 month before GNB bacteremia as the independent risk factor. These diverse results can be explained by the different definitions of a resistant GNB isolate, [24][25][26][27] different study designs, 24,25 different empirical antibiotic policies, and different inclusion criteria (nosocomial infection instead of bacteremia in the other studies). 24,25,27 Previous antibiotic therapy has been recognized to be significantly related to bacterial resistance development, [24][25][26][27][28] but all issues regarding appropriate control group selection, case definition, description of previous antibiotic exposure, and adjustment for confounding factors should be refined.…”

Section: Discussioncontrasting

confidence: 54%

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:There is a perception that Gram-negative bacilli (GNB) bloodstream infection is increasing in the NICU, and those infections caused by a multidrug-resistant (MDR) strain are a growing threat to hospitalized patients. WHAT THIS STUDY ADDS:Exposure to broad-spectrum antibiotics is the most important risk factor for MDR GNB bacteremia, which is associated with higher mortality. Neonates with risk factors for bacteremia caused by a MDR GNB strain may benefit from empirical antimicrobial therapy with carbapenem. abstract OBJECTIVES: To assess the risk factors antibiotic therapy and outcomes of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bacteremia in NICU patients. METHODS:Episodes of MDR GNB bacteremia were compared with a non-MDR GNB bacteremia group in an 8-year cohort study. RESULTS:Of 1106 bacteremias, 393 (35.5%) were caused by GNB. Seventy (18.6%) were caused by an MDR strain. The most frequent mechanism of resistance was extended-spectrum b-lactamase production (67.1%), mainly by Klebsiella pneumoniae (59.6%). Previous antibiotic exposure to third-generation cephalosporin (odds ratio [OR]: 5.97; 95% confidence interval [CI]: 2.37-15.08; P , .001) and carbapenem (OR: 3.60; 95% CI: 1.26-10.29; P = .017) and underlying renal disease (OR: 7.08; 95% CI: 1.74-28.83; P = .006) were identified as independent risk factors for MDR GNB acquisition. Patients with MDR GNB bacteremia more likely received inadequate initial antibiotic therapy (72.9% vs 7.8%; P , .001) had higher rates of infectious complication (21.4% vs 10.5%; P = .011) and overall case fatality 1rate (28.6% vs 10.5%; P , .001). Independent risk factors for overall mortality were presence of infectious complications after bacteremia (OR: 3.16; 95% CI: 1.41-7.08; P = .005) and underlying secondary pulmonary hypertension with or without cor pulmonale (OR: 6.19; 95% CI: 1.88-20.31; P = .003).CONCLUSIONS: MDR GNB accounted for 18.6% of all neonatal GNB bacteremia in the NICU, especially in those with previous broad-spectrum antibiotic therapy and underlying renal disease. The most frequent mechanism of resistance was extended-spectrum b-lactamase (ESBL) production. Neonates with MDR GNB were more likely to develop infectious complications, which were independently associated with a higher overall case-fatality rate. Pediatrics 2014;133:e322-e329

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“…The presence of three or more of these predisposing factors (for children older than 30 days), has a sensitivity to detect patients with EPE ~84.6% and a specificity ~96.4%. RF for EPE infections in newborns involves different aspects, mostly related to the perinatal period [13].…”

Section: The Studymentioning

confidence: 99%

Risk factors for the acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in hospitalized children

Robino

Telechea

Speranza

et al. 2013

J Infect Dev Ctries

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Risk Factors of Nosocomial Infection with Extended-Spectrum Beta-Lactamase-Producing Bacteria in a Neonatal Intensive Care Unit in China

Abstract: Preterm low birth weight, prolonged mechanical ventilation and prior use of third-generation cephalosporins are risks factors for nosocomial infection with ESBL-producing bacteria in NICU.

Cited by 54 publications

References 32 publications

RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

RETRACTED ARTICLE: Extended-spectrum β-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU

Risk factors for the acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in hospitalized children

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