PDF(Sci-hub)
Abstract：
Multi-drug resistant organisms are an increasingly important cause of neonatal sepsis.
This study aimed to review neonatal sepsis caused by multi-drug resistant Enterobacteriaceae (MDRE) in neonates in Johannesburg, South Africa.
This was a cross sectional retrospective review of MDRE in neonates admitted to a tertiary neonatal unit between 1 January 2013 and 31 December 2015.
There were 465 infections in 291 neonates. 68.6% were very low birth weight (< 1500 g). The median age of infection was 14.0 days. Risk factors for MDRE included prematurity (p = 0.01), lower birth weight (p = 0.04), maternal HIV infection (p = 0.02) and oxygen on day 28 (p < 0.001). The most common isolate was Klebsiella pneumoniae (66.2%). Total MDRE isolates increased from 0.39 per 1000 neonatal admissions in 2013 to 1.4 per 1000 neonatal admissions in 2015 (p < 0.001). There was an increase in carbapenem-resistant Enterobacteriaceae (CRE) from 2.6% in 2013 to 8.9% in 2015 (p = 0.06). Most of the CRE were New Delhi metallo-β lactamase- (NDM) producers. The all-cause mortality rate was 33.3%. Birth weight (p = 0.003), necrotising enterocolitis (p < 0.001) and mechanical ventilation (p = 0.007) were significantly associated with mortality. Serratia marcescens was isolated in 55.2% of neonates that died.
There was a significant increase in MDRE in neonatal sepsis during the study period, with the emergence of CRE. This confirms the urgent need to intensify antimicrobial stewardship efforts and address infection control and prevention in neonatal units in LMICs. Overuse of broad- spectrum antibiotics should be prevented.
This study aimed to review neonatal sepsis caused by multi-drug resistant Enterobacteriaceae (MDRE) in neonates in Johannesburg, South Africa.
This was a cross sectional retrospective review of MDRE in neonates admitted to a tertiary neonatal unit between 1 January 2013 and 31 December 2015.
There were 465 infections in 291 neonates. 68.6% were very low birth weight (< 1500 g). The median age of infection was 14.0 days. Risk factors for MDRE included prematurity (p = 0.01), lower birth weight (p = 0.04), maternal HIV infection (p = 0.02) and oxygen on day 28 (p < 0.001). The most common isolate was Klebsiella pneumoniae (66.2%). Total MDRE isolates increased from 0.39 per 1000 neonatal admissions in 2013 to 1.4 per 1000 neonatal admissions in 2015 (p < 0.001). There was an increase in carbapenem-resistant Enterobacteriaceae (CRE) from 2.6% in 2013 to 8.9% in 2015 (p = 0.06). Most of the CRE were New Delhi metallo-β lactamase- (NDM) producers. The all-cause mortality rate was 33.3%. Birth weight (p = 0.003), necrotising enterocolitis (p < 0.001) and mechanical ventilation (p = 0.007) were significantly associated with mortality. Serratia marcescens was isolated in 55.2% of neonates that died.
There was a significant increase in MDRE in neonatal sepsis during the study period, with the emergence of CRE. This confirms the urgent need to intensify antimicrobial stewardship efforts and address infection control and prevention in neonatal units in LMICs. Overuse of broad- spectrum antibiotics should be prevented.
摘要：
多重耐药生物体是新生儿败血症的一个日益重要的原因。
本研究旨在回顾约翰内斯堡新生儿多重耐药肠杆菌（MDRE）引起的新生儿败血症，南非。
这是2013年1月1日至2015年12月31日在三级新生儿病房住院的新生儿MDRE的横断面回顾性研究。
291例新生儿中有465例感染。68.6%为极低出生体重(<1500g)。中位感染年龄为14.0天。MDRE的危险因素包括早产(p=0.01)，较低的出生体重（p=0.04），母体HIV感染（p=0.02）和第28天的氧气（p<0.001）。最常见的分离株为肺炎克雷伯菌(66.2%)。MDRE分离株总数从2013年的0.39/1000新生儿入院增加到2015年的1.4/1000新生儿入院(p<0.001)。耐碳青霉烯类肠杆菌（CRE）从2013年的2.6％增加到2015年的8.9％（p=0.06）。大多数CRE是新德里金属β内酰胺酶(NDM)生产者。全因死亡率为33.3%。出生体重（p=0.003），坏死性小肠结肠炎(p<0.001)和机械通气(p=0.007)与死亡率显著相关.55.2％的死亡新生儿分离出粘质沙雷菌。
在研究期间，新生儿败血症中MDRE显著增加，随着CRE的出现。这证实了迫切需要加强抗菌药物管理工作，并解决LMICs新生儿病房的感染控制和预防问题。应防止广谱抗生素的过度使用。
本研究旨在回顾约翰内斯堡新生儿多重耐药肠杆菌（MDRE）引起的新生儿败血症，南非。
这是2013年1月1日至2015年12月31日在三级新生儿病房住院的新生儿MDRE的横断面回顾性研究。
291例新生儿中有465例感染。68.6%为极低出生体重(<1500g)。中位感染年龄为14.0天。MDRE的危险因素包括早产(p=0.01)，较低的出生体重（p=0.04），母体HIV感染（p=0.02）和第28天的氧气（p<0.001）。最常见的分离株为肺炎克雷伯菌(66.2%)。MDRE分离株总数从2013年的0.39/1000新生儿入院增加到2015年的1.4/1000新生儿入院(p<0.001)。耐碳青霉烯类肠杆菌（CRE）从2013年的2.6％增加到2015年的8.9％（p=0.06）。大多数CRE是新德里金属β内酰胺酶(NDM)生产者。全因死亡率为33.3%。出生体重（p=0.003），坏死性小肠结肠炎(p<0.001)和机械通气(p=0.007)与死亡率显著相关.55.2％的死亡新生儿分离出粘质沙雷菌。
在研究期间，新生儿败血症中MDRE显著增加，随着CRE的出现。这证实了迫切需要加强抗菌药物管理工作，并解决LMICs新生儿病房的感染控制和预防问题。应防止广谱抗生素的过度使用。
