Bandyopadhyay T, Kumar A, Saili A, Randhawa V S
Department of Neonatology, Lady Hardinge Medical College, New Delhi, India.
Department of Microbiology, Lady Hardinge Medical College, New Delhi, India.
J Neonatal Perinatal Med. 2018;11(2):145-153. doi: 10.3233/NPM-1765.
The aim of this study is to investigate etiological agents, patterns of antimicrobial resistance and predictors of mortality in culture proven neonatal sepsis.
This is a twenty-four month retrospective cohort study of infants with culture proven sepsis. Demographic data, type of isolates and its sensitivity pattern were recorded. Multidrug resistant gram-negative isolates were defined as resistance to any three of five antibiotic classes: extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones and piperacillin-tazobactam.
A total of 183 case with culture positive sepsis were identified. Early onset sepsis occurred in 59% of cases. The majority of isolates (56.2%) were gram-positive but the most common individual isolates were klebsiella spp. (31.1%), Staphylococcus aureus (24.5%) and coagulase-negative staphylococci (CONS) (22.9%). The pathogen mix in early-onset did not differ from late-onset sepsis. High rates of multidrug resistance were observed in klebsiella spp. (49.1%), Escherichia coli (50%), citrobacter spp (50%), acinetobacter spp. (28.5%), pseudomonas spp. (100%) isolates. Methicillin resistance prevailed in 16.6% of coagulase-negative staphylococci, 24.4% of Staphylococcus aureus and 62.5% of enterococcus spp. Multivariate analysis revealed invasive ventilation and early onset sepsis to be independently associated with increased risk of mortality in contrast to breast milk feeding which is associated with decreased risk of mortality.
A high degree of antimicrobial resistance underscores the need to understand the pathogenesis of resistance, curtail the irrational prescription of antibiotics in neonates and the requirement for measures to prevent it in low-income and middle-income countries.
本研究旨在调查经培养证实的新生儿败血症的病原体、抗菌药物耐药模式及死亡预测因素。
这是一项对经培养证实患有败血症的婴儿进行的为期24个月的回顾性队列研究。记录人口统计学数据、分离株类型及其敏感性模式。耐多药革兰氏阴性分离株定义为对以下五类抗生素中的任意三种耐药：广谱头孢菌素、碳青霉烯类、氨基糖苷类、氟喹诺酮类和哌拉西林-他唑巴坦。
共识别出183例血培养阳性的败血症病例。59%的病例发生早发型败血症。大多数分离株（56.2%）为革兰氏阳性，但最常见的单一分离株是克雷伯菌属（31.1%）、金黄色葡萄球菌（24.5%）和凝固酶阴性葡萄球菌（CONS）（22.9%）。早发型和晚发型败血症的病原体组合无差异。在克雷伯菌属（49.1%）、大肠杆菌（50%）、柠檬酸杆菌属（50%）、不动杆菌属（28.5%）、假单胞菌属（100%）分离株中观察到高耐多药率。16.6%的凝固酶阴性葡萄球菌、24.4%的金黄色葡萄球菌和62.5%的肠球菌属存在耐甲氧西林情况。多变量分析显示，有创通气和早发型败血症与死亡风险增加独立相关，而母乳喂养则与死亡风险降低相关。
高度的抗菌药物耐药性凸显了了解耐药机制、减少新生儿抗生素不合理处方的必要性，以及在低收入和中等收入国家采取预防措施的需求。
