Neonatal Unit, Department of Paediatrics and Child Health, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
Infection control, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, 2196, South Africa.
BMC Pediatr. 2019 Sep 7;19(1):320. doi: 10.1186/s12887-019-1709-y.
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.
多药耐药菌是新生儿败血症日益重要的病因。
本研究旨在回顾南非约翰内斯堡新生儿多药耐药肠杆菌科（MDRE）败血症。
这是一项对 2013 年 1 月 1 日至 2015 年 12 月 31 日期间在一家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）。感染的中位年龄为 14.0 天。MDRE 的危险因素包括早产（p=0.01）、低出生体重（p=0.04）、母亲 HIV 感染（p=0.02）和 28 天吸氧（p<0.001）。最常见的分离株为肺炎克雷伯菌（66.2%）。2013 年每 1000 例新生儿入院的 MDRE 分离株为 0.39 株，2015 年增加到 1.4 株（p<0.001）。耐碳青霉烯肠杆菌科（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）产生菌。总死亡率为 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。死亡的新生儿中分离出 55.2%的黏质沙雷菌。
在研究期间，新生儿败血症中 MDRE 显著增加，同时出现 CRE。这证实了迫切需要加强抗菌药物管理工作，并解决中低收入国家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。
