Labi Appiah-Korang, Bjerrum Stephanie, Enweronu-Laryea Christabel C, Ayibor Prosper K, Nielsen Karen L, Marvig Rasmus L, Newman Mercy J, Andersen Leif P, Kurtzhals Jorgen A L
Department of Microbiology, Korle-Bu Teaching Hospital, Accra, Ghana.
Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
Open Forum Infect Dis. 2020 Mar 28;7(4):ofaa109. doi: 10.1093/ofid/ofaa109. eCollection 2020 Apr.
Carriage of multidrug resistant (MDR) Gram-negative bacteria (GN) in hospitalized neonates may increase the risk of difficult-to-treat invasive infections at neonatal intensive care units (NICUs). Data on MDRGN carriage among hospitalized newborns in Africa are limited.
We conducted a cross-sectional study at the NICUs of 2 tertiary hospitals in Ghana. Swabs from the axilla, groin, perianal region, and the environment were cultured, GN were identified, and antibiotic susceptibility was tested. We obtained blood culture isolates from neonates with sepsis. Whole-genome sequencing was used to characterize carbapenemase-producing . Typing was done by multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP) analysis.
A total of 276 GN were isolated from 228 screened neonates. Pathogenic GN were cultured in 76.8% (175 of 228) of neonates. spp (41.7%; 115 of 276) and (26.4%; 73 of 276) were the commonest organisms. Carriage rates of MDRGN and third-generation cephalosporin resistant organisms were 49.6% (113 of 228) and 46.1% (105 of 228), respectively. Among spp, 75.6% (87 of 115) phenotypically expressed extended-spectrum β-lactamase activity, whereas 15.6% expressed carbapenemase and harbored and . Overall, 7.0% (16 of 228) of neonates developed GN bloodstream infection. In 2 of 11 neonates, sequencing showed the same identity between carriage and the bloodstream isolate. Length of stay before specimen collection and antibiotic use were independently associated with carriage rates, which increased from 13% at admission to 42% by day 2 and reached a plateau at 91% by day 15.
High carriage rates of MDRGN, including carbapenemase-producing enterobacterales may be an emerging problem in NICUs in Africa.
住院新生儿携带多重耐药（MDR）革兰氏阴性菌（GN）可能会增加新生儿重症监护病房（NICU）发生难以治疗的侵袭性感染的风险。非洲住院新生儿中MDRGN携带情况的数据有限。
我们在加纳的2家三级医院的新生儿重症监护病房进行了一项横断面研究。采集腋窝、腹股沟、肛周区域和环境的拭子进行培养，鉴定GN，并测试抗生素敏感性。我们从患有败血症的新生儿中获取血培养分离株。采用全基因组测序来鉴定产碳青霉烯酶的菌株。通过多位点序列分型（MLST）和单核苷酸多态性（SNP）分析进行分型。
从228名筛查的新生儿中共分离出276株GN。76.8%（228名中的175名）的新生儿培养出致病性GN。肺炎克雷伯菌（41.7%；276株中的115株）和大肠埃希菌（26.4%；276株中的73株）是最常见的菌株。MDRGN和对第三代头孢菌素耐药菌株的携带率分别为49.6%（228名中的113名）和46.1%（228名中的105名）。在肺炎克雷伯菌中，75.6%（115株中的87株）表型表达超广谱β-内酰胺酶活性，而15.6%表达碳青霉烯酶并携带blaKPC和blaNDM。总体而言，7.0%（228名中的16名）的新生儿发生了GN血流感染。在11名新生儿中的2名中，测序显示携带菌与血流分离株具有相同的特征。标本采集前的住院时间和抗生素使用与携带率独立相关，携带率从入院时的13%增加到第2天的42%，并在第15天达到91%的平台期。
包括产碳青霉烯酶肠杆菌在内的MDRGN的高携带率可能是非洲新生儿重症监护病房中一个新出现的问题。
