Abrahams Ilhaam, Dramowski Angela, Moloto Kedisaletse, Lloyd Lizel, Whitelaw Andrew, Bekker Adrie
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
S Afr J Infect Dis. 2023 Jan 30;38(1):487. doi: 10.4102/sajid.v38i1.487. eCollection 2023.
Colistin is increasingly prescribed for neonates with carbapenem-resistant (CRE) infections.
We described patient demographics, infection episodes, treatment and clinical outcomes, colistin related adverse events and relatedness of isolates in neonates with clinically confirmed or clinically suspected CRE infections.
The authors retrospectively reviewed culture-confirmed and clinically suspected culture-negative CRE infections at a South African neonatal unit during a CRE outbreak.
Fifty-three neonates (median gestational age 29 weeks and birth weight 1185 g) were included. Twenty-three of 53 neonates (43%) had culture-confirmed CRE (17 received colistin; 6 died without receiving colistin) and 30 (57%) received colistin for clinically suspected CRE infection but were ultimately culture-negative. Prior respiratory support and surgical conditions were present in 37/53 (70%) and 19/53 (36%) neonates, respectively. Crude mortality was high (20/53; 38%) with no significant difference between culture-confirmed CRE versus clinically suspected culture-negative CRE groups (10/23 [44%] vs 10/30 [33%]; = 0.45). Hypomagnesaemia (10/38; 26%) and hypokalaemia (15/38; 40%) were frequent; acute kidney injury was rare (1/44; 2%). Three CRE infection clusters were identified by genotypic analysis of 20 available isolates (18 [90%] [New Delhi metallo-beta-lactamase], 2 [10%] [oxacillinase]-48).
Neonates receiving colistin therapy were predominantly preterm, with multiple risk factors for infection. Colistin-associated electrolyte derangement was frequent. Over one-third of neonates died. was the most frequent carbapenemase gene identified in the outbreak isolates.
Colistin was safely used during an outbreak in predominantly premature and surgical neonates. The mortality was high.
黏菌素越来越多地被用于治疗耐碳青霉烯类肠杆菌科细菌（CRE）感染的新生儿。
我们描述了临床确诊或临床疑似CRE感染新生儿的患者人口统计学特征、感染发作情况、治疗及临床结局、黏菌素相关不良事件以及分离株的相关性。
作者回顾性分析了南非一家新生儿病房在CRE暴发期间经培养确诊及临床疑似培养阴性的CRE感染情况。
共纳入53例新生儿（中位胎龄29周，出生体重1185克）。53例新生儿中有23例（43%）经培养确诊为CRE（17例接受了黏菌素治疗；6例未接受黏菌素治疗死亡），30例（57%）因临床疑似CRE感染接受了黏菌素治疗，但最终培养结果为阴性。分别有37/53（70%）和19/53（36%）的新生儿既往有呼吸支持和外科手术史。粗死亡率较高（20/53；38%），经培养确诊的CRE组与临床疑似培养阴性的CRE组之间无显著差异（10/23 [44%] 对10/30 [33%]；P = 0.45）。低镁血症（10/38；26%）和低钾血症（15/38；40%）很常见；急性肾损伤罕见（1/44；2%）。通过对20株可用分离株进行基因分型分析，确定了3个CRE感染聚集性病例（18株 [90%] 为新德里金属β-内酰胺酶，2株 [10%] 为oxacillinase-48）。
接受黏菌素治疗的新生儿主要为早产儿，有多种感染危险因素。黏菌素相关的电解质紊乱很常见。超过三分之一的新生儿死亡。新德里金属β-内酰胺酶是暴发分离株中最常见的碳青霉烯酶基因。
在主要为早产儿和外科手术新生儿的CRE暴发期间，黏菌素得到了安全使用。死亡率较高。
