Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India.

Autor: Jajoo M; Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India., Manchanda V; Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India., Chaurasia S; Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India., Sankar MJ; Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India., Gautam H; Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India., Agarwal R; Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India., Yadav CP; Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.; National Institute of Malaria Research, New Delhi, India., Aggarwal KC; Department of Pediatrics, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India., Chellani H; Department of Pediatrics, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India., Ramji S; Department of Pediatrics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India., Deb M; Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India., Gaind R; Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India., Kumar S; Department of Microbiology, Maulana Azad Medical College and LNJP Hospital, New Delhi, India., Arya S; Department of Pediatrics, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India., Sreenivas V; Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India., Kapil A; Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India., Mathur P; Department of Laboratory Medicine, JPNA Trauma Centre, AIIMS, New Delhi, India., Rasaily R; Division of Reproductive Health & Nutrition, Indian Council of Medical Research (ICMR), New Delhi, India., Deorari AK; Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India., Paul VK; Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2018 Jun 28; Vol. 13 (6), pp. e0180705. Date of Electronic Publication: 2018 Jun 28 (Print Publication: 2018).
DOI: 10.1371/journal.pone.0180705
Abstrakt: Background: There is a paucity of data on the epidemiology of sepsis in outborn neonates being referred to level-3 units in low- and middle-income countries (LMIC). The objective of the present study was to evaluate the prevalence of sepsis and outcomes of outborn neonates with sepsis, and to characterize the pathogen profile and antimicrobial resistance (AMR) patterns of common isolates in them.
Methods: In this prospective observational cohort study (2011-2015), a dedicated research team enrolled all neonates admitted to an outborn level-3 neonatal unit and followed them until discharge/death. Sepsis work-up including blood culture(s) was performed upon suspicion of sepsis. All the isolates were identified and tested for antimicrobial susceptibility. Gram-negative pathogens resistant to any three of the five antibiotic classes (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam) were labeled multi-drug resistant.
Results: Of the total of 2588 neonates enrolled, culture positive sepsis and total sepsis-i.e. culture positive and/or culture negative sepsis-was diagnosed in 13.1% (95% CI 11.8% to 14.5%) and 54.7% (95% CI 52.8% to 56.6%), respectively. The case fatality rates were 23.4% and 11.0% in culture-positive and total sepsis, respectively. Sepsis accounted for two-thirds of total neonatal deaths (153/235, 63.0%). Bacterial isolates caused about three-fourths (296/401; 73.8%) of the infections. The two common pathogens-Klebsiella pneumoniae (n = 50, 12.5%) and Acinetobacter baumannii (n = 46, 11.5%)-showed high degree of multi-drug resistance (78.0% and 91.3%, respectively) and carbapenem resistance (84.0% and 91.3%, respectively). About a quarter of infections were caused by Candida spp. (n = 91; 22.7%); almost three-fourths (73.7%) of these infections occurred in neonates born at or after 32 weeks' gestation and about two-thirds (62.1%) in those weighing 1500 g or more at birth.
Conclusions: In this large outborn cohort, we report high burden of sepsis, high prevalence of systemic fungal infections, and alarming rates of antimicrobial resistance among bacterial pathogens.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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