Bloodstream infections due to Gram-negative bacilli in a neonatal intensive care unit: a6year study
Abstract number: P1482
Papadimitriou M., Alexaki A., Kyriakou D., Paleologou N., Kallergi K., Kapetanakis J., Lebessi E.
Objectives: Bloodstream infection (BSI) due to Gram-negative bacilli (GNB) is a frequent complication in neonatal intensive care units (NICUs). Moreover, multidrug resistant organisms are on the increase and pose a formidable clinical challenge. The aim of the present study was to assess the BSI due to GNB in a 30-bed, university-affiliated, level III-IV NICU at a large pediatric hospital in Athens.
Methods: The charts of all neonates with culture-proven BSI due to GNB admitted to our NICU over six years (Jan 2003 Dec 2008) were reviewed, in order to estimate epidemiological and clinical features, bacteriologic pattern and antimicrobial susceptibility.
Results: A total of 2815 neonates (58.5% males) were admitted during the study period. Among those, 57 episodes of BSI involving 59 GNB were diagnosed in 55 neonates (63.6% males, 50.9% preterms). Associated pathology in the above group included congenital anomalies (44.6%), necrotizing enterocolitis (21.4%), while meningitis was diagnosed in 10%. Mortality rate was 18.2% (10/55), while overall mortality in the NICU was 3.7% (104/2815). Average hospitalization in the NICU before infection was 39.4 days (0 to 322 d), and the mean NICU length of stay was 70.4 days (7 to 338 d). Thirty two cases were NICU-acquired. The incidence of NICU-acquired BSI due to GNB was 11.3/1000 admissions. No outbreaks or epidemics were observed. GNB accounted for 19.6% of organisms isolated from blood cultures. Twelve bacterial species were identified: Escherichia coli 42% (25), Klebsiella pneumoniae 23% (14), Enterobacter cloacae 12% (7), Enterobacter aerogenes 5% (3), Klebsiella oxytoca (2), Acinetobacter baumannii (2), Serratia marcescens (1), Proteus mirabilis (1), Salmonella non typhi (1), Pantoea agglomerans (1), Pseudomonas aeruginosa (1) and Chryseomonas luteola (1). Production of extended-spectrum b-lactamases (ESBLs) was detected in Klebsiella spp (63%), E. coli (16%) and Enterobacter spp (10%). Overproduction of AmpC b-lactamases was recognized in 20% of Enterobacter spp. Susceptibility to carbapenems was found to be 100%, to ciprofloxacin 98% and to aminoglycosides 8590%.
Conclusion: Neonatal septicemia due to GNB is a major cause of morbidity and mortality. There was appreciable resistance to commonly used antimicrobials. Understanding the local epidemiology of neonatal BSI can lead to more appropriate initial antibiotic therapy and may contribute to improvement of infection control practices.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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