Emerging Antibiotic Resistance Patterns in a Neonatal Intensive Care Unit in Pune, India: A 2-Year Retrospective Study

Ten-year review of hospital-acquired neonatal meningitis in a tertiary-level NICU: the important role of acinetobacter species

BACKGROUND

Meningitis during the neonatal period is a potentially devastating condition with high morbidity and mortality. Pathogens cause meningitis varying with gestational age at birth, age at presentation, and geographic location.

METHODS

This 10-year retrospective cross-sectional study, conducted from 2014 to 2023, involved thoroughly evaluating patient files who developed hospital-acquired neonatal meningitis during their hospitalization, with the aim of identifying the causative pathogens and predisposing factors to mortality and hydrocephalus. in a large, referral neonatal intensive care unit at Imam Khomeini Hospital in Ahvaz, Iran.

RESULTS

The files of 33 infants with meningitis were examined. The number of premature and low birth weight babies was 30(90.9%) and 27(81.8%), respectively. The studied neonates' mean gestational age and birth weight were 32.6 ± 3.3 weeks and 1812 ± 739 g, respectively. Meningitis with late-onset occurred in 28(84.8%) infants and Gram-negative bacteria in 24(72.7%) infants. Out of a total of 33 neonates with meningitis, 13(39.3%) of whom died. The pathogen most frequently isolated from cerebrospinal fluid cultures was Acinetobacter species, found in 16(48.4%) patients. Occurrences of seizures in the first three days of meningitis, meningitis with gram-negative bacteria, and leukocytosis of more than 15,000 at the onset of meningitis increased the probability of death and hydrocephalus in infants.

CONCLUSION

Considering that most of the neonates in this study were premature, had low birth weight, and had nosocomial late-onset meningitis with Gram-negative bacteria, it is necessary to prevent them from contracting meningitis with strict and multifaceted care while hospitalized.

16 S rRNA-based molecular identification of coagulase-negative Staphylococcus species in neonates with sepsis and their antibiotic resistance patterns in Ahvaz, Iran

INTRODUCTION

Coagulase-negative staphylococci (CoNS) are among the leading causes of neonatal sepsis (NS). NS can be divided into two types: early-onset sepsis (EOS), which usually occurs less than 72 h after birth, and late-onset sepsis (LOS), which can occur 8 to 28 days after birth. According to newly published statistics, the incidence rates of EOS and LOS in neonates are 0.5-3.1% and 2-32%, respectively. This study aimed to determine the prevalence of common CoNS isolates and their antibiotic resistance patterns in NS cases in Ahvaz, Iran.

METHODS

This cross-sectional study (October 2022-April 2023) was conducted on all neonates (0-28 days old) with NS manifestations admitted to Imam Khomeini Hospital. Blood culture samples were collected and incubated at 37 °C for 24 h. The bacterial isolates were identified via standard biochemical tests, and the Staphylococcus epidermidis strains were identified via polymerase chain reaction (PCR) of the SesC gene. The other suspected CoNS species were identified using 16 S rRNA sequencing.

RESULTS

In total, 1221 blood culture bottles were collected from 1330 neonates with NS manifestations. A total of 111 (9.1%) blood cultures were positive for bacterial growth. Overall, 51 staphylococcal isolates, including 39 (76.5%) CoNS species and 12 (23.5%) S. aureus isolates, were identified. Using SesC gene PCR and 16 S rRNA sequencing, the CoNS species were as follows: 28 (71.8%) S. epidermidis, 5 (12.8%) S. hominis, 4 (10.38%) S. haemolyticus and 2 (5.1%) S. warneri. In total, the frequency of NS caused by CoNS isolates was 35.1% (n = 39/111). All CoNS isolates were methicillin resistant and presented the highest antibiotic resistance rates (100.0%) to cefoxitin, ampicillin, erythromycin, and linezolid.

CONCLUSIONS

This study revealed a high incidence of methicillin-resistant coagulase-negative staphylococci (MRCoNS) with high antibiotic resistance rates in NS patients from Ahvaz. To prevent the spread of these isolates in healthcare systems, measures such as monitoring the optimal use of antibiotics on the basis of the results of laboratory antibiograms seem necessary.

Dynamics of Antimicrobial Susceptibility and Risk Factors Associated with Infections Caused by Colistin-Resistant Bacteria: A Study from the Northern Region of Haryana, India

Antimicrobial resistance poses a significant threat to global health, with colistin as a last-resort antibiotic against multidrug-resistant (MDR) microorganisms. The present study aimed to investigate the dynamics of antimicrobial susceptibility patterns and risk factors associated with infections caused by colistin-resistant bacteria in the Northern region of Haryana, India. Clinical samples (n = 12,652) collected from a single hospital in Haryana were subjected to microbiological analysis for five months. Among the total samples (n = 12,652) processed, 24% (n = 3,061) showed growth of pathogenic bacteria. Within the Gram-negative isolates, 56% (n = 1,242) were non-MDR, while 44% (n = 995) were MDR. Among MDR isolates (n = 995), 6% (n = 57) showed resistance to colistin. Notably, Pseudomonas spp. (12%, n = 19) and Acinetobacter spp. (11%, n = 8) demonstrated the highest resistance to colistin, followed by Klebsiella spp. (5%, n = 13), Escherichia coli (3%, n = 16), and Citrobacter freundii (1%, n = 1), respectively. The study revealed significant associations between the level of education (demographic variable) and the occurrence of colistin resistance. Prolonged hospital stays (> 5 days) and specific comorbidities, including diabetes (p < 0.01) and chronic obstructive pulmonary disease (p < 0.01), were identified as risk factors for colistin-resistant infections. Importantly, none of the colistin-resistant bacteria harbored mcr genes, suggesting alternative resistance mechanisms. Antibiotic sensitivity analysis indicated promising efficacy of antibiotics such as amikacin and gentamicin against colistin-resistant strains, though with variations across bacterial species. In summary, the study emphasizes the urgent need for enhanced surveillance, infection control protocols, and antimicrobial stewardship programs in healthcare settings to minimize the dissemination of MDR and colistin-resistant bacteria.

Bacterial profiles and their antibiotic susceptibility patterns in neonatal sepsis at the University of Gondar Comprehensive Specialized Hospital, Ethiopia

Background

Neonatal sepsis is a major cause of morbidity and mortality worldwide. Understanding the bacterial profiles and antibiotic susceptibility patterns causing neonatal sepsis is crucial for guiding appropriate treatment, improving patient outcomes, and combating the emergence of antibiotic resistance. Despite its importance, data regarding neonatal sepsis in the study area is limited. Therefore, this study aimed to characterize the bacterial pathogens and identify associated factors among neonates with suspected sepsis at the University of Gondar Comprehensive Specialized Hospital, Ethiopia.

Methods

A cross-sectional study was conducted by reviewing laboratory records of neonates admitted for suspected sepsis from January 2019 to December 2021. Data were checked for completeness and encoded in a spreadsheet program. Then, data were exported to STATA version 17 for analysis. Descriptive statistics such as frequency and percentage were computed. The association between neonatal sepsis and potential risk factors was assessed using Pearson's chi-square test. A p-value of < 0.05, was considered statistically significant.

Results

A total of 1,236 neonates were included. Of these, 96.2% (1,190/1,236) had a fever before admission. The prevalence of culture-confirmed sepsis was 25.4% (314/1,236). Bacterial pathogens accounted for 23% (284/1,236) of these isolates, with Gram-negative bacteria being more prevalent at 75.3% (214/284) than Gram-positive bacteria at 24.7% (70/284). The most frequently isolated bacterial pathogens were K. pneumoniae 38.7% (110/284) and S. aureus 13% (37/284). The isolates demonstrated a high resistance level to commonly used antibiotics, with 61.6% exhibiting multidrug resistance. K. pneumoniae showed the highest rate of multidrug resistance (90.9%). Neonatal sepsis was associated with several factors, including fever before and after admission, hypothermia, increased respiration, suspected pneumonia, and suspected meningitis.

Conclusion

This study identified a high prevalence of culture-confirmed sepsis in neonates at UoGCSH, with Gram-negative bacteria, especially K. pneumoniae, dominating the isolated pathogens. The isolated bacteria exhibited alarming resistance to commonly used antibiotics, with a high proportion demonstrating multidrug resistance. Implementing effective antibiotic stewardship programs is crucial to optimize antibiotic use, reduce unnecessary prescriptions, and curb the spread of resistant strains.

Investigating the antimicrobial potential of bovine lactoferrin against the neonatal pathogen, Staphylococcus capitis

Lactoferrin is an antimicrobial glycoprotein that demonstrates a broad-spectrum of activity against a wide variety of clinical pathogens. This study investigated the potential of bovine lactoferrin (bLf) against multidrug resistant Staphylococcus capitis (S. capitis) strains. Growth curve analysis and time-kill curves demonstrated that at 750 µg ml-1 lactoferrin significantly inhibited (50.6%, P < 0.05) the growth of most isolates tested (90%), and this effect was based on a bacteriostatic mechanism. At the same concentration, bLf also significantly inhibited (30%, P < 0.05) biofilm formation in 40% of strains tested. Combinations of bLf with selected antibiotics were assessed for enhanced antimicrobial activity using growth curves. BLf combined with β-lactam antibiotics reduced the growth of S. capitis strains, however, the effects were not significant. BLf displays antimicrobial effects against multidrug resistant S. capitis isolates, but with strain-specific effects.

A Case of Enterococcal Patent Ductus Arteriosus-associated Endarteritis in a Preterm Neonate

INTRODUCTION

The persistent patency of the ductus arteriosus frequently occurs in premature neonates and can cause infective endocarditis (IE) or ductal endarteritis (DE) during sepsis. Even though neonatal IE and DE are believed to be a rare eventuality, their incidence has been increasing in the last decades due to the improved survival of even more preterm babies, favored by highly invasive procedures and therapies. In parallel, antimicrobial resistance is another rising problem in neonatal intensive care units, which frequently compels to treat infections with broad-spectrum or last generation antibiotics.

CASE PRESENTATION

We report the case of a preterm neonate affected by patent ductus arteriosus-associated DE that followed an episode of sepsis caused by a high-level aminoglycoside-resistant enterococcus. The neonate was successfully treated with the synergistic combination of ampicillin and cefotaxime.

DISCUSSION

IE and patent ductus arteriosus-associated DE are rising inside neonatal intensive care units and neonatologists should be aware of these conditions. Enterococcal IE and patent ductus arteriosus-associated DE sustained by high-level aminoglycoside-resistant strains can be successfully treated with the synergistic combination of ampicillin and cefotaxime even in preterm neonates.

Incidence, pathogens and antimicrobial resistance of blood and cerebrospinal fluid isolates from a tertiary neonatal unit in South Africa: A 10 year retrospective review

OBJECTIVE

To determine trends in incidence, etiology and antimicrobial susceptibility of blood and cerebrospinal fluid (CSF) culture confirmed infections in hospitalized infants in a large tertiary neonatal unit in South Africa.

METHODS

Single-center, retrospective review of laboratory records of bacteria and fungi, and their susceptibility profiles, isolated from blood and CSF of infants hospitalized in the neonatal unit at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, from 1st January 2010 to 31st December 2019. Laboratory data on isolates and their antimicrobial susceptibilities were collected. Coagulase-negative Staphylococcus, Corynebacteria and Bacillus spp. were excluded. Patient-level clinical and laboratory data were not available.

RESULTS

There were 8,319 significant isolates, giving an infection rate of 14.3/1000 patient-days. Infection rates increased from 12.0 to 15.7/1000 patient-days (estimated average yearly change 0.6[95%CI, 0.5-0.7];p = <0.001). Gram-negative infection rates increased from 4.3 to 10.8/1000 patient-days (estimated average yearly change 0.7[95%CI,0.6-0.8];p = <0.001). The 2 most commonly isolated Gram-negative organisms were Acinetobacter baumannii (44%) and Klebsiella pneumoniae (39%). Carbapenem resistance was seen in 31% of all Gram-negatives and increased over time (estimated average yearly change 4.8%[95%CI,4.2%-5.3%];p<0.001). Gram-positive infection rates decreased (estimated average yearly change -0.1[95%CI,-0.2- -0.05];p = <0.001). Staphylococcus aureus was the most common Gram-positive isolated. Rates of methicillin-resistant Staphylococcus aureus decreased from 91% to 55%(estimated average yearly change -2.8%[95%CI,-3.5%-2%],p< 0.001). Rates of fungal isolates decreased (estimated average yearly change -0.06[95%CI,-0.1 --0.02]);p = 0.007). Candida parapsilosis (52%) and Candida albicans (35%) were the most common fungi isolated.

CONCLUSIONS

There has been a marked overall increase in rates of blood and/or CSF infections, with an absolute increase in Gram-negative infections observed, replacing Gram-positive and fungal pathogens. Extended spectrum beta-lactamase Gram-negative isolates are being replaced by carbapenem resistance, with around one third of all significant Gram-negative isolates now carbapenem resistant. Research into hospital based novel treatment and prevention interventions for neonatal sepsis should be urgently prioritized.

Improving the Treatment of Neonatal Sepsis in Resource-Limited Settings: Gaps and Recommendations

Neonatal sepsis causes significant global morbidity and mortality, with the highest burden in resource-limited settings where 99% of neonatal deaths occur. There are multiple challenges to achieving successful treatment of neonates in this setting. Firstly, reliable and low-cost strategies for risk identification are urgently needed to facilitate treatment as early as possible. Improved laboratory capacity to allow identification of causative organisms would support antimicrobial stewardship. Antibiotic treatment is still hampered by availability, but also increasingly by antimicrobial resistance - making surveillance of organisms and judicious antibiotic use a priority. Finally, supportive care is key in the management of the neonate with sepsis and has been underrecognized as a priority in resource-limited settings. This includes fluid balance and nutritional support in the acute phase, and follow-up care in order to mitigate complications and optimise long-term outcomes. There is much more work to be done in identifying the holistic needs of neonates and their families to provide effective family-integrated interventions and complete the package of neonatal sepsis management in resource-limited settings.