RESUMO
Extended spectrum beta-lactamase [ESBL] producing E. coli and K. pneumoniae [EK] are on the rise globally. To highlight the prevalence, predictors for infection and outcome of ESBL-EK septicemia in neonates. In a prospective study, all septic neonates in a neonatal intensive care unit and special care baby unit [NICU/SCBU] from whom blood culture was positive for EK between January 1, 2006, and June 30, 2007, were included. Cases were identified as inpatients with ESBL-EK while the control patients were those with non-ESBL-EK during the same period. Antibiotic susceptibility was performed on Vitek-2 using the AST-N020 card. Vitek-2 system was used for screening ESBL. Potential ESBL-EK underwent a confirmatory test using either the E-test ESBL screen [AB Biodise, Solna, Sweden] or the double-disk diffusion test. During the study period, of 167 septic episode, 38 [23%] were EK; 16 of them [42%] were ESBL-EK. Of the 16 cases, 13 [81%] were caused by E. coli and 3 [19%] were caused by K. pneumoniae. The most significant predictor of ESBL in EK was co-resistance to gentamicin [OR: 63, CI: 6.3-630.4] and pipracillin /tazobactam [OR: 13.9, 31:2.9-65.9] and the organism being E. coli [OR: 19.5, CI:3.71-102.4]. Other independent predictors were prior exposure to cefotaxime or amikacin [OR: 9.9, CI: 2.7-45], exposure to >/= 2 courses of antibiotics [OR: 10, CI: 1.7-57.7], WBCs count >/= 25x10[9]/L [OR: 12.6, CI: 1.3-119] and associated NEC [OR: 21, CI: 2.3-195.5]. The crude mortality was 31%.In septic neonates, ESBLs were significantly found in E. coli and showed gentamicin and pipracillin / tazobactam co-resistance. Prior exposure to cefotaxime or amikacin, >/= 2 courses of antibiotics before infection, neutophilia >/= 25x10[9]/L and associated NEC were independent predictors of ESBL-EK sepsis. No significant difference in mortality between ESBL-EK and non- ESBL-EK infected patients