Extended-spectrum B-lactamase producing escherichia coli and klebsiella pneumoniae in septicemic neonates
Bulletin of Alexandria Faculty of Medicine. 2007; 43 (4): 945-951
en Inglés
| IMEMR
| ID: emr-82041
ABSTRACT
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, 312.9-65.9] and the organism being E. coli [OR 19.5, CI3.71-102.4]. 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
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Índice:
IMEMR (Mediterraneo Oriental)
Asunto principal:
Beta-Lactamasas
/
Recién Nacido
/
Unidades de Cuidado Intensivo Neonatal
/
Estudios Prospectivos
/
Escherichia coli
/
Klebsiella pneumoniae
Límite:
Femenino
/
Humanos
/
Masculino
Idioma:
Inglés
Revista:
Bull. Alex. Fac. Med.
Año:
2007
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