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Antibiotic exposure, renal disease linked to MDR gram-negative bacteremia in neonates
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Antibiotic exposure to third-generation cephalosporins and carbapenems in neonates with underlying renal disease increases these patients’ risk for developing multidrug-resistant gram-negative bacteremia in the neonatal ICU.
Researchers observed newborns hospitalized with bacteremia in the neonatal ICU at Chang Gung Memorial Hospital in Taiwan from 2004 to 2011.
During the study period, 1,106 cases of bacteremia were reported. Of these, 35.5% were caused by gram-negative bacilli (GNB). Of the 376 cases of GNB bacteremia included in the study, 18.6% were caused by a MDR strain.
MDR strains were defined as strains resistant to at least one agent in three or more of these categories: carbapenems, penicillins, broad-spectrum cephalosporins, monobactams, aminoglycosides and fluoroquinolones.
For polymicrobial bacteremia, defined as more than one microorganism identified from a single set of blood culture, the episode was considered to be MDR GNB if one of the isolates was an MDR GNB strain, according to the researchers.
More than half of the 70 cases of MDR GNB bacteremia were caused by extended-spectrum beta-lactamase-producing bacteria, including Klebsiella pneumoniae (n=28), Escherichia coli (n=9), K. oxytoca (n=6) and Enterobacter cloacae (n=4), according to study data published in Pediatrics.
After applying a logistic regression model, researchers found the independent risk factors for developing MDR GNB bacteremia included underlying renal disease and previous antibiotic exposure to a third-generation cephalosporin and carbapenem.
Low birth weight, preterm delivery, prenatal complications and most chronic underlying conditions were not linked to the development of MDR GNB bacteremia among study participants. Infants with MDR GNB bacteremia were more likely to receive inappropriate antibiotic treatment and develop infectious complications.
Disclosure: The researchers report no relevant financial disclosures.
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