Download PDF
J Pediatr Infect Dis 2023; 18(06): 326-330
DOI: 10.1055/s-0043-1775838
Original Article

Emergence of Drug-Resistant Pathogens in a Neonatal Intensive Care Unit

Aydın Aydınlı 
1   Department of Medical Microbiology, Faculty of Medicine, İstanbul Okan University, İstanbul, Türkiye
,
Deniz Sertel Şelale 
2   Department of Microbiology and Clinical Microbiology, Faculty of Medicine, İstinye University, İstanbul,Türkiye
,
Ayşe Demet Kaya 
1   Department of Medical Microbiology, Faculty of Medicine, İstanbul Okan University, İstanbul, Türkiye
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective Neonatal bloodstream infections (BSIs) due to drug-resistant pathogens are a major cause of neonatal morbidity and mortality. Unfortunately, data regarding the pathogens and their resistance profile are limited in developing countries. The aim of this study was to determine the bacteriological profile and antimicrobial susceptibility patterns in neonatal BSI at a university hospital in Türkiye.

Methods Medical records of neonates with suspected sepsis were retrospectively reviewed during the study period (between January 1, 2018, and December 31, 2020) for demographic data, blood culture, and antimicrobial susceptibility test results.

Results During the study period, 117 BSI episodes were encountered in 106 neonates. The most common pathogen isolated was Staphylococcus epidermidis (n = 86, 73.5%), followed by Klebsiella pneumoniae (n = 11, 9.4%). Methicillin resistance among staphylococci (77/93, 82.8%) and extended-spectrum beta-lactamase (ESBL) production among Enterobacterales (14/17, 82.4%) were common. Gentamicin resistance was detected in 70.1% (54/77) of methicillin-resistant staphylococci and 78.6% (11/14) of ESBL (+) Enterobacterales. Vancomycin and colistin resistance were not detected.

Conclusion The high rate of resistant pathogens encountered in neonatal BSIs underline the importance of constant surveillance of the local pathogens and their antimicrobial susceptibility patterns, which is crucial for implementing appropriate therapy that could save lives and lower the burden of antimicrobial resistance.

Keywords

bloodstream infection - neonatal sepsis - blood culture - antibiotic resistance - neonatal ICU


Publication History

Received: 17 July 2023

Accepted: 11 September 2023

Article published online:
16 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 World Health Statistics 2022: Monitoring Health for the SDGs, Sustainable Development Goals. Geneva: World Health Organization; 2022
    Google Scholar
  • 2 Global Burden of Disease Study 2019. Neonatal sepsis and other neonatal infections—Level 4 cause [serial online]. The Lancet. Accessed March 1, 2023, at: https://www.thelancet.com/pb-assets/Lancet/gbd/summaries/diseases/neonatal-sepsis-infections.pdf
    PubMed
  • 3 Singh M, Alsaleem M, Gray CP. Neonatal Sepsis. [Updated March 3, 2021]. In: StatPearls [Serial Online]. Treasure Island (FL): StatPearls Publishing; 2021
    Google Scholar
  • 4 Schelonka RL, Chai MK, Yoder BA, Hensley D, Brockett RM, Ascher DP. Volume of blood required to detect common neonatal pathogens. J Pediatr 1996; 129 (02) 275-278
    CrossrefPubMedGoogle Scholar
  • 5 Johnson J, Robinson ML, Rajput UC. et al. High burden of bloodstream infections associated with antimicrobial resistance and mortality in the neonatal intensive care unit in Pune, India. Clin Infect Dis 2021; 73 (02) 271-280
    CrossrefPubMedGoogle Scholar
  • 6 Morkel G, Bekker A, Marais BJ, Kirsten G, van Wyk J, Dramowski A. Bloodstream infections and antimicrobial resistance patterns in a South African neonatal intensive care unit. Paediatr Int Child Health 2014; 34 (02) 108-114
    CrossrefPubMedGoogle Scholar
  • 7 TÜİK [Turkish Statistics Institute]: İstatistiklerle Çocuk, 2022 [Child statistics, 2022]. Ankara, 2023. Turkish. Accessed April 20, 2023, at: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Cocuk-2022-49674
    PubMed
  • 8 World Health Organization. Maternal, Newborn, Child and Adolescent Health and Ageing. Data Portal. Number of neonatal deaths by cause. Selected WHO region: Europe, Selected Country: Türkiye, Year: 2019. Accessed April 20, 2023, at: https://platform.who.int/data/maternal-newborn-child-adolescent-ageing/indicator-explorer-new/MCA/number-of-neonatal-deaths—by-cause
    PubMed
  • 9 Hall KK, Lyman JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006; 19 (04) 788-802
    CrossrefPubMedGoogle Scholar
  • 10 Clinical and Laboratory Standards Institute. Principles and Procedures for Blood Cultures. Approved Guideline. M47-A, Vol. 27. Switzerland: WHO Press Geneva; 2007
    Google Scholar
  • 11 World Health Organization. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. World Health Organization; 2013
    Google Scholar
  • 12 Fleischmann C, Reichert F, Cassini A. et al. Global incidence and mortality of neonatal sepsis: a systematic review and meta-analysis. Arch Dis Child 2021; 106 (08) 745-752
    CrossrefPubMedGoogle Scholar
  • 13 Zelellw DA, Dessie G, Worku Mengesha E, Balew Shiferaw M, Mela Merhaba M, Emishaw S. A systemic review and meta-analysis of the leading pathogens causing neonatal sepsis in developing countries. BioMed Res Int 2021; 2021: 6626983
    CrossrefPubMedGoogle Scholar
  • 14 Okomo U, Akpalu ENK, Le Doare K. et al. Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines. Lancet Infect Dis 2019; 19 (11) 1219-1234
    CrossrefPubMedGoogle Scholar
  • 15 Wang J, Zhang H, Yan J, Zhang T. Literature review on the distribution characteristics and antimicrobial resistance of bacterial pathogens in neonatal sepsis. J Matern Fetal Neonatal Med 2022; 35 (05) 861-870
    CrossrefPubMedGoogle Scholar
  • 16 Mariani M, Parodi A, Minghetti D. et al. Early and late onset neonatal sepsis: epidemiology and effectiveness of empirical antibacterial therapy in a III level neonatal intensive care unit. Antibiotics (Basel) 2022; 11 (02) 284
    CrossrefPubMedGoogle Scholar
  • 17 Tessema B, Lippmann N, Knüpfer M, Sack U, König B. Antibiotic resistance patterns of bacterial isolates from neonatal sepsis patients at university hospital of Leipzig, Germany. Antibiotics (Basel) 2021; 10 (03) 323
    CrossrefPubMedGoogle Scholar
  • 18 Sorsa A, Früh J, Stötter L, Abdissa S. Blood culture result profile and antimicrobial resistance pattern: a report from neonatal intensive care unit (NICU), Asella teaching and referral hospital, Asella, south East Ethiopia. Antimicrob Resist Infect Control 2019; 8: 42
    CrossrefPubMedGoogle Scholar
  • 19 Sands K, Carvalho MJ, Portal E. et al; BARNARDS Group. Characterization of antimicrobial-resistant gram-negative bacteria that cause neonatal sepsis in seven low- and middle-income countries. Nat Microbiol 2021; 6 (04) 512-523
    CrossrefPubMedGoogle Scholar
  • 20 Topcuoglu S, Demirhan S, Dincer E, Ozalkaya E, Karatekin G. Early-onset neonatal sepsis in Turkey: a single-center 7-year experience in etiology and antibiotic susceptibility. Children (Basel) 2022; 9 (11) 1642
    PubMedGoogle Scholar
  • 21 Al-Matary A, Heena H, AlSarheed AS. et al. Characteristics of neonatal sepsis at a tertiary care hospital in Saudi Arabia. J Infect Public Health 2019; 12 (05) 666-672
    CrossrefPubMedGoogle Scholar