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Emergence of multidrug-resistant gram-negative organisms in a neonatal unit and the therapeutic implications
1Department of Paediatrics, University of Nairobi, Kenya.
Insights
Multidrug-resistant organisms are a growing concern in neonatal units, with Gram-negative bacteria like Klebsiella species showing high resistance rates. This resistance impacts treatment effectiveness and increases infant mortality, necessitating urgent review of antibiotic use. Keywords: multidrug-resistant organisms, neonatal sepsis, antibiotic resistance, Gram-negative bacteria, Klebsiella species.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Microbiology
Background:
- Increasing rates of multidrug-resistant organisms (MDROs) are a global health concern.
- Neonatal units are particularly vulnerable to the emergence of antibiotic resistance.
- Previous observations indicated a rising trend of resistance in isolated organisms within the neonatal unit.
Purpose of the Study:
- To scrutinize the problem of increasing antibiotic resistance in a neonatal unit.
- To identify predominant pathogens and their resistance patterns.
- To inform future strategies for combating antimicrobial resistance in neonates.
Main Methods:
- Prospective study over a 5-month period.
- Inclusion of 716 admitted infants, with 192 screened for sepsis.
- Analysis of blood culture results, organism identification, and antimicrobial susceptibility testing.
Main Results:
- 16.7% of screened infants had positive blood cultures.
- Gram-negative organisms predominated (73.6%), with Klebsiella species being most common (31%).
- High resistance rates observed: amoxicillin/ampicillin (66.3%), ceftazidime (19.1%-27%), cefuroxime (21.3%-27%).
- Case fatality rate for Gram-negative infections was 41%.
Conclusions:
- Significant antibiotic resistance, particularly to third-generation cephalosporins, poses a serious threat in neonatal care.
- Contributing factors include under-investigation of infants on antibiotics, prolonged/unjustified antibiotic use, and delayed diagnostic results.
- Urgent interventions are needed to optimize antibiotic stewardship and infection control in neonatal units.
Abstract:
Multidrug-resistant organisms are increasing worldwide. Over the years we have noted increasing resistance of organisms isolated in our neonatal unit. There is a need therefore to scrutinize the problem so as to be able to plan for the future. Over a 5-month period, 716 infants were admitted of which 192 were screened for sepsis. Overall, 121 (16.7 per cent) had positive blood cultures. The predominant organisms were Gram negative (73.6 per cent of isolates) with Klebsiella species topping the list at 31 per cent. Case fatality for infants infected with Gram negative organisms was 41 per cent. Resistance to gentamicin was 20 per cent chloramphenicol 23.6 per cent, and amoxicillin/ampicillin 66.3 per cent. Of worry is the resistance to ceftazidime 19.1 per cent, and cefuroxime 21.3 per cent, with the figures rising to 27 per cent when more specialized tests are done (disc approximation and potentiation tests). If these drugs cannot be used in 20-27 per cent of cases then the situation is serious. The contributory factors to increased resistance include: non-investigation of infants put on antibiotics (50 per cent of cases); prolonged (73 per cent) and sometimes unjustified (41.7 per cent) use of antibiotics; and non-utilization of investigations when these are done (52 per cent) together with the delay in getting results back in the ward (6 days).