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Third-generation cephalosporin resistant Enterobacteriaceae in neonates and young infants: impact and outcome

Alex Guri1, Natalie Flaks-Manov2, Adi Ghilai2

  • 1Division of Pediatrics, Kaplan Medical Center, Rehovot, Israel*.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|September 4, 2020
PubMed

Insights

Third-generation cephalosporins resistant Enterobacteriaceae (3GCR-EB) significantly increase hospital stay and mortality in neonates. This threat is particularly pronounced in normal birth weight newborns, highlighting the need for targeted interventions.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Public Health

Background:

  • Third-generation cephalosporins resistant Enterobacteriaceae (3GCR-EB) pose a significant threat to hospitalized neonates, especially those in Neonatal Intensive Care Units.
  • The impact of 3GCR-EB on the broader neonatal population remains under-appreciated.

Purpose of the Study:

  • To investigate the impact of 3GCR-EB on hospital length of stay and mortality in a general population of neonates and young infants.
  • To assess the specific outcomes associated with 3GCR-EB infections in neonates.

Main Methods:

  • Retrospective cohort study involving neonates and young infants born between 2009 and 2013 in eight Israeli hospitals.
  • Data extracted from centralized electronic health records, including inpatient, outpatient, socio-demographic, administrative, and laboratory information.
  • Analysis focused on length of stay and mortality, with 3GCR-EB isolation as the primary explanatory variable.

Main Results:

  • Out of 31,921 neonates, 8.3% tested positive for Enterobacteriaceae (EB), with 11% of those positive for 3GCR-EB.
  • Neonates with 3GCR-EB experienced a 2.8-fold longer hospital stay compared to those with 3GC-susceptible EB.
  • 3GCR-EB infection was associated with a significantly increased mortality risk (OR: 12.06).

Conclusions:

  • Third-generation cephalosporins resistant Enterobacteriaceae significantly extend hospitalization duration and increase mortality in neonates.
  • The adverse effects of 3GCR-EB were most pronounced in neonates with normal gestational weight.
  • Findings underscore the critical threat of 3GCR-EB in neonatal populations and inform clinical management strategies.
Abstract

Keywords:
Neonatesenterobacteriaceae infectionsextended-spectrum beta-lactamase (ESBL)outcomesthird-generation cephalosporins resistant enterobacteriaceae

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