Carbapenem-Resistant Enterobacteriaceae Bloodstream Infections in Neonates: Clinical Characteristics and...

To analyze the clinical characteristics, antimicrobial therapies, and outcomes of neonates with carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infections.

This single-center retrospective study included 22 neonates with CRE bloodstream infections at a tertiary children's hospital in China (September 1, 2019-August 31, 2024). Data of clinical characteristics, risk factors, pathogens, carbapenemase testing, antimicrobial therapy, and outcomes were analyzed.

All 22 neonates had hospital-acquired late-onset infections (males, 77.3%; preterm infants, 81.8%). Prior to onset, 72.7% of the neonates had a history of broad-spectrum antibiotic exposure. Klebsiella pneumoniae was the predominant pathogen (91.9%). Eighteen isolates underwent carbapenemase testing, with KPC being the most prevalent carbapenemase (66.7%). The antimicrobial agents were changed for 8 infants based on the carbapenemase testing results. Six neonates with KPC-producing CRE infections received ceftazidime-avibactam (CAZ-AVI), and two neonates with NDM-producing CRE infections were treated with CAZ-AVI plus aztreonam. All 20 neonates who completed full treatment achieved clinical cure, while two neonates succumbed to infection before effective therapy initiation. The all-cause mortality rate was 13.6%.

Neonates with immature immunity are more susceptible to CRE bloodstream infections, but clinical cure could be achieved after effective antimicrobial therapy. Carbapenemase testing plays a crucial role in the decision making on treatment of neonatal CRE infections.