High Burden of Bloodstream Infections Associated With Antimicrobial Resistance and Mortality in the Neonatal Intensive Care Unit in Pune, India

被引：44

作者：

Johnson, Julia ^{[1
]}

Robinson, Matthew L. ^{[2
]}

Rajput, Uday C. ^{[3
]}

Valvi, Chhaya ^{[3
]}

Kinikar, Aarti ^{[3
]}

Parikh, Tushar B. ^{[4
]}

Vaidya, Umesh ^{[4
]}

Malwade, Sudhir ^{[5
]}

Agarkhedkar, Sharad ^{[5
]}

Randive, Bharat ^{[6
]}

Kadam, Abhay ^{[6
]}

Smith, Rachel M. ^{[7
]}

Westercamp, Matthew ^{[7
]}

Mave, Vidya ^{[2
,6
]}

Gupta, Amita ^{[2
]}

Milstone, Aaron M. ^{[8
]}

Manabe, Yukari C. ^{[2
]}

机构：

[1] Johns Hopkins Univ, Sch Med, Dept Pediat, Div Neonatol, Baltimore, MD 21205 USA

[2] Johns Hopkins Univ, Sch Med, Dept Med, Div Infect Dis, Baltimore, MD 21205 USA

[3] Byramjee Jeejeebhoy Govt Med Coll, Dept Pediat, Pune, Maharashtra, India

[4] King Edward Mem Hosp, Dept Pediat, Div Neonatol, Pune, Maharashtra, India

[5] Dr DY Patil Med Coll, Dept Pediat, Pune, Maharashtra, India

[6] Johns Hopkins Univ, Clin Res Site, Byramjee Jeejeebhoy Govt Med Coll, Pune, Maharashtra, India

[7] Ctr Dis Control & Prevent, Atlanta, GA USA

[8] Johns Hopkins Univ, Sch Med, Dept Pediat, Div Pediat Infect Dis, Baltimore, MD 21205 USA

来源：

CLINICAL INFECTIOUS DISEASES | 2021年 / 73卷 / 02期

基金：

美国国家卫生研究院;

关键词：

neonatal sepsis; antimicrobial resistance; neonatal intensive care unit; low- and middle-income countries; BACTERIOLOGICAL PROFILE; RISK-FACTORS; SEPSIS; OUTBREAK; SEPTICEMIA;

D O I：

10.1093/cid/ciaa554

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. Antimicrobial resistance (AMR) is a growing threat to newborns in low- and middle-income countries (LMIC). Methods. We performed a prospective cohort study in 3 tertiary neonatal intensive care units (NICUs) in Pune, India, to describe the epidemiology of neonatal bloodstream infections (BSIs). All neonates admitted to the NICU were enrolled. The primary outcome was BSI, defined as positive blood culture. Early-onset BSI was defined as BSI on day of life (DOL) 0-2 and late-onset BSI on DOL 3 or later. Results. From 1 May 2017 until 30 April 2018, 4073 neonates were enrolled. Among at-risk neonates, 55 (1.6%) developed early-onset BSI and 176 (5.5%) developed late-onset BSI. The majority of BSIs were caused by gram-negative bacteria (GNB; 58%); among GNB, 61 (45%) were resistant to carbapenems. Klebsiella spp. (n = 53, 23%) were the most common cause of BSI. Compared with neonates without BSI, all-cause mortality was higher among neonates with early-onset BSI (31% vs 10%, P < .001) and late-onset BSI (24% vs 7%, P < .001). Non-low-birth-weight neonates with late-onset BSI had the greatest excess in mortality (22% vs 3%, P < .001). Conclusions. In our cohort, neonatal BSIs were most commonly caused by GNB, with a high prevalence of AMR, and were associated with high mortality, even in term neonates. Effective interventions are urgently needed to reduce the burden of BSI and death due to AMR GNB in hospitalized neonates in LMIC.

引用

页码：271 / 280

页数：10

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