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Frequency and characteristics of infections caused by extended-spectrum beta-lactamase-producing organisms in neonates: a prospective cohort study.

Vijayakanthi N, Bahl D, Kaur N, Maria A, Dubey NK - Biomed Res Int (2013)

Bottom Line: The frequency of ESBL-producing organisms was found to be 5.3%.Risk factors found significant by univariate analysis (P < 0.05) were preterm, low birthweight, perinatal asphyxia, respiratory distress syndrome, anaemia, metabolic acidosis, prolonged mechanical ventilation (>7 days), length of hospitalization, length of level 3 stay, prior antibiotic use, central venous catheter duration, peripherally inserted central venous catheter duration, and total parenteral nutrition duration.There was no significant difference in the mortality between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics & Neonatology, PGIMER & Associated Dr. Ram Manohar Lohia Hospital, Baba Kharag Singh Marg, New Delhi 110001, India.

ABSTRACT
This prospective cohort study was conducted to determine the frequency of infections caused by extended-spectrum beta-lactamase- (ESBL-) producing organisms, various bacteria producing ESBL, antibiotic susceptibility of these organisms, and the risk factors associated with these infections in a neonatal intensive care unit in a tertiary care hospital in North India. Of the 150 neonates enrolled in the study, 47 culture-positive neonates were included in the study cohort and were divided into two groups: ESBL-positive (8 neonates) and ESBL-negative (39 neonates) cohorts. Various organisms were isolated from 72 culture samples in these 47 neonates. Of these, 10 culture samples grew ESBL-positive organisms and 62 samples grew ESBL-negative organisms. The frequency of ESBL-producing organisms was found to be 5.3%. ESBL infection incidence densities were found to be 3.4 per 1000 patient-days. Klebsiella (60%) was the most common organism producing ESBL followed by Escherichia coli (30%) and Pseudomonas (10%). Eighty percent of the ESBL-producing organisms were sensitive to piperacillin-tazobactam. Risk factors found significant by univariate analysis (P < 0.05) were preterm, low birthweight, perinatal asphyxia, respiratory distress syndrome, anaemia, metabolic acidosis, prolonged mechanical ventilation (>7 days), length of hospitalization, length of level 3 stay, prior antibiotic use, central venous catheter duration, peripherally inserted central venous catheter duration, and total parenteral nutrition duration. Factors that retained significance in the logistic regression model were duration of hospital stay (adjusted OR: 0.958, CI: 0.920-0.997, and P value = 0.037) and gestational age (adjusted OR: 1.39, CI: 1.037-1.865, and P value = 0.028). There was no significant difference in the mortality between the two groups.

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Related in: MedlinePlus

Antimicrobial resistance patterns of the ESBL-producing and non-ESBL-producing organisms. Data are expressed in percentage. ESBL: extended-spectrum beta-lactamase; A: ampicillin; Ao: aztreonam; Ak: amikacin; Ca: ceftazidime; Ce: cefotaxime; Cf: ciprofloxacin; Cpm: cefepime; Co: cotrimoxazole; G: gentamicin; Mr: meropenem; Nt: netilmicin; Of: ofloxacin; Pt: piperacillin-tazobactam.
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Related In: Results  -  Collection


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fig2: Antimicrobial resistance patterns of the ESBL-producing and non-ESBL-producing organisms. Data are expressed in percentage. ESBL: extended-spectrum beta-lactamase; A: ampicillin; Ao: aztreonam; Ak: amikacin; Ca: ceftazidime; Ce: cefotaxime; Cf: ciprofloxacin; Cpm: cefepime; Co: cotrimoxazole; G: gentamicin; Mr: meropenem; Nt: netilmicin; Of: ofloxacin; Pt: piperacillin-tazobactam.

Mentions: Prior antibiotic use (ampicillin and cephalosporins) was found to be a significant risk factor associated with ESBL-positive infections (RR: 5.29, CI: 1.21–23.19, and P value = 0.011). Eighty percent of ESBL-producing organisms were sensitive to piperacillin-tazobactam, fifty percent to meropenem, and ten percent to aztreonam, amikacin, and gentamicin. The antimicrobial resistance patterns of the ESBL-producing and non-ESBL-producing organisms are given in Figure 2. Analysis of the antimicrobial resistance patterns reveals that ESBL-producing organisms were more resistant to beta-lactam antibiotics compared to non-ESBL-producing organisms.


Frequency and characteristics of infections caused by extended-spectrum beta-lactamase-producing organisms in neonates: a prospective cohort study.

Vijayakanthi N, Bahl D, Kaur N, Maria A, Dubey NK - Biomed Res Int (2013)

Antimicrobial resistance patterns of the ESBL-producing and non-ESBL-producing organisms. Data are expressed in percentage. ESBL: extended-spectrum beta-lactamase; A: ampicillin; Ao: aztreonam; Ak: amikacin; Ca: ceftazidime; Ce: cefotaxime; Cf: ciprofloxacin; Cpm: cefepime; Co: cotrimoxazole; G: gentamicin; Mr: meropenem; Nt: netilmicin; Of: ofloxacin; Pt: piperacillin-tazobactam.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3794505&req=5

fig2: Antimicrobial resistance patterns of the ESBL-producing and non-ESBL-producing organisms. Data are expressed in percentage. ESBL: extended-spectrum beta-lactamase; A: ampicillin; Ao: aztreonam; Ak: amikacin; Ca: ceftazidime; Ce: cefotaxime; Cf: ciprofloxacin; Cpm: cefepime; Co: cotrimoxazole; G: gentamicin; Mr: meropenem; Nt: netilmicin; Of: ofloxacin; Pt: piperacillin-tazobactam.
Mentions: Prior antibiotic use (ampicillin and cephalosporins) was found to be a significant risk factor associated with ESBL-positive infections (RR: 5.29, CI: 1.21–23.19, and P value = 0.011). Eighty percent of ESBL-producing organisms were sensitive to piperacillin-tazobactam, fifty percent to meropenem, and ten percent to aztreonam, amikacin, and gentamicin. The antimicrobial resistance patterns of the ESBL-producing and non-ESBL-producing organisms are given in Figure 2. Analysis of the antimicrobial resistance patterns reveals that ESBL-producing organisms were more resistant to beta-lactam antibiotics compared to non-ESBL-producing organisms.

Bottom Line: The frequency of ESBL-producing organisms was found to be 5.3%.Risk factors found significant by univariate analysis (P < 0.05) were preterm, low birthweight, perinatal asphyxia, respiratory distress syndrome, anaemia, metabolic acidosis, prolonged mechanical ventilation (>7 days), length of hospitalization, length of level 3 stay, prior antibiotic use, central venous catheter duration, peripherally inserted central venous catheter duration, and total parenteral nutrition duration.There was no significant difference in the mortality between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatrics & Neonatology, PGIMER & Associated Dr. Ram Manohar Lohia Hospital, Baba Kharag Singh Marg, New Delhi 110001, India.

ABSTRACT
This prospective cohort study was conducted to determine the frequency of infections caused by extended-spectrum beta-lactamase- (ESBL-) producing organisms, various bacteria producing ESBL, antibiotic susceptibility of these organisms, and the risk factors associated with these infections in a neonatal intensive care unit in a tertiary care hospital in North India. Of the 150 neonates enrolled in the study, 47 culture-positive neonates were included in the study cohort and were divided into two groups: ESBL-positive (8 neonates) and ESBL-negative (39 neonates) cohorts. Various organisms were isolated from 72 culture samples in these 47 neonates. Of these, 10 culture samples grew ESBL-positive organisms and 62 samples grew ESBL-negative organisms. The frequency of ESBL-producing organisms was found to be 5.3%. ESBL infection incidence densities were found to be 3.4 per 1000 patient-days. Klebsiella (60%) was the most common organism producing ESBL followed by Escherichia coli (30%) and Pseudomonas (10%). Eighty percent of the ESBL-producing organisms were sensitive to piperacillin-tazobactam. Risk factors found significant by univariate analysis (P < 0.05) were preterm, low birthweight, perinatal asphyxia, respiratory distress syndrome, anaemia, metabolic acidosis, prolonged mechanical ventilation (>7 days), length of hospitalization, length of level 3 stay, prior antibiotic use, central venous catheter duration, peripherally inserted central venous catheter duration, and total parenteral nutrition duration. Factors that retained significance in the logistic regression model were duration of hospital stay (adjusted OR: 0.958, CI: 0.920-0.997, and P value = 0.037) and gestational age (adjusted OR: 1.39, CI: 1.037-1.865, and P value = 0.028). There was no significant difference in the mortality between the two groups.

Show MeSH
Related in: MedlinePlus