A review of -multidrug-resistant Enterobacteriaceae in a neonatal unit in Johannesburg, South Africa

Daynia E Ballot,Victor A Davies,Rosella Bandini,Trusha Nana,Teena Thomas,Peter A Cooper,Noma Bosman,Mervyn Mer,Jeffrey Lipman

doi:10.1186/s12887-019-1709-y

Abstract

BackgroundMulti-drug resistant organisms are an increasingly important cause of neonatal sepsis.AimThis study aimed to review neonatal sepsis caused by multi-drug resistant Enterobacteriaceae (MDRE) in neonates in Johannesburg, South Africa.MethodsThis was a cross sectional retrospective review of MDRE in neonates admitted to a tertiary neonatal unit between 1 January 2013 and 31 December 2015.ResultsThere were 465 infections in 291 neonates. 68.6% were very low birth weight (< 1500 g). The median age of infection was 14.0 days. Risk factors for MDRE included prematurity (p = 0.01), lower birth weight (p = 0.04), maternal HIV infection (p = 0.02) and oxygen on day 28 (p < 0.001). The most common isolate was Klebsiella pneumoniae (66.2%). Total MDRE isolates increased from 0.39 per 1000 neonatal admissions in 2013 to 1.4 per 1000 neonatal admissions in 2015 (p < 0.001). There was an increase in carbapenem-resistant Enterobacteriaceae (CRE) from 2.6% in 2013 to 8.9% in 2015 (p = 0.06). Most of the CRE were New Delhi metallo—β lactamase- (NDM) producers.The all-cause mortality rate was 33.3%. Birth weight (p = 0.003), necrotising enterocolitis (p < 0.001) and mechanical ventilation (p = 0.007) were significantly associated with mortality. Serratia marcescens was isolated in 55.2% of neonates that died.ConclusionsThere was a significant increase in MDRE in neonatal sepsis during the study period, with the emergence of CRE. This confirms the urgent need to intensify antimicrobial stewardship efforts and address infection control and prevention in neonatal units in LMICs. Overuse of broad- spectrum antibiotics should be prevented.

Highlights

Multi-drug resistant organisms are an increasingly important cause of neonatal sepsis
There was a significant increase in multi-drug resistant Enterobacteriaceae (MDRE) in neonatal sepsis during the study period, with the emergence of carbapenem-resistant Enterobacteriaceae (CRE)
The aim of this study is to describe the patterns of MDRE, including CRE, in a neonatal unit in Johannesburg, South Africa

Summary

Introduction

Multi-drug resistant organisms are an increasingly important cause of neonatal sepsis. Sepsis remains a major cause of morbidity and mortality in preterm infants [1]. There has been a significant increase in neonatal sepsis caused by multi-drug resistant organisms (MDRO) in the past decade [1, 2]. Infections with multi-drug resistant gram-negative organisms, especially Enterobacteriaceae, are of concern in preterm infants. Ballot et al BMC Pediatrics (2019) 19:320 resistant Enterobacteriaceae (MRDE) are associated with poor outcome and high case fatality rates, especially in low and middle income countries (LMIC) [5]. Mechanisms of antibiotic resistance in Enterobacteriaceae include production of ESBLs or carbapenemases [5]. There are recent reports of colistin-resistant Enterobacteriaceae in neonates [4]

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