Characterization of Neonatal Infections by Gram-Negative Bacilli and Associated Risk Factors, Havana, Cuba.

Arlenis Oliva,Yenisel Carmona,Nobumichi Kobayashi,Elizabeth De La C López,Dianelys Quiñones,Meiji Soe Aung,Roberto Álvarez

doi:10.3390/idr13010025

Abstract

Infections represent an important problem in neonates because of the high mortality. An increase in neonatal infections has been found in Cuban hospitals in recent years. The aim of this study was to provide evidence on the clinical and microbiological behavior of Gram-negative bacilli that cause neonatal infections in hospitals of Havana, Cuba. It was carried out as a descriptive cross-sectional investigation from September 2017 to July 2018 in The Tropical Medicine Institute “Pedro Kouri” (IPK). Sixty-one Gram-negative bacilli isolated from neonates with infections in six Gyneco-Obstetric and Pediatric Hospitals of Havana were analyzed for their species and antimicrobial susceptibility. Late-onset infections were more common than early-onset ones and included urinary tract infection in the community (87%) and sepsis in hospitals (63.3%). Catheter use (47%) and prolonged stay (38%) were the most frequent risk factors. Species of major pathogens were Escherichia coli (47%) and Klebsiella spp. (26%). The isolated Gram-negative bacilli showed high resistance rates to third-generation cephalosporins, ciprofloxacin and gentamicin, while being more susceptible to carbapenems, fosfomycin, colistin and amikacin. The present study revealed the clinical impact of Gram-negative bacilli in neonatology units in hospitals of Havana. Evaluation of antimicrobial susceptibilities to the isolates from neonates is necessary for selection of appropriate empirical therapy and promotion of the rational antibiotic use.

Highlights

Neonatal infection is the pathological process that is caused by the invasion of pathogenic or potentially pathogenic microorganisms in normally sterile tissues, fluids or body cavities
Our results show the impact of enterobacteria as a cause of infection in neonates, in contrast with the non-isolation of P. aeruginosa and A. baumannii, which are Gram-negative bacilli that circulate in neonatology services.In the cases of neonatal infection, it is not always possible to identify the causative agent
This research is a response to neonatal infections, which areone of the priorities in the Maternal and Child Program in Cuba

Summary

Introduction

Neonatal infection is the pathological process that is caused by the invasion of pathogenic or potentially pathogenic microorganisms in normally sterile tissues, fluids or body cavities. The most serious manifestation is sepsis, with a lethality over 50%. The incidence of neonatal sepsis in the developed world is between 0.6% and 1.2% of all live born babies, but, in the developing world, it can reach from 20% and 40% of all live born babies [2]. The postnatal period is risky for the multiple opportunities of exposure to pathogenic microorganisms. Prematurity, low birth weight, exposure to invasive procedures, receiving parenteral nutrition with lipid emulsions, alterations in the skin and/or mucous membrane barriers, frequent use of broad-spectrum antibiotics and prolonged hospital stay are the most common risk factors for infections in newborns [3]

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