Abstract
BackgroundCarbapenem-resistant infections in neonates are increasing worldwide. These organisms are associated with poor outcomes because of the severity of the disease, lack of treatment options and impaired immune systems of premature neonates. These infections are associated with significantly higher morbidity, mortality and prolonged hospitalisations, especially in developing countries.MethodsA retrospective study was conducted to evaluate the prevalence and clinical outcomes of neonates with Carbapenem-resistant Enterobacteriaceae (CRE) infection over 24 months, from January 2015 to December 2016. All charts for neonates with positive cultures were reviewed, including characteristics of neonates that acquired the infection, possible risk factors and outcomes.ResultsA total of 32 cases were included with a prevalence of 5/1000 admissions. The mortality rate was 0.6/1000, with case facility rate at 12.5%. Most neonates developed CRE infections within the first 7 days of admission. There was an equal distribution between early neonatal deaths (ENND) and late neonatal deaths (LNND). Neonates (34.4%) had prior exposure to Carbapenem, with a higher mortality rate of (75%). There was zero mortality in the HIV-exposed group.ConclusionNeonates developed CRE much earlier than previously reported. Invasive procedures on admission carry an associated higher risk for developing CRE, more than the length of stay as previously stipulated. Prevalence of CRE seems to be high in middle-income countries with higher mortality. Thus, strict infection prevention and control (IPC) measures during admission and during the first weeks of life can decrease the incidence and outcome of CRE-related mortality and morbidity.
Highlights
There has been a gradual increase in Carbapenem-resistant Enterobacteriaceae (CRE) cases reported in neonatal settings
Carbapenemresistant organisms were already described as a cause of neonatal septicaemia in India as early as in 2007.2 The Centers for Disease Control (CDC) reported an increase in CRE cases from 0.04% in 1998 to 3.8% in 2008 and estimated cases to be at 9.7% in 2018.3 The latest reports already report the prevalence to be around 6.7% worldwide, this might just be the reflection of an improvement in microbiological diagnosis and screening techniques.[1]
Fifty-six point three per cent (56.3%) (n = 18) of patients were male, 65.8% (n = 21) of the patients had birth weight below 2.5 kilograms, and the very low birth weight (VLBW) category between 1500 g and 2500 g had the highest mortality of 50%
Summary
There has been a gradual increase in Carbapenem-resistant Enterobacteriaceae (CRE) cases reported in neonatal settings. Neonatal sepsis caused by these pathogens is increasing, and there are limited choices available for treatment.[1] Carbapenemresistant organisms were already described as a cause of neonatal septicaemia in India as early as in 2007.2 The Centers for Disease Control (CDC) reported an increase in CRE cases from 0.04% in 1998 to 3.8% in 2008 and estimated cases to be at 9.7% in 2018.3 The latest reports already report the prevalence to be around 6.7% worldwide, this might just be the reflection of an improvement in microbiological diagnosis and screening techniques.[1] The high mortality rate associated with CRE infections, especially in adults, makes the rise in prevalence a worrying factor It is, no surprise that much attention is being placed on disease prevention. These infections are associated with significantly higher morbidity, mortality and prolonged hospitalisations, especially in developing countries
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