High rates of colonisation with ESBL (+) gram negative bacteria in newly admitted neonates in a neonatal care unit, Port au Prince, Haiti

Abstract

Background Nosocomial invasive Gram negative bacterial (GNB) infections are common causes of mortality in neonatal care units (NCU). Gastrointestinal tracts of hospitalized infants can serve as a reservoir for these infections. We aimed to estimate the faecal colonisation proportion by GNB and ESBL (+) GNB of systematically sampled newly admitted neonates in an NCU in Haiti, to describe the antimicrobial resistance profiles (AMR) of isolated GNB and identify factors associated with colonisation. Materials/methods We included all neonates admitted to the NCU from May to August 2016 who were started on prophylactic antibiotics or treated for infection. Neonates had fecal swabs taken before treatment was initiated; these were tested for GNB, AMR profiles and ESBL status. We calculated adjusted prevalence ratios (aPR) using binomial regression. Results Of the 800 neonates admitted in NCU, 409 were treated with antimicrobials and 78 received second treatment. One hundred and twenty-five out of 279 (45%) screened neonates were colonised by GNB, 85% before the second treatment and 34% before the first treatment (aPR 2.5; 95% CI: 2.0–3.0). Twenty-three percent (52/224) of neonates were colonised by ESBL (+) GNB, 70% (32/46) before the second treatment, 8.8 (95% CI: 5.6–14) times higher than those before first treatment (7.9%; 20/254). Ninety-eight out of 175 (56%) of isolated GNB were Escherichia coli, Klebsiella oxytoca and Klebsiella pneumoniae. Fifty percent of the tested GNB were susceptible to first-line antimicrobials and 99% to second-line antimicrobials; 4% and 35% of isolates indicated intermediate resistance to amikacin and ceftazidime, respectively. Vaginal delivery (aPR 2.1; 95% CI: 1.4–3.2) and length of stay (aPR 1.82; 95% CI: 1.2–2.7) were associated with GNB colonisation among newly admitted neonates. Neonates sampled > 48 h after admission were 19 times more likely to be colonised by ESBL (+) GNB (aPR 19; 95% CI: 8.9–41) than those sampled Conclusions GNB colonisation was high and increased with length of stay. Second line antimicrobial treatment seems still adequate, but signs of intermediate resistance to ceftazidime were observed. We recommend to re-enforce: –surveillance for suspected pathogens of nosocomial infections using blood cultures for septic infants; –monitoring of antimicrobial treatment failure in infants receiving antibiotics.