Multidrug-Resistant Healthcare-Associated Infections in Neonates with Severe Respiratory Failure and the Impacts of Inappropriate Initial Antibiotic Therap.

Jen-Fu Hsu,Mei-Yin Lai,Ming-Chou Chiang,Chen-Chu Liao,Shih-Ming Chu,Hsiao-Chin Wang,Hsuan-Rong Huang,Ming-Horng Tsai,Ren-Huei Fu

doi:10.3390/antibiotics10040459

Jen-Fu Hsu, Mei-Yin Lai + Show 7 more

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https://doi.org/10.3390/antibiotics10040459

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Journal: Antibiotics	Publication Date: Apr 18, 2021
Citations: 5	License type: CC BY 4.0

Affiliation: Chang Gung Memorial Hospital, Chang Gung University

Abstract

Background: Multidrug-resistant (MDR) pathogens have emerged as an important issue in neonatal intensive care units (NICUs), especially in critically ill neonates with severe respiratory failure. We aimed to investigate neonatal healthcare-associated infections (HAIs) caused by MDR pathogens and the impacts of inappropriate initial antibiotic therapy on the outcomes. Methods: We retrospectively analyzed all cases of HAIs in neonates with severe respiratory failure in a tertiary-level NICU in Taiwan between January 2014 and May 2020. All clinical features, microbiology, therapeutic interventions, and outcomes were compared between the MDR-HAI and non-MDR HAI groups. Multivariate regression analyses were used to investigate independent risk factors for sepsis-attributable mortality. Results: A total of 275 critically ill neonates with severe respiratory failure who had HAIs were enrolled. Ninety-five cases (34.5%) were caused by MDR pathogens, and 141 (51.3%) cases had positive bacterial cultures from multiple sterile sites. In this cohort, the MDR-HAI group was more likely to receive inappropriate initial antibiotic therapy (51.0% versus 4.7%, respectively; p < 0.001) and exhibit delayed control of the infectious focus (52.6% versus 37.8%, respectively; p = 0.021) compared with the non-MDR HAI group. The sepsis-attributable and final in-hospital rates were 21.8% and 37.1%, respectively, and they were comparable between the MDR-HAI and non-MDR HAI groups. Empirically broad-spectrum antibiotics were prescribed in 76.7% of cases, and inappropriate initial antibiotic treatment was not significantly associated with worse outcomes. Independent risk factors for sepsis-attributable mortality in neonates with severe respiratory failure included the presence of septic shock (OR: 3.61; 95% CI: 1.54–8.46; p = 0.003), higher illness severity (OR: 1.33; 95% CI: 1.04–1.72; p = 0.026), and neonates with bronchopulmonary dysplasia (OR: 2.99; 95% CI: 1.47–6.09; p = 0.003). Conclusions: MDR pathogens accounted for 34.5% of all neonatal HAIs in the NICU, but neither MDR pathogens nor inappropriate initial antibiotics were associated with final adverse outcomes. Because the overuse of broad-spectrum antibiotics has emerged as an important issue in critically ill neonates, the implementation of antimicrobial stewardship to promote the appropriate use of antimicrobials is urgently needed.

Highlights

Neonatal sepsis is the most common healthcare-associated infection (HAI) in neonatal intensive care units (NICUs) and is associated with significantly increased morbidity and in-hospital mortality [1,2]
All neonates with severe respiratory failure who had bacterial sepsis in the NICUs of Chang Gung Memorial Hospital (CGMH) between January 2014 and May 2020 were reviewed, and their records were retrieved for analyses
Since the emergence of MDR pathogens has been a significant issue in NICUs in recent years, we suggest that more surveillance and systemic data on regional epidemiology may be needed to develop optimized therapeutic strategies for neonatal severe sepsis and decrease the overuse of broad-spectrum antibiotics [36]

Summary

Introduction

Neonatal sepsis is the most common healthcare-associated infection (HAI) in neonatal intensive care units (NICUs) and is associated with significantly increased morbidity and in-hospital mortality [1,2]. Neonatal sepsis occasionally occurs in extremely preterm infants with underlying pulmonary comorbidities or in critical neonates with respiratory failure [3,4,9] In these situations, clinicians tend to use empiric broad-spectrum antibiotics because they cannot take the risk of clinical deterioration [10,11]. Multidrug-resistant (MDR) pathogens are more likely to be associated with a higher severity of illness and a higher mortality rate, especially when the neonates do not receive adequate antibiotic treatment on time [12,13] In some cases, these patients experience culture-negative sepsis due to previous exposure to broad-spectrum antibiotics, which potentially cause emergence of MDR pathogens [14,15,16]. Because the overuse of broad-spectrum antibiotics has emerged as an important issue in critically ill neonates, the implementation of antimicrobial stewardship to promote the appropriate use of antimicrobials is urgently needed

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