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Risk factors and outcomes for multidrug-resistant Gram-negative bacteremia in the NICU.
Pediatrics. 2014 Feb; 133(2):e322-9.Ped

Abstract

OBJECTIVES

To assess the risk factors antibiotic therapy and outcomes of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bacteremia in NICU patients.

METHODS

Episodes of MDR GNB bacteremia were compared with a non-MDR GNB bacteremia group in an 8-year cohort study.

RESULTS

Of 1106 bacteremias, 393 (35.5%) were caused by GNB. Seventy (18.6%) were caused by an MDR strain. The most frequent mechanism of resistance was extended-spectrum β-lactamase production (67.1%), mainly by Klebsiella pneumoniae (59.6%). Previous antibiotic exposure to third-generation cephalosporin (odds ratio [OR]: 5.97; 95% confidence interval [CI]: 2.37-15.08; P < .001) and carbapenem (OR: 3.60; 95% CI: 1.26-10.29; P = .017) and underlying renal disease (OR: 7.08; 95% CI: 1.74-28.83; P = .006) were identified as independent risk factors for MDR GNB acquisition. Patients with MDR GNB bacteremia more likely received inadequate initial antibiotic therapy (72.9% vs 7.8%; P < .001) had higher rates of infectious complication (21.4% vs 10.5%; P = .011) and overall case fatality +rate (28.6% vs 10.5%; P < .001). Independent risk factors for overall mortality were presence of infectious complications after bacteremia (OR: 3.16; 95% CI: 1.41-7.08; P = .005) and underlying secondary pulmonary hypertension with or without cor pulmonale (OR: 6.19; 95% CI: 1.88-20.31; P = .003).

CONCLUSIONS

MDR GNB accounted for 18.6% of all neonatal GNB bacteremia in the NICU, especially in those with previous broad-spectrum antibiotic therapy and underlying renal disease. The most frequent mechanism of resistance was extended-spectrum β-lactamase (ESBL) production. Neonates with MDR GNB were more likely to develop infectious complications, which were independently associated with a higher overall case-fatality rate.

Authors+Show Affiliations

Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan;No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24420803

Citation

Tsai, Ming-Horng, et al. "Risk Factors and Outcomes for Multidrug-resistant Gram-negative Bacteremia in the NICU." Pediatrics, vol. 133, no. 2, 2014, pp. e322-9.
Tsai MH, Chu SM, Hsu JF, et al. Risk factors and outcomes for multidrug-resistant Gram-negative bacteremia in the NICU. Pediatrics. 2014;133(2):e322-9.
Tsai, M. H., Chu, S. M., Hsu, J. F., Lien, R., Huang, H. R., Chiang, M. C., Fu, R. H., Lee, C. W., & Huang, Y. C. (2014). Risk factors and outcomes for multidrug-resistant Gram-negative bacteremia in the NICU. Pediatrics, 133(2), e322-9. https://doi.org/10.1542/peds.2013-1248
Tsai MH, et al. Risk Factors and Outcomes for Multidrug-resistant Gram-negative Bacteremia in the NICU. Pediatrics. 2014;133(2):e322-9. PubMed PMID: 24420803.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors and outcomes for multidrug-resistant Gram-negative bacteremia in the NICU. AU - Tsai,Ming-Horng, AU - Chu,Shih-Ming, AU - Hsu,Jen-Fu, AU - Lien,Reyin, AU - Huang,Hsuan-Rong, AU - Chiang,Ming-Chou, AU - Fu,Ren-Huei, AU - Lee,Chiang-Wen, AU - Huang,Yhu-Chering, Y1 - 2014/01/13/ PY - 2014/1/15/entrez PY - 2014/1/15/pubmed PY - 2014/4/2/medline KW - Gram-negative bacilli KW - bacteremia KW - extended-spectrum β-lactamase–producing bacteria KW - mortality KW - nosocomial infection SP - e322 EP - 9 JF - Pediatrics JO - Pediatrics VL - 133 IS - 2 N2 - OBJECTIVES: To assess the risk factors antibiotic therapy and outcomes of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bacteremia in NICU patients. METHODS: Episodes of MDR GNB bacteremia were compared with a non-MDR GNB bacteremia group in an 8-year cohort study. RESULTS: Of 1106 bacteremias, 393 (35.5%) were caused by GNB. Seventy (18.6%) were caused by an MDR strain. The most frequent mechanism of resistance was extended-spectrum β-lactamase production (67.1%), mainly by Klebsiella pneumoniae (59.6%). Previous antibiotic exposure to third-generation cephalosporin (odds ratio [OR]: 5.97; 95% confidence interval [CI]: 2.37-15.08; P < .001) and carbapenem (OR: 3.60; 95% CI: 1.26-10.29; P = .017) and underlying renal disease (OR: 7.08; 95% CI: 1.74-28.83; P = .006) were identified as independent risk factors for MDR GNB acquisition. Patients with MDR GNB bacteremia more likely received inadequate initial antibiotic therapy (72.9% vs 7.8%; P < .001) had higher rates of infectious complication (21.4% vs 10.5%; P = .011) and overall case fatality +rate (28.6% vs 10.5%; P < .001). Independent risk factors for overall mortality were presence of infectious complications after bacteremia (OR: 3.16; 95% CI: 1.41-7.08; P = .005) and underlying secondary pulmonary hypertension with or without cor pulmonale (OR: 6.19; 95% CI: 1.88-20.31; P = .003). CONCLUSIONS: MDR GNB accounted for 18.6% of all neonatal GNB bacteremia in the NICU, especially in those with previous broad-spectrum antibiotic therapy and underlying renal disease. The most frequent mechanism of resistance was extended-spectrum β-lactamase (ESBL) production. Neonates with MDR GNB were more likely to develop infectious complications, which were independently associated with a higher overall case-fatality rate. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/24420803/Risk_factors_and_outcomes_for_multidrug_resistant_Gram_negative_bacteremia_in_the_NICU_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=24420803 DB - PRIME DP - Unbound Medicine ER -