Clinical and molecular characteristics of neonatal extended-spectrum β-lactamase-producing gram-negative bacteremia: A 12-year case-control-control study of a referral center in Taiwan

Ming Horng Tsai, I-Ta Lee, Shih Ming Chu, Reyin Lien, Hsuan Rong Huang, Ming Chou Chiang, Ren Huei Fu, Jen Fu Hsu, Yhu Chering Huang

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Abstract

Extended-spectrum β-lactamase (ESBL)-producing Gram-negative bacteremia (GNB) in the neonatal intensive care unit was characterized by comparison with two control groups: a susceptible control group and a general base population group over 2001 to 2012. The influence of ESBL production on mortality was studied in all study subjects and ESBL-GNB isolates were microbiologically characterized. We identified 77 episodes of ESBL-GNB (14.2% of all neonatal late-onset GNB), which were caused by Klebsiella spp. (62.3%), E. coli (20.8%) and Enterobacter spp. (16.9%). Most ESBL-GNB strains were genetically unrelated and the SHV-type ESBLs were the most prevalent (67% of isolates). Comparison with both control groups disclosed previous usage of 3rd generation cephalosporin (odds ratio [OR], 4.72; 95% confidence interval [CI], 2.03-10.97; P < 0.001), and underlying renal disease (OR, 4.07; 95% CI, 1.10-15.08; P = 0.035) as independent risk factors for ESBL-GNB. Inadequate empiric antibiotics, a higher illness severity, higher rates of infectious complications and sepsis-attributable mortality were more frequently seen in neonates with ESBL-GNB than those with non-ESBL GNB (20.8% and 15.6% vs. 9.2% and 7.9%, respectively; P = 0.008 and 0.049, respectively). Neonates with underlying secondary hypertension (OR, 7.22; 95% CI, 2.17-24.06) and infectious complications after bacteremia (OR, 6.66; 95% CI, 1.81-19.31) were identified as independent risk factor for in-hospital mortality. ESBL-GNB accounted for one-seventh of all neonatal gram-negative bacteremia, especially in neonates exposed to broad-spectrum cephalosporins. Neonates with ESBL-GNB bacteremia more frequently received inadequate empirical antibiotic therapy, which were associated with a higher rate of infectious complications and an adverse outcome.

Original languageEnglish
Article numbere0159744
JournalPLoS One
Volume11
Issue number8
DOIs
Publication statusPublished - Aug 1 2016
Externally publishedYes

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bacteremia
compound A 12
Bacteremia
Taiwan
Referral and Consultation
Cephalosporins
Anti-Bacterial Agents
Intensive care units
Escherichia coli
odds ratio
confidence interval
neonates
Odds Ratio
Confidence Intervals
cephalosporins
Newborn Infant
Control Groups
risk factors
antibiotics
Enterobacter

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Clinical and molecular characteristics of neonatal extended-spectrum β-lactamase-producing gram-negative bacteremia : A 12-year case-control-control study of a referral center in Taiwan. / Tsai, Ming Horng; Lee, I-Ta; Chu, Shih Ming; Lien, Reyin; Huang, Hsuan Rong; Chiang, Ming Chou; Fu, Ren Huei; Hsu, Jen Fu; Huang, Yhu Chering.

In: PLoS One, Vol. 11, No. 8, e0159744, 01.08.2016.

Research output: Contribution to journalArticle

Tsai, Ming Horng ; Lee, I-Ta ; Chu, Shih Ming ; Lien, Reyin ; Huang, Hsuan Rong ; Chiang, Ming Chou ; Fu, Ren Huei ; Hsu, Jen Fu ; Huang, Yhu Chering. / Clinical and molecular characteristics of neonatal extended-spectrum β-lactamase-producing gram-negative bacteremia : A 12-year case-control-control study of a referral center in Taiwan. In: PLoS One. 2016 ; Vol. 11, No. 8.
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abstract = "Extended-spectrum β-lactamase (ESBL)-producing Gram-negative bacteremia (GNB) in the neonatal intensive care unit was characterized by comparison with two control groups: a susceptible control group and a general base population group over 2001 to 2012. The influence of ESBL production on mortality was studied in all study subjects and ESBL-GNB isolates were microbiologically characterized. We identified 77 episodes of ESBL-GNB (14.2{\%} of all neonatal late-onset GNB), which were caused by Klebsiella spp. (62.3{\%}), E. coli (20.8{\%}) and Enterobacter spp. (16.9{\%}). Most ESBL-GNB strains were genetically unrelated and the SHV-type ESBLs were the most prevalent (67{\%} of isolates). Comparison with both control groups disclosed previous usage of 3rd generation cephalosporin (odds ratio [OR], 4.72; 95{\%} confidence interval [CI], 2.03-10.97; P < 0.001), and underlying renal disease (OR, 4.07; 95{\%} CI, 1.10-15.08; P = 0.035) as independent risk factors for ESBL-GNB. Inadequate empiric antibiotics, a higher illness severity, higher rates of infectious complications and sepsis-attributable mortality were more frequently seen in neonates with ESBL-GNB than those with non-ESBL GNB (20.8{\%} and 15.6{\%} vs. 9.2{\%} and 7.9{\%}, respectively; P = 0.008 and 0.049, respectively). Neonates with underlying secondary hypertension (OR, 7.22; 95{\%} CI, 2.17-24.06) and infectious complications after bacteremia (OR, 6.66; 95{\%} CI, 1.81-19.31) were identified as independent risk factor for in-hospital mortality. ESBL-GNB accounted for one-seventh of all neonatal gram-negative bacteremia, especially in neonates exposed to broad-spectrum cephalosporins. Neonates with ESBL-GNB bacteremia more frequently received inadequate empirical antibiotic therapy, which were associated with a higher rate of infectious complications and an adverse outcome.",
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