Pediatrics & Therapeutics
Open Access

Clinical and molecular characteristics of neonatal Extended-Spectrum β-Lactamase-producing Gram-Negative Bacteremia: A 2-year case-control-control study of a teaching hospital in Taiwan

3^rd International Conference on Pediatrics

May 18-20, 2015 San Antonio, Texas, USA

Ming-Horng Tsai

Chang Gung Memorial Hospital, Taiwan

Posters-Accepted Abstracts: Pediat Therapeut

Abstract :

Background: To assess the clinical features, risk factors, Molecular Epidemiology and outcome of Extended-Spectrum �²-Lactamase (ESBL)-producing Gram-Negative Bacteremia (GNB) in the neonatal intensive care unit. Methods: Risk factors were assessed using a case-control-control study. Clinical features of ESBL producers were compared with a susceptible control group and the influence of ESBL production on mortality was studied in all study subjects. ESBLGNB isolates were microbiologically characterized. Results: 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 andthe SHVtype 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), and underlying renal disease (OR, 4.07; 95% CI, 1.10-15.08) 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% and7.9%, respectively; P=0.008 and 0.049, respectively). Neonates with underlying secondary hypertension and infectious complications after bacteremia were identified as independent risk factor for in-hospital mortality. Conclusion: 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.

Biography :

Email: mingmin.tw@yahoo.com.tw