Neonatal Sepsis: The impact of Hypervirulent Klebsiella pneumonia in a Tertiary Care Hospital (original) (raw)
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Neonatal Sepsis due to Klebsiella: Frequency, Outcome and Antibiotic Sensitivity
Iranian J Publ Health, 2004
Sepsis is a significant cause of morbidity and mortality in neonates. The most common pathogens of bacterial sepsis and antibiotic sensitivity patterns vary in different parts of the world. The aim of this study was to determine the most common pathogens and outcome of neonatal sepsis and also antibiotic sensitivity patterns of Klebsiella species. A retrospective descriptive study was carried out. The study was performed at a neonatal care unit in Kashan between October 2000 to October 2003.Only those neonates with positive blood culture were included. Patients with Klebsiella septicemia were categorized into two groups of early and late-onset sepsis. Patterns of the antibiotic resistance of the bacterial isolates were studied by disc diffusion technique. Frequencies and Fisher's Exact test was used to compare the early-onset outcome versus late-onset outcome. One hundred and thirty-six neonates had positive blood cultures out of 453 cases. The most common pathogens were Pseudomonas, Klebsiella and coagulase negative Staphylococci respectively. Overall crude mortality rate was 39% (Pseudomonas was the predominant cause). All Klebsiella species were resistant to ampicillin. Twenty-three percent of Klebsiella species were multiresistant considering our most common etiologic pathogens of bacterial sepsis and the significant number of resistant bacteria to ampicillin and gentamicin; it seems prudent to consider revising the present choice of empirical antibiotic treatment.
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 2013
Introduction: The incidence, change in antibiotic susceptibility, and risk factors associated with mortality of late-onset Klebsiella pneumoniae sepsis during 2006-2011, in a neonatal intensive care unit (NICU) of a developing country, were analyzed. Methods: The medical records of neonates with a discharge diagnosis of sepsis due to late-onset K. pneumoniae were retrieved. Demographic features, gestational age, date and year of admission, antibiotic susceptibility of isolates, and discharge status were recorded. The late-onset K. pneumoniae incidence per 1000 NICU admissions and risk factors for mortality due to late-onset K. pneumoniae sepsis are reported. Results: During the period 2006-2011, 104 of 2768 neonates developed late-onset K. pneumoniae sepsis. The overall incidence of late-onset K. pneumoniae sepsis was 3.7% (37/1000 NICU admissions), with the highest annual incidence being 53/1000 in 2010. Most cases were males (n = 64; 62%) and most were premature and very low birth weight (n = 68; 65%). More than 80% of isolates were resistant to ampicillin + clavulanic acid, gentamicin, aztreonam, and cephalosporins. An increasing trend of resistance to amikacin, fluoroquinolones, piperacillin/tazobactam, and imipenem was observed. In 2011, threequarters (72%; n = 13) of late-onset K. pneumoniae were CR K. pneumoniae. Seventeen (16%) neonates died. Being male (p = 0.06, adjusted odds ratio (AOR) 9.2, 95% confidence interval (CI) 1.3-66.9), having an extremely low birth weight (p = 0.01, AOR 6.1, 95% CI 0.8-44.4), having severe thrombocytopenia (p = 0.07, AOR 3.9, 95% CI 1.2-13.0), and failure to achieve microbiological clearance (p < 0.001, AOR 19.6, 95% CI 4.0-98.0) were significantly associated with mortality due to late-onset K. pneumoniae sepsis. Conclusion: There has been a rise in carbapenem-resistant strains of late-onset K. pneumoniae, associated with an increased mortality and limited antibacterial choices. Antimicrobial stewardship and rigorous infection control measures seem to be the only way to limit the spread of these strains.
Klebsiella pneumoniae in neonatal sepsis: a 3-year-study in the pediatric hospital of Tabriz, Iran
Japanese journal of infectious diseases, 2007
Neonatal sepsis is a life-threatening emergency, and any delay in treatment may cause death. Because of the importance of the problem in Iran, the aim of this retrospective study was to determine the etiological agents of neonatal septicemia, and the prevalence and epidemiology of Klebsiella bacteremia in the neonatal wards. Two hundred and ten cases of neonatal sepsis occurred during the study period. The most common organism was coagulase-negative staphylococci. Gram-negative organisms were isolated in 66 cases (31.43%), and the most common Gram-negative organism causing neonatal sepsis was Klebsiella pneumoniae. The mortality rate due to Gram-negative bacteria including K. pneumoniae was higher than that due to other bacteria. The distribution of the main pathogens is different in the Azerbaijan state, northwest of Iran, and K. pneumoniae is predominant, but Streptococcus agalactiae plays a relatively minor role in the etiology of sepsis during the first month of life.
Journal of Pharmaceutical Research International, 2022
Neonatal sepsis is one of the most prevalent infections today, claiming the lives of almost one million newborns in developing countries. Our objective is to determine the bacteria that cause sepsis in newborns in Egyptian hospitals, as well as to discover their resistance profiles, allowing for the selection of appropriate drug combinations against multidrug resistant (MDR) bacteria. Nine hundred and eighty-nine blood samples were collected from neonates in Al Demerdash and Ain Shams University Specialized Hospital from March 2019 to March 20121 according to the standard protocols. Bacterial identification and antimicrobial susceptibility test AST were performed using VITEK® 2 system. The results revealed that 51.4 % of patients had positive blood cultures, with 60.3 % females and 39.7 %. Males. Sepsis with late onset was detected in 95% of positive cases, while sepsis with early onset was observed in only 5% of the total positive cases. According to the Original Research Article
Frontiers in Microbiology, 2020
Background: Neonatal sepsis is a nuisance to clinicians and medical microbiologists, particularly those cases caused by Klebsiella pneumoniae. Thus, we aimed at investigating the profile and mechanisms of antibiotic resistance and the clonal relationships between K. pneumoniae isolated from neonates at the largest tertiary care hospital's neonatal intensive care units (NICUs) in Minia, Egypt. Methods: This study comprised 156 neonates diagnosed with culture-proven sepsis from February 2019 to September 2019, at a major NICU of Minia City. All K. pneumoniae isolates were collected and characterized by antimicrobial profile, resistance genotype, and pulsed-field gel electrophoresis typing. Results: Twenty-four K. pneumoniae isolates (15.3%) were collected out of the 156 sepsis diagnosed neonates. These samples showed extensive drug resistance (XDR) to most of the tested antimicrobials, except fluoroquinolones. All the K. pneumoniae isolates possessed bla VIM and bla NDM carbapenemase genes, while bla KPC gene was detected in 95.8%. Considering extended-spectrum β-lactamases genes, bla CTX−M was found in all the isolates and bla OXA−1 gene in 75% of them. The plasmid-mediated quinolone resistance gene qnrS, was predominantly found among our isolates in comparison to qnrB or qnrA. A moderate degree of clonal relatedness was observed between the isolates. Conclusion: To the best of our knowledge, this the first report of an alarming occurrence of XDR among K. penumoniae isolates recovered from neonatal sepsis in Egypt. Our data necessitate proper antimicrobial stewardship as the choices will be very limited.
Egyptian Pediatric Association Gazette
Background Infections with multidrug-resistant K. pneumoniae is associated with high morbidity and mortality especially among critically ill patients. This was the main principle to conduct a detailed study about this organism, its resistance pattern, and type of its resistance genes Subjects and methods A cross-sectional study was carried out in a pediatric intensive care unit on patients with age range from 1 month to 12 years over a period of 1 year with positive K. pneumoniae using standard microbiological culture and antibiogram sensitivity testing. All collected samples were processed using multiplex PCR technique to identify the most relevant resistant genes. Results Forty-four patients had 54 positive cultures for K. pneumoniae, out of which 17 patients (38.6%) passed away. The most prevalent-resistant gene was New Delhi metallo-beta lactamase (NDM) gene (65.4%) followed by cefotaximase (CTX-M) gene (57.7%). Extensively drug-resistant K. pneumoniae was detected in (15.9%) of...
Risk factors and outcome of Klebsiella pneumonia sepsis among newborns in Northern India
International Journal of Research in Medical Sciences, 2019
Background: The increasing clinical incidence of antibiotic-resistant bacteria is a major global health care issue. Among MDR pathogens, Klebsiella pneumoniae (KP) is one of the world's most dangerous superbugs; and becoming resistant to virtually every antibiotic available today. The objective were to study the clinical characteristics of neonatal sepsis caused by KP and the antibiotic sensitivity pattern of Klebsiella pneumoniae in a neonatal intensive care unit (NICU) in northern india.Methods: This observational study was conducted with neonates who were admitted in NICU of Government Medical College (GMC) Jammu (Jammu and Kashmir) India and whose blood culture showed growth of KP in a study period of 1 year between 1st January 2018 to 31st December 2018. The data was entered into a register and presented by descriptive statistics.Results: Twenty four neonates were included in the study. The clinical presentations include refusal of feed (83.3%), lethargy (79.2%), respirator...
Brazilian Journal of Microbiology, 2019
Background Klebsiella infections are reported from neonatal intensive care units (NICUs) worldwide, but data on their incidence and genetic diversity remain scarce. Objective We determined the incidence and genetic diversity of Klebsiella infections in NICU patients in Rio de Janeiro. Methods This was a prospective study including newborns admitted to NICU in three hospitals during April 2005-November 2006 and March 2008-February 2009. Klebsiella pneumoniae isolates were genotyped by multilocus sequence typing (MLST) and extended spectrum β-lactamases (ESBL) were characterized. Results Klebsiella infections occurred in 38 of 3984 patients (incidence rate, 9.5/1000 admissions); 14 (37%) of these 38 newborns died. Two clonal groups, CC45 and CC1041, caused 11 cases (42% of K. pneumoniae infection). Ten (32%) of the isolates causing infection produced ESBL, 9 of which (83%) carried bla CTX-M-15 , all belonging to clonal complex (CC) 45 and CC1041. Nine of these ESBL-producing isolates were confined to only one of the NICUs. Major conclusions The high incidence of Klebsiella infections in NICU in Rio de Janeiro appeared to be due to a combination of frequent sporadic infections caused by multiple K. pneumoniae genotypes and small outbreaks caused by dominant multidrugresistant clones.
Neonatal sepsis due to ESBL producing Klebsiella
IP innovative publication pvt. ltd, 2019
Introduction: Septicemia is a major cause of morbidity and mortality among neonates in India, significantly threatening the survival in this period. Over the past decade, Klebsiella species, especially ESBL producers have emerged as an important cause of neonatal septicemia. ESBL producing Klebsiella species are of serious concern as they exhibit high resistance to commonly used antibiotics. Hence, the present study was undertaken to evaluate the prevalence of ESBL producing Klebsiella species as a causative agent in neonatal sepsis. Objectives: 1. To determine the incidence of Klebsiella species as an etiological agent of neonatal septicemia from blood cultures in patients admitted in Neonatal Intensive Care Unit (NICU); 2: To evaluate the prevalence of Extended spectrum β-lactamase (ESBL) production in these isolates. Materials and Methods: All the blood samples of clinically diagnosed neonatal septicemia, received at the Department of Microbiology, at a tertiary care center, South India, for a period of one year were included for the study. Klebsiella species were isolated by following conventional standard microbiological technique. Antibiotic susceptibility testing was done by Kirby Bauer disk diffusion method. For the resistant isolates, extended spectrum β-lactamase detection was done by phenotypic confirmatory disk diffusion test (PCDDT) as per CLSI guidelines 2010. Results: A total of 300 blood samples which met the study criteria were processed. Among these, Blood culture positivity rate was 68.33%, of which 100(49.5%) were Klebsiella isolates. Of these, 96 (96%) were K.pneumoniae and 4 (4%) were K.oxytoca. And out of these 100 Klebsiella isolates, 39 (39%) were ESBL producers, where 38 (97.43%) were K. pneumoniae and 1 (2.56%) was K.oxytoca. Conclusion: The present study showed that Klebsiella species are the leading cause of neonatal septicemia. Prevalence of antibiotic resistant strains among Klebsiella species is predominant and deserves more consideration. Routine testing for ESBL production will guide for proper and judicious use of antibiotics. Implementation of appropriate infection control measures and adherence to them are crucial to control the spread of antibiotic resistant organisms.
European Journal of Clinical Microbiology & Infectious Diseases, 2007
The extended-spectrum beta-lactamase (ESBL)producing Klebsiella spp. cause worldwide problems in intensive care units. The aim of this study was to investigate the molecular epidemiology of ESBL-producing Klebsiella pneumoniae and K. oxytoca strains in a neonatal intensive care unit (NICU) in Budapest, Hungary and to determine the risk factors of the infections and the epidemiological features. Infections with Klebsiella spp. were analyzed retrospectively by reviewing the medical records between January 2001 and December 2005. Antibiotic susceptibility tests, isoelectric focusing, pulsed field gel electrophoresis, plasmid analysis, PCR for bla TEM and bla SHV and DNA sequencing analysis were performed on ESBL-producing Klebsiella isolates. A total of 45 babies were found to be infected with non-ESBL-producing Klebsiella spp. and 39 with ESBL-producing Klebsiella spp. Of the parameters analyzed, including sex, gestational age, twin pregnancy, birth weight, presence of central vascular catheter, mechanical ventilator use, parenteral nutrition, polymicrobial infection, caesarean section, transfusion and mortality, we found no statistically significant difference between the ESBL and the non-ESBL groups, or between the K. pneumoniae and K. oxytoca species. Further characterization of the ESBLproducing K. pneumoniae and K. oxytoca strains isolated between February 2001 and January 2003 revealed three distinct PFGE patterns of SHV-5-producing K. pneumoniae (A, B, E) and two distinct patterns of SHV-12-producing K. oxytoca (C,D) isolates; these had different plasmid profiles. From July to November 2005, a new SHV-5 producing K. oxytoca (F) was isolated. The molecular epidemiology of ESBL-producing organisms in a NICU over time shows substantial shifts in predominant strains. The ESBL production of the infected organisms has an impact on the survival of newborn babies with infections caused by Klebsiella spp.