Dataset Information

Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India.

ABSTRACT:

Background

There is a paucity of data on the epidemiology of sepsis in outborn neonates being referred to level-3 units in low- and middle-income countries (LMIC). The objective of the present study was to evaluate the prevalence of sepsis and outcomes of outborn neonates with sepsis, and to characterize the pathogen profile and antimicrobial resistance (AMR) patterns of common isolates in them.

Methods

In this prospective observational cohort study (2011-2015), a dedicated research team enrolled all neonates admitted to an outborn level-3 neonatal unit and followed them until discharge/death. Sepsis work-up including blood culture(s) was performed upon suspicion of sepsis. All the isolates were identified and tested for antimicrobial susceptibility. Gram-negative pathogens resistant to any three of the five antibiotic classes (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam) were labeled multi-drug resistant.

Results

Of the total of 2588 neonates enrolled, culture positive sepsis and total sepsis-i.e. culture positive and/or culture negative sepsis-was diagnosed in 13.1% (95% CI 11.8% to 14.5%) and 54.7% (95% CI 52.8% to 56.6%), respectively. The case fatality rates were 23.4% and 11.0% in culture-positive and total sepsis, respectively. Sepsis accounted for two-thirds of total neonatal deaths (153/235, 63.0%). Bacterial isolates caused about three-fourths (296/401; 73.8%) of the infections. The two common pathogens-Klebsiella pneumoniae (n = 50, 12.5%) and Acinetobacter baumannii (n = 46, 11.5%)-showed high degree of multi-drug resistance (78.0% and 91.3%, respectively) and carbapenem resistance (84.0% and 91.3%, respectively). About a quarter of infections were caused by Candida spp. (n = 91; 22.7%); almost three-fourths (73.7%) of these infections occurred in neonates born at or after 32 weeks' gestation and about two-thirds (62.1%) in those weighing 1500 g or more at birth.

Conclusions

In this large outborn cohort, we report high burden of sepsis, high prevalence of systemic fungal infections, and alarming rates of antimicrobial resistance among bacterial pathogens.

SUBMITTER: Jajoo M

PROVIDER: S-EPMC6023165 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India.

Jajoo Mamta M Manchanda Vikas V Chaurasia Suman S Sankar M Jeeva MJ Gautam Hitender H Agarwal Ramesh R Yadav Chander Prakash CP Aggarwal Kailash C KC Chellani Harish H Ramji Siddharth S Deb Monorama M Gaind Rajni R Kumar Surinder S Arya Sugandha S Sreenivas Vishnubhatla V Kapil Arti A Mathur Purva P Rasaily Reeta R Deorari Ashok K AK Paul Vinod K VK

PloS one 20180628 6

<h4>Background</h4>There is a paucity of data on the epidemiology of sepsis in outborn neonates being referred to level-3 units in low- and middle-income countries (LMIC). The objective of the present study was to evaluate the prevalence of sepsis and outcomes of outborn neonates with sepsis, and to characterize the pathogen profile and antimicrobial resistance (AMR) patterns of common isolates in them.<h4>Methods</h4>In this prospective observational cohort study (2011-2015), a dedicated resear ...[more]

PMID: 29953451

Similar Datasets

Project description:Background:Hospital acquired infections (HAI) are principal threats to the patients of intensive care units. An increase in the antimicrobial resistance (AMR) observed in gram negative bacteria is a great challenge to deal with. HAI and AMR lead to prolonged hospitalization and additional doses of anti-microbial treatment affecting patient's fitness and finances. Present study was undertaken to determine the pathotypes, genetic diversity and the antimicrobial resistance of E.coli in isolates from the patients admitted to intensive care unit at a tertiary care hospital in Delhi, India. Methods:E.coli isolates (N = 77) obtained from the blood culture of patients diagnosed with sepsis and the isolates (N = 71) from the stool culture of patients admitted in intensive care unit (ICU) but not diagnosed with sepsis were investigated for their pathotypes, adherence patterns and genetic diversity by Enterobacterial Repeated Intergenic Consensus-polymerase chain reaction (ERIC-PCR). A Kirby-Bauer Disc diffusion test and antimicrobial susceptibility assays were performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Extended-spectrum β-lactamase (ESBL) genes and sequence type 131 (ST131) clone were characterised genotypically by gene-specific PCRs. Results:Pathotypes analysis revealed 46 and 16% of the blood E.coli isolates were ETEC and EAEC respectively, in contrast to the fecal isolates wherein 22% of the isolates were ETEC and 28.5% were EAEC. EPEC, STEC and EIEC pathotypes were not detected in blood or fecal isolates. Of all the isolates studied, more than 90% of the blood and 70% of the fecal isolates were found to be resistant to cephalosporins. On the other hand, 68% of blood and 44% of the fecal isolates were found to be ESBL producers. Interestingly 83% of the blood isolates contained CTX-M15, whereas only 21% of them contained CTX-M9 genes. On the other hand CTX-M15 genes were found in 90% and CTX-M9 genes were found in 63% of the fecal isolates. Conclusion:The antimicrobial resistant profile found in this study is alarming and poses a great threat to public health. Apparently an increased antimicrobial resistance to the extensively used cephalosporins is affecting an optimal drug therapy for patients. In addition, the presence of catheters, prolonged duration of stay in the hospital and poor hygienic conditions due to infrequent urination of the patient can lead to an additional vulnerability. Therefore continuous surveillance and rational use of antibiotics along with effective hygienic measures are urgently recommended in such settings.

Project description:The arid coasts of North Africa, extending over 4633 km from the Gulf of Tunis to the Nile Delta, are undergoing pronounced shoreline retreats and coastal floodings that are reported as a consequence of the ongoing sea level rise resulting from global warming. Of particular interest are the abnormal shoreline dynamics for deltaic and sandy beaches, which are severely impacted by abrupt decadal variabilities in both climatic and anthropogenic drivers resulting in their increased vulnerability to disturbances from coastal hazards. Unfortunately, the evolution, distribution and impacts of these drivers remain largely unquantified, let alone understood, for these extensive arid coasts that harbor the major portion of North Africa's population as well as unique and fragile marine ecosystems. To address this deficiency, we use GIS-based multi-criteria approaches combined with analytic hierarchy process to map the Coastal Vulnerability Index and the Socioeconomic Vulnerability Index along these coasts to investigate the amplitude and extent of shoreline deterioration resulting from sudden fluctuations in sediment transport to the coastline. We use the western bay of the Gulf of Tunis, the coasts of Tripoli and the Nile Delta as three validation sites for our vulnerability assessment. The statistical Integrated Coastal Vulnerability Index map reveals that 47% of arid North African coasts are characterized by high to very high vulnerability. In particular, we observe that the densely populated deltaic coasts in both Tunisia and Egypt are 70% more vulnerable than any others coast in the eastern Mediterranean Basin. These abnormally high-vulnerability extensive areas are also correlated with significant deterioration of coastal aquifers and hence in crop production, compromising local food security and resulting in increasing outflow migration trends. Both Tunisia and Egypt observed dramatic increases in the net population outflow migration by respectively 62% and 248% between 2000 and 2016, mostly from coastal areas. Our source analysis of the amplitude and extent of these high coastal vulnerabilities suggests that they result from the anthropogenic drivers of damming and rapid urban growth over the last few decades rather than the effects of global warming.

Project description:Introduction:Klebsiella pneumoniae is one of the most important infectious agents in neonates. There are "classic" and hypervirulent strains of K. pneumoniae. The "classic" non-virulent strain of K. pneumoniae, producing extended-spectrum beta-lactamases (ESBLs), is associated with nosocomial infections. Hypervirulent K. pneumoniae strains are associated with invasive infections in previously healthy adult people, and most of them exhibit antimicrobial susceptibility. The role of virulent strains of K. pneumoniae (including hv-KP) in neonatal infections is unknown. The aim of the study was the assessment of the impact of virulence factors and antibiotic resistance of K. pneumoniae strains on clinical features and outcomes of neonatal infection. Materials and Methods: Two groups of infants were enrolled. The first group consisted of 10 neonates with sepsis caused by K. pneumoniae. The second group consisted of 10 neonates with urinary tract infection (UTI) caused by K. pneumoniae. We investigated the susceptibility of K. pneumoniae isolates to antibiotics, the ability of the microorganism to produce ESBL, and virulence factors, including the rmpA gene, aerobactin, and colibactin genes. In neonates with sepsis, we investigated K. pneumoniae isolates, which was taken from the blood, in neonates with UTI-from the urine. Results: In neonates with sepsis testing of K. pneumoniae isolates for ESBL production was positive in 60% of cases, in neonates with UTI-in 40% of cases. All blood and urine ESBL producing K. pneumoniae isolates were resistant to ampicillins, including protected ones, and third-generation cephalosporins. At the same time, these isolates were sensitive to meropenem, amikacin, and ciprofloxacin. The rmpA gene was detected in four blood, and three urine K. pneumoniae isolates. In neonates with sepsis rmpA gene in two cases was detected in ESBL-producing K. pneumoniae isolates. They were infants with meningitis, and both cases were fatal. In the group of infants with UTI, the rmpA gene was detected only in K. pneumoniae isolates not producing ESBL. Aerobactin and colibactin genes were detected in two neonates with sepsis and in three neonates with UTI. In all cases, aerobactin and colibactin genes were detected only in rmpA-positive K. pneumoniae isolates. Out of three fatal outcomes, two cases were caused by hv-KP producing ESBL. Conclusion: The prevalence of virulent strains of K. pneumoniae among neonates with sepsis and other neonatal infection is higher than we think. The most severe forms of neonatal sepsis with an unfavorable outcome in our study were due to virulent strains of K. pneumoniae.

Dataset Information

Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India.

Background

Methods

Results

Conclusions

Publications

Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets