medigraphic.com
Órgano Oficial de la Asociación Mexicana de Infectología Pediátrica y la SLIPE.

2010, Number 93

<< Back Next >>

Rev Enfer Infec Pediatr 2010; 23.24 (93)

Antimicrobial susceptibility in a neonatal intensive care unit: experience of 43 months

Mendoza TLA, Arias GMD

Language: Spanish
References: 43
Page: 13-24
PDF size: 333.18 Kb.


ABSTRACT

Objective: to evaluate the etiology of extra (IEH) and nosocomial (IIH) and the antibiotic susceptibility of microorganisms isolated from patients in a Neonatal Intensive Care Unit.
Patients and methods: prospective study in 75 isolates. The susceptibility of strains was identified by MicroScan 4 (Dade Berihng) and confirmed with standard discs specific. We calculated rates for each 100 admissions and analyzed the susceptibility and resistance to different bacterial groups.
Results: the incidence of IEH was 2.1% and 1.5% for the IIH. Among all IEH and IIH were predominant Gram-negative bacteria such as Escherichia coli, and Klebsiella pneumoniae. Streptococcus and Listeria monocytogenes (Gram-positive bacteria) were the most responsible for IEH, while the mainly microorganism isolated was coagulase-negative Staphylococci from nosocomial infections. Among the IEH is highly resistant to ampicillin by Escherichia (71.0%) and Klebsiella (60.0%), while gentamicin was 23.0% and 40.0% respectively. In IIH, Escherichia and Klebsiella have a sensitivity of less than 30.0% to ampicillin, cefotaxime sensitive for 42.9% of Escherichia and 16.7% of Klebsiella, sensitive to cefepime 33.3% of Escherichia and 14.3% of Klebsiella. At 100% of meropenem Escherichia sensitive and 80.0% of Klebsiella, while amikacin and piperacillin-tazobactan shows better coverage (100% and Klebsiella, Eschercichia, 87.5% susceptibility).
Conclusions: the high resistance of microorganisms isolated outpatient and inpatient and variety of patterns identified, confirms the emergence of this problem in the institution concerned.


REFERENCES

  1. Ducel G, Fabry J, Nicolle L, Girard R, Perraud M, Prüss A, et al. Prevención de las infecciones nosocomiales. Guía práctica, 2003. Internet, en línea, disponible en: http://www.who.int/csr/resources/publications/drugresist/PISpanish3.pdf. Consultado el 16 de mayo de 2010.

  2. Vergnano S, Sharland M, Kazembe P, Mwansambo C, Heath PT. Neonatal sepsis: an international perspective. Arch Dis Child Fetal and Neonatal Ed 2005;90:220-4.

  3. Härtel C, Osthues I, Rupp J, Haase B, Röder K, Göpel W, et al. Characterization of the host inflammatory response to S. epidermidis in neonatal whole blood. Arch Dis Chile Fetal Neonatal Ed 2008;93:140-5.

  4. Kumar Y, Qunibi M, Neal TJ, Yoxall CW. Time to positivity of neonatal blood cultures. Arch Dis Child Fetal Neonatal Ed 2001;85F:182-6.

  5. Polin RA, Saiman L. Nosocomial infections in the neonatal intensive care unit. NeoReviews 2003;4(3):e81.

  6. Randolph DA. The neonatal adaptive immune system. NeoReviews 2005;6(10):e454-e62.

  7. Schrag S, Schuchat A. Prevention of neonatal sepsis. Clin Perinatol 2005;32:601-15.

  8. Vargas L, Casellas JM, Gales A, Tomé G, Sader H, Lanza A, et al. Survey of bloodstream infection isolates: SENTRY Antimicrobial Surveillance Program in Buenos Aires, Argentina (1997-2002). Rev Panam Infectol 2006;8(3):11-7.

  9. Hoberman A, Wald ER, Reynolds EA. Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever. J Pediatr 1994;124:513-9.

  10. Hellerstein S. Urinary tract infections: old and new concepts. Ped Clin N America 1995;42:6:1433-57.

  11. Byrington CL, Rittichier KK, Basserr KE, Castillo H, Glasgow TS, Daly J, et al. Serious bacterial infections in febrile Infants younger than 90 days of age: the importance of ampicillin-resistant pathogens. Pediatr 2003;111:964-8.

  12. Bauer S, Eliakim A, Pomeranz A, Regev R, Litmanovits I, Arnon S, et al. Urinary tract infection in very low birth weight preterm infants. Pediatr Infect Dis J 2003;22:426-9.

  13. Tamim M, Alesseh H, Aziz H. Analysis of the efficacy of urine culture as part of sepsis. Littlewood JM, Kite P, Kite BA. Incidence of neonatal urinary tract infection. Arch Dis Child 1969;44:617–20.

  14. Heath PT, Balfour G, Weisner AM, et al. McCartney AC. Group B streptococcal disease in UK and Irish infants younger than 90 days. Lancet 2004;363:292-4.

  15. Fluegge K, Siedler A, Heinrich B, et al. Incidence and clinical presentation of invasive neonatal group B streptococcal infections in Germany. Pediatrics 2006;117:e1139-45.

  16. Neto MT. Group B streptococcal disease in Portuguese infants younger than 90 days. Arch Dis Child Fetal Neonatal Ed 2008;93:F90-F93.

  17. Hyde TB, Hilger TM, Reingold A, Farley M, O’Brien K, and Schuchat A. Trends in incidence and antimicrobial resistance of early-onset sepsis: population-based surveillance in San Francisco and Atlanta. Pediatrics 2002;110:690-95.

  18. González M, Caraballo M, Guerrero S, Montenegro S. Sepsis neonatal y prematurez. Revista de Posgrado de la VIa Cátedra de Medicina 2006;160:22-8.

  19. Stoll BJ, Hansen NI, Higgins RD, Fanaroff AA, Duara S, Goldberg R, Laptook A, Walsh M, Oh W, Hale E. Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002-2003. Pediatr Infect Dis J 2005;24(7):635-9.

  20. Lopez Sastre JB, Fernandez Colomer B, Coto Cotallo GD, Ramos Aparicio A. Trends in the epidemiology of neonatal sepsis of vertical transmission in the era of group B streptococcal prevention. Acta Paediatr 2005;94(4):451-7.

  21. Berger A, Witt A, Haiden N, Kretzer V, Heinze G, Pollak A. Amniotic cavity cultures, blood cultures, and surface swabs in preterm infants--useful tools for the management of early-onset sepsis? J Perinat Med 2004;32(5):446-52.

  22. Jardine L, Davies MW, Faoagali J. Incubation time required for neonatal blood cultures to become positive. J Paediatr Child Health 2006;42(12):797-802.

  23. Metsvaht T, Pisarev H, Ilmoja M, Parm Ü, Maipuu L, Merila M, Müürsepp P, Lutsar l. Clinical parameters predicting failure of empirical antibacterial therapy in early onset neonatal sepsis, identified by classification and regression tree analysis. BMC Pediatrics 2009;9:72. Internet. En línea, disponible en: http://www.biomedcentral.com/1471-2431/9/72. Consultado el 07 de enero de 2009.

  24. Morales WJ, Dickey SS, Bornick P, Lim DV. Change in the antibiotic resistance of group B Streptococcus: impact on intrapartum management. Am J Obstet Gynecol 1999;181:310-4.

  25. Towers CV, Carr MH, Padilla G, Asrat T. Potential consequences of widespread antepartal use of ampicillin. Am J Obstet Gynecol 1998;179:879-83.

  26. Drews MB, Ludwig AC, Leititis JU, Easchner FD. Low birth weight and nosocomial infection of neonates in a neonatal intensive care unit. J Hosp Infect 1995;30:65-72.

  27. Urrea M, Iriondo M, Thio M, Krauel X, Serra M, LaTorre C, Jimenez Rl. A prospective incidence study of nosocomial infections in a neonatal care unit. Am J Infect Control 2003;31:505-7.

  28. Efird MM, Rojas MA, Lozano JM, Bose CL, Rojas MX, Rondon MA, Ruiz G, Pineros JG, Rojas C, Robayo G, Hoyos A, Gosendi ME, Cruz H, Leon A. Epidemiology of nosocomial infections in selected neonatal intensive care units in Colombia, South America. J Perinatol 2005;25(8):531-6.

  29. van der Zwet WC, Kaiser AM, van Elburg RM, Berkhof J, Fetter WPF, Parlevliet GA, Vandenbroucke-Grauls CMJE: Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect 2006, 61:300-11.

  30. Garner JS, Jarvis WR, Emori TG, Horan TC: CDC definitions for nosocomial infections. En: RN Olmsted, ed. APIC infection control and applied epidemiology: principles and practice. Mosby Editores. St. Louis, 1996. p. A1-20.

  31. Baltimore RS. Neonatal nosocomial infections. Semin Perinatol 1998;22:25-32.

  32. Buttery JP. Blood cultures in newborns and children: optimizing an everyday test. Arch Dis Child Fetal Neonatal Ed 2002;87(1):F25-28.

  33. Clark R, Powers R, White R, Bloom B, Sanchez P, Benjamin DK. Nosocomial infection in the NICU: a medical complication or unavoidable problem?. Journal of Perinatology 2004;24:382-8.

  34. Salamati P. Rahbarimanesh A, Yunesian M, Naseri M. Neonatal nosocomial infections in Bahrami Children Hospital. Indian J Pediatr 2006;73(3):197-200.

  35. Cifuentes Y, Ruiz A, Leal A, Muñoz L, Herrera M, Jiménez L. Perfil microbiológico de aislamientos en unidades neonatales en un hospital de tercer nivel de Bogotá, Colombia. Rev. Salud Pública 2005;7(2):191-200.

  36. López JB, Coto D, Fernandez B. Neonatal sepsis of nosocomial origin: an epidemiological study from the “Grupo de Hospitales Castrillo”. J Perinat Med 2002;30(2):149-57.

  37. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110(2 Pt 1):285-91.

  38. Mehr SS, Sadowsky JL, Doyle LW, Carr J. Sepsis in neonatal intensive care in the late 1990s. J Paediatr Child Health 2002;38(3):246-51.

  39. Ahmed AS, Chowdhury MA, Hoque M, Darmstadt GL. Clinical and bacteriological profile of neonatal septicemia in a tertiary level pediatric hospital in Bangladesh. Indian Pediatr 2002;39(11):1034-9.

  40. Nambiar S, Singh N. Change in epidemiology of health care-associated infections in a neonatal intensive care unit. Pediatr Infect Dis J 2002;21(9):839-42.

  41. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 2002;347(4):240-7.

  42. Shimabuku R, Velásquez P, Yabar J, Zerpa R, Arribasplata G, Fernández S, et al. Etiología y susceptibilidad antimicrobiana de las infecciones neonatales. An Fac Med 2004;65(1):19-24.

  43. Peregrino B, Villegas S, Leaños M, Solórzano SF, Miranda NM. Cefalotina y amicacina para el tratamiento de la sepsis neonatal de adquisición nosocomial en una Unidad de Cuidados Intensivos Neonatales. Bol Med Hosp Infant Mex 2004;61(5):393-401.




2020     |     www.medigraphic.com