High Burden of Bloodstream Infections Associated With Antimicrobial Resistance and Mortality in the Neonatal Intensive Care Unit in Pune, India. (18th May 2020)

• Record Type: Journal Article
• Authors: Johnson, Julia; Robinson, Matthew L; Rajput, Uday C; Valvi, Chhaya; Kinikar, Aarti; Parikh, Tushar B; Vaidya, Umesh; Malwade, Sudhir; Agarkhedkar, Sharad; Randive, Bharat; Kadam, Abhay; Smith, Rachel M; Westercamp, Matthew; Mave, Vidya; Gupta, Amita; Milstone, Aaron M; Manabe, Yukari C
• Is Part Of: Clinical infectious diseases. Volume 73:Number 2(2021)
• Page Start: 271
• Page End: 280
• Publication Date: 2020-05-18
• Subjects: neonatal sepsis -- antimicrobial resistance -- neonatal intensive care unit -- low- and middle-income countries; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa554
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Antimicrobial resistance (AMR) is a growing threat to newborns in low- and middle-income countries (LMIC). Methods: We performed a prospective cohort study in 3 tertiary neonatal intensive care units (NICUs) in Pune, India, to describe the epidemiology of neonatal bloodstream infections (BSIs). All neonates admitted to the NICU were enrolled. The primary outcome was BSI, defined as positive blood culture. Early-onset BSI was defined as BSI on day of life (DOL) 0–2 and late-onset BSI on DOL 3 or later. Results: From 1 May 2017 until 30 April 2018, 4073 neonates were enrolled. Among at-risk neonates, 55 (1.6%) developed early-onset BSI and 176 (5.5%) developed late-onset BSI. The majority of BSIs were caused by gram-negative bacteria (GNB; 58%); among GNB, 61 (45%) were resistant to carbapenems. Klebsiella spp. (n = 53, 23%) were the most common cause of BSI. Compared with neonates without BSI, all-cause mortality was higher among neonates with early-onset BSI (31% vs 10%, P < .001) and late-onset BSI (24% vs 7%, P < .001). Non–low-birth-weight neonates with late-onset BSI had the greatest excess in mortality (22% vs 3%, P < .001). Conclusions: In our cohort, neonatal BSIs were most commonly caused by GNB, with a high prevalence of AMR, and were associated with high mortality, even in term neonates. Effective interventions are urgently needed to reduce the burden of BSI and death due to AMR GNB in hospitalized neonates in LMIC. Abstract : Among 4073 neonates admitted to the neonatal intensive care unit in Pune, India, the majority of bloodstream infections occurred during the first 2 weeks of life, were caused chiefly by resistant gram-negative bacteria, and were associated with higher mortality, including in term neonates.