Carriage and Acquisition of Extended-spectrum β-Lactamase-producing Enterobacterales Among Neonates Admitted to Hospital in Kilifi, Kenya
Carriage and Acquisition of Extended-spectrum β-Lactamase-producing Enterobacterales Among Neonates Admitted to Hospital in Kilifi, Kenya
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DOI：
10.1093/cid/ciy976
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发表时间：
2019-09-01
影响因子：
11.8
通讯作者：
Morpeth, Susan C.
中科院分区：
文献类型：
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作者：
Kagia, Ngure;Kosgei, Patrick;Morpeth, Susan C.
背景产超广谱β-内酰胺酶肠杆菌(ESBL-E)在撒哈拉以南非洲的住院新生儿中引起的感染构成了巨大的临床挑战。关于该地区住院新生儿中ESBL-E携带者的患病率和获得性的数据很少，传播的危险因素也没有明确的定义。方法在Kilifi县医院2013年7月至2014年8月连续收治的新生儿队列研究中，我们通过直肠拭子培养估计入院时ESBL-E携带者的患病率，并使用Logistic回归分析确定危险因素。结果入院时ESBL-E携带率为10%(59/569)。剖腹产、新生儿年龄较大和家庭规模较小是显著的危险因素。在没有携带ESBL-E的510名住院婴儿中，238名(55%)在住院期间获得了携带。获得率为21.4%(95%可信区间，19.0%~24.0%)。新生儿ESBL-E携带率与已知新生儿ESBL-E携带量及同一病区新生儿总数呈正相关。结论新生儿入院时携带ESBL-E较常见，院内感染较快。ESBL-E的传播和选择似乎受到医院暴露、手术分娩和新生儿病房患者密度的推动。我们报告了一项基于医院的前瞻性纵向研究，评估新生儿入院时产超广谱β-内酰胺酶肠杆菌(ESBL-E)携带率、在医院获得ESBL-E携带率，以及新生儿流行和发生ESBL-E携带者的危险因素。
Background Infections caused by extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) among hospitalized neonates in sub-Saharan Africa pose significant clinical challenges. Data on prevalence and acquisition of ESBL-E carriage among hospitalized neonates in the region are few, and risk factors for transmission are not clearly defined.Methods In a cohort study of consecutive neonatal admissions to Kilifi County Hospital from July 2013 through August 2014, we estimated ESBL-E carriage prevalence on admission using rectal swab cultures and identified risk factors using logistic regression. Using twice-weekly follow-up swabs, we estimated the incidence and identified risk factors for ESBL-E acquisition in hospital using Poisson regression.Results The prevalence of ESBL-E carriage at admission was 10% (59/569). Cesarean delivery, older neonatal age, and smaller household size were significant risk factors. Of the 510 infants admitted without ESBL-E carriage, 238 (55%) acquired carriage during their hospital stay. The incidence of acquisition was 21.4% (95% confidence interval, 19.0%-24.0%) per day. The rate was positively associated with the number of known neonatal ESBL-E carriers and with the total number of neonates on the same ward.Conclusions Carriage of ESBL-E was common among neonates on admission, and in-hospital acquisition was rapid. The dissemination and selection of ESBL-E appears to be driven by hospital exposures, operative delivery, and neonatal ward patient density. Further attention to infection control, patient crowding, and carriage surveillance is warranted.We report a prospective hospital-based longitudinal study that estimates the extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) carriage prevalence among neonates on admission, the incidence of acquisition of ESBL-E carriage in hospital, and the risk factors for neonatal prevalent and incident ESBL-E carriage.