High Carriage Rates of Multidrug-Resistant Gram-Negative Bacteria in Neonatal Intensive Care Units From Ghana
High Carriage Rates of Multidrug-Resistant Gram-Negative Bacteria in Neonatal Intensive Care Units From Ghana
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DOI：
10.1093/ofid/ofaa109
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发表时间：
2020-04-01
影响因子：
4.2
通讯作者：
Kurtzhals, Jorgen A. L.
中科院分区：
文献类型：
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作者：
Labi, Appiah-Korang;Bjerrum, Stephanie;Kurtzhals, Jorgen A. L.
背景住院新生儿携带多重耐药（MDR）革兰氏阴性菌（GN）可能会增加新生儿重症监护室（NICU）难以治疗的侵袭性感染的风险。在非洲住院新生儿MDRGN携带的数据是有限的。我们在加纳2家三级医院的NICU进行了一项横断面研究。对腋窝、腹股沟、肛周和周围环境的拭子进行培养，鉴定GN，并进行抗生素敏感性试验。我们从败血症新生儿中获得血培养分离株。使用全基因组测序来表征产碳青霉烯酶肺炎克雷伯菌。采用多位点序列分型（MLST）和单核苷酸多态性（SNP）分析进行分型。从228例筛查新生儿中共分离出276例GN。76.8%（175/228）的新生儿培养出致病性GN。克雷伯菌属（41.7%; 115/276）和大肠埃希菌（26.4%; 73/276）是最常见的微生物。MDRGN和第三代头孢菌素耐药菌的携带率分别为49.6%（113/228）和46.1%（105/228）。在克雷伯菌属中，75.6%（87/115）的表型表达超广谱β-内酰胺酶活性，而15.6%表达碳青霉烯酶并携带bla-（OXA-181）和bla-（CTX-M-15）。总体而言，7.0%（16/228）的新生儿发生GN血流感染。在2/11例新生儿中，测序显示携带和血流分离株之间具有相同的同一性。标本采集前的住院时间和抗生素的使用与携带率独立相关，从入院时的13%增加到第2天的42%，到第15天达到91%的平台。MDRGN（包括产碳青霉烯酶的肠球菌）的高携带率可能是非洲新生儿重症监护病房的一个新问题。
Background. Carriage of multidrug resistant (MDR) Gram-negative bacteria (GN) in hospitalized neonates may increase the risk of difficult-to-treat invasive infections at neonatal intensive care units (NICUs). Data on MDRGN carriage among hospitalized newborns in Africa are limited.Methods. We conducted a cross-sectional study at the NICUs of 2 tertiary hospitals in Ghana. Swabs from the axilla, groin, perianal region, and the environment were cultured, GN were identified, and antibiotic susceptibility was tested. We obtained blood culture isolates from neonates with sepsis. Whole-genome sequencing was used to characterize carbapenemase-producing Klebsiella pneumoniae. Typing was done by multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP) analysis.Results. A total of 276 GN were isolated from 228 screened neonates. Pathogenic GN were cultured in 76.8% (175 of 228) of neonates. Klebsiella spp (41.7%; 115 of 276) and Escherichia coli (26.4%; 73 of 276) were the commonest organisms. Carriage rates of MDRGN and third-generation cephalosporin resistant organisms were 49.6% (113 of 228) and 46.1% (105 of 228), respectively. Among Klebsiella spp, 75.6% (87 of 115) phenotypically expressed extended-spectrum beta-lactamase activity, whereas 15.6% expressed carbapenemase and harbored bla-(OXA-181) and bla-(CTX-M-15). Overall, 7.0% (16 of 228) of neonates developed GN bloodstream infection. In 2 of 11 neonates, sequencing showed the same identity between carriage and the bloodstream isolate. Length of stay before specimen collection and antibiotic use were independently associated with carriage rates, which increased from 13% at admission to 42% by day 2 and reached a plateau at 91% by day 15.Conclusions. High carriage rates of MDRGN, including carbapenemase-producing enterobacterales may be an emerging problem in NICUs in Africa.