Advertisement

World Journal of Pediatrics

, Volume 15, Issue 6, pp 580–585 | Cite as

Community-acquired serious bacterial infections in the first 90 days of life: a revisit in the era of multi-drug-resistant organisms

  • Dawood YusefEmail author
  • Tamara Jahmani
  • Sajeda Kailani
  • Rawan Al-Rawi
  • Wasim Khasawneh
  • Miral Almomani
Original Article

Abstract

Background

Infants in the first 90 days of life are more prone to develop serious bacterial infections (SBIs). Multi-drug-resistant organisms (MDROs) are emerging as important pathogens causing SBIs. We reviewed the epidemiology of SBIs in infants 0–90 days old and compared the clinical features, laboratory values and final outcome for SBIs due to MDROs vs. non-MDROs.

Methods

Episodes of culture-proven SBIs (bacteremia, urinary tract infections, or meningitis) with age at onset of 0–90 days during a 7-year period were retrospectively reviewed. Health care-associated infections were excluded. We collected demographics, clinical features, and laboratory and microbiology data. We compared clinical characteristics, laboratory data, microbiologic results and final outcome for SBIs due to MDROs vs. non-MDROs.

Results

Ninety-four episodes (88 patients) including bacteremia (42.6%), urinary tract infections (54.3%) and meningitis (3.1%) were caused by Gram-negative bacteria (67%), and Gram-positive bacteria (33%). Escherichia coli, Klebsiella pneumoniae and GBS were the most common causes. MDROs caused SBIs in 39 patients (44.3%). SBIs due to MDROs were associated with more delay in providing targeted antimicrobial therapy compared to non-MDROs (74.4% vs. 0%, P ≤ 0.001), but no difference in case-fatality rate (12.8% vs. 12.2%, P = 1.0). Clinical features or basic laboratory values were not statistically different between the two groups.

Conclusions

The bacteriology of SBIs in the first 90 days of life is changing to include more MDROs, which causes more delay in providing targeted antimicrobial therapy. Awareness of the local epidemiology is crucial to ensure appropriate antibiotics are provided in a timely manner.

Keywords

Multi-drug-resistance organisms Neonates Serious bacterial infections Young infants 

Notes

Author contributions

All authors have seen and approved the manuscript and contributed significantly to the study. DY contributed to the study design and primary idea, data collection, data analysis, drafting and final edit of the manuscript. TJ, SK, and RA each contributed to the primary idea and study design, data collection and editing the manuscript. WK and MA each contributed to the study design, data analysis and editing the manuscript.

Funding

None.

Compliance with ethical standards

Ethical approval

This research has been approved by the IRB committee at Jordan University of Science and Technology (Project approval number 20170116).

Conflict of interest

No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

References

  1. 1.
    Shin SH, Choi CW, Lee JA, Kim EK, Choi EH, Kim HS, et al. Risk factors for serious bacterial infection in febrile young infants in a community referral hospital. J Korean Med Sci. 2009;24:844–8.CrossRefGoogle Scholar
  2. 2.
    Byington CL, Enriquez FR, Hoff C, Tuohy R, Taggart EW, Hillyard DR, et al. Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections. Pediatrics. 2004;113:1662–6.CrossRefGoogle Scholar
  3. 3.
    Levine DA, Platt SL, Dayan PS, et al. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics. 2004;113:1728–34.CrossRefGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention (CDC). Progress toward elimination of Haemophilus influenzae type b invasive disease among infants and children—United States, 1998–2000. MMWR Morb Mortal Wkly Rep. 2002;51:234–7.Google Scholar
  5. 5.
    Moore MR, Link-Gelles R, Schaffner W, Lynfield R, Holtzman C, Harrison LH, et al. Effectiveness of 13-valent pneumococcal conjugate vaccine for prevention of invasive pneumococcal disease in children in the USA: a matched case-control study. Lancet Respir Med. 2016;4:399–406.CrossRefGoogle Scholar
  6. 6.
    Fairlie T, Zell ER, Schrag S. Effectiveness of intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal disease. Obstet Gynecol. 2013;121:570–7.CrossRefGoogle Scholar
  7. 7.
    Gaspari RJ, Dickson E, Karlowsky J, Doern G. Multidrug resistance in pediatric urinary tract infections. Microb Drug Resist. 2006;12:126–9.CrossRefGoogle Scholar
  8. 8.
    Singh N, Patel KM, Léger MM, Short B, Sprague BM, Kalu N, et al. Risk of resistant infections with enterobacteriaceae in hospitalized neonates. Pediatr Infect Dis J. 2002;21:1029–33.CrossRefGoogle Scholar
  9. 9.
    Yusef D, Shalakhti T, Awad S, Algharaibeh H, Khasawneh W. Clinical characteristics and epidemiology of sepsis in the neonatal intensive care unit in the era of multi-drug resistant organisms: a retrospective review. Pediatr Neonatol. 2016;59:35–41. CrossRefGoogle Scholar
  10. 10.
    Munita JM, Arias CA. Mechanisms of antibiotic resistance. Microbiol Spectr.  https://doi.org/10.1128/microbiolspec.VMBF-0016-2015.
  11. 11.
    Deporre AG, Aronson PL, Mcculloh RJ. Facing the ongoing challenge of the febrile young infant. Crit Care. 2017;21:68.CrossRefGoogle Scholar
  12. 12.
    CDC, Ncezid, DHQP (2018) Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance 2019. https://www.cdc.gov/nhsn/PDFs/pscManual/2PSC_IdentifyingHAIs_NHSNcurrent.pdf. Accessed 3 June 2019
  13. 13.
    Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128:595–610.CrossRefGoogle Scholar
  14. 14.
    Bedford Russell AR. Neonatal sepsis. Paediatr Child Health (Oxford). 2011;21:265–9.CrossRefGoogle Scholar
  15. 15.
    Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81.CrossRefGoogle Scholar
  16. 16.
    Biondi E, Evans R, Mischler M, Bendel-Stenzel M, Horstmann S, Lee V, Aldag J, Gigliotti F. Epidemiology of bacteremia in febrile infants in the United States. Pediatrics. 2013;132:990–6.CrossRefGoogle Scholar
  17. 17.
    Greenhow TL, Hung YY, Herz AM. Changing epidemiology of bacteremia in infants aged 1 week to 3 months. Pediatrics. 2012;129:e590–6.CrossRefGoogle Scholar
  18. 18.
    Powell EC, Mahajan PV, Roosevelt G, Hoyle JD Jr, Gattu R, Cruz AT, et al. Epidemiology of bacteremia in febrile infants aged 60 days and younger. Ann Emerg Med. 2018;71:211–6.CrossRefGoogle Scholar
  19. 19.
    Woll C, Neuman MI, Pruitt CM, Wang ME, Shapiro ED, Shah SS, et al. Epidemiology and etiology of invasive bacterial infection in infants ≤ 60 Days old treated in emergency departments. J Pediatr. 2018;200:210–217.e1.CrossRefGoogle Scholar
  20. 20.
    Byington CL, Rittichier KK, Bassett 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. Pediatrics. 2003;111:964–8.CrossRefGoogle Scholar
  21. 21.
    Greenhow TL, Hung YY, Herz AM, Losada E, Pantell RH. The changing epidemiology of serious bacterial infections in young infants. Pediatr Infect Dis J. 2014;33:595–9.CrossRefGoogle Scholar
  22. 22.
    Feldman EA, McCulloh RJ, Myers AL, Aronson PL, Neuman MI, Bradford MC, et al. Empiric antibiotic use and susceptibility in infants with bacterial infections: a Multicenter Retrospective Cohort Study. Hosp Pediatr. 2017;7:427.CrossRefGoogle Scholar
  23. 23.
    Hand WL. Current challenges in antibiotic resistance. Adolesc Med. 2000;11:427–38.PubMedGoogle Scholar
  24. 24.
    Ye JJ, Huang CT, Shie SS, Huang PY, Su LH, Chiu CH, et al. Multidrug resistant Acinetobacter baumannii: risk factors for appearance of imipenem resistant strains on patients formerly with susceptible strains. PLoS ONE. 2010;5:e9947.CrossRefGoogle Scholar
  25. 25.
    Yusef D, Babaa AI, Bashaireh AZ, Al-Bawayeh HH, Al-Rijjal K, Nedal M, et al. Knowledge, practices & attitude toward antibiotics use and bacterial resistance in Jordan: a cross-sectional study. Infect Dis Heal. 2017;23:33–40.CrossRefGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine 2019

Authors and Affiliations

  1. 1.Pediatric Infectious DiseasesJordan University of Science and Technology, King Abdullah University HospitalIrbidJordan
  2. 2.Faculty of MedicineJordan University of Science and TechnologyIrbidJordan
  3. 3.Pediatric DepartmentJordan University of Science and TechnologyIrbidJordan

Personalised recommendations