Predictors of the extended-spectrum-beta lactamases producing Enterobacteriaceae neonatal sepsis at a tertiary hospital, Tanzania

• Published in: International journal of medical microbiology 2018-10, Vol.308 (7), p.803-811
• Main Authors: Marando, Rehema, Seni, Jeremiah, Mirambo, Mariam M., Falgenhauer, Linda, Moremi, Nyambura, Mushi, Martha F., Kayange, Neema, Manyama, Festo, Imirzalioglu, Can, Chakraborty, Trinad, Mshana, Stephen E.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; beta-Lactamases - genetics; Blood Culture; ESBL-PE; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal - statistics & numerical data; Klebsiella Infections - drug therapy; Klebsiella Infections - microbiology; Klebsiella Infections - mortality; Klebsiella pneumoniae; Klebsiella pneumoniae - classification; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - genetics; Klebsiella pneumoniae - isolation & purification; Male; Microbial Sensitivity Tests; Neonatal sepsis; Neonatal Sepsis - microbiology; Neonatal Sepsis - mortality; Predictors; ST45; Tanzania; Tertiary Care Centers; Treatment Outcome
• ISSN: 1438-4221; 1618-0607
• DOI: 10.1016/j.ijmm.2018.06.012

•ESBL-PE sepsis was predicted by admission at ICU and ESBL-PE colonization.•Neonates infected with ESBL-PE had significantly high mortality.•ESBL-producing Klebsiella pneumoniae (ST45) carrying blaCTX-M-15 were predominant.•Whole genome SNP analysis revealed clonal origin in 50% of ESBL-PE paired cases with similar sequence type. The study was conducted to establish predictors of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) neonatal sepsis and mortality in a tertiary hospital, Tanzania. Between July and December 2016, blood culture was performed in neonates with clinical features of sepsis and neonates/mothers/guardians were screened for ESBL colonization. Selected isolates underwent whole genome sequencing to investigate relatedness. Logistic regression analysis was performed to determine predictors for ESBL-PE associated neonatal sepsis and mortality. Neonatal ESBL-PE sepsis was detected in 32(10.5%) of the 304 neonates investigated. Neonatal ESBL-PE sepsis was independently predicted by admission at the Intensive care Unit and positive mother and neonate ESBL-PE colonization. Deaths occurred in 55(18.1%) of neonates. Neonates infected with ESBL-PE, admitted at ICU, increased age and those transferred from other centres had significantly high mortality rates. Gram-negative bacteria formed the majority (76%) of the isolates, of which 77% were ESBL-PE. Virulent Klebsiella pneumoniae ST45 carrying blaCTX-M-15 were commonly isolated from neonates. Klebsiella pneumoniae (ST45) were the predominant cause of ESBL-PE neonatal sepsis and mortality. Improved infection control and antibiotic stewardship are crucial in controlling the spread of resistant strains. Rapid diagnostic tests to detect ESBL-PE in low-income countries are needed to guide treatment and reduce ESBL-PE-associated mortality.