title: Risk factors and outcomes for multidrug-resistant Gram-negative bacteremia in the NICU.
abstract: OBJECTIVE
  To assess the risk factors antibiotic therapy and outcomes of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bacteremia in NICU patients.
  
  
  METHODS
  Episodes of MDR GNB bacteremia were compared with a non-MDR GNB bacteremia group in an 8-year cohort study.
  
  
  RESULTS
  Of 1106 bacteremias, 393 (35.5%) were caused by GNB. Seventy (18.6%) were caused by an MDR strain. The most frequent mechanism of resistance was extended-spectrum β-lactamase production (67.1%), mainly by Klebsiella pneumoniae (59.6%). Previous antibiotic exposure to third-generation cephalosporin (odds ratio [OR]: 5.97; 95% confidence interval [CI]: 2.37-15.08; P < .001) and carbapenem (OR: 3.60; 95% CI: 1.26-10.29; P = .017) and underlying renal disease (OR: 7.08; 95% CI: 1.74-28.83; P = .006) were identified as independent risk factors for MDR GNB acquisition. Patients with MDR GNB bacteremia more likely received inadequate initial antibiotic therapy (72.9% vs 7.8%; P < .001) had higher rates of infectious complication (21.4% vs 10.5%; P = .011) and overall case fatality +rate (28.6% vs 10.5%; P < .001). Independent risk factors for overall mortality were presence of infectious complications after bacteremia (OR: 3.16; 95% CI: 1.41-7.08; P = .005) and underlying secondary pulmonary hypertension with or without cor pulmonale (OR: 6.19; 95% CI: 1.88-20.31; P = .003).
  
  
  CONCLUSIONS
  MDR GNB accounted for 18.6% of all neonatal GNB bacteremia in the NICU, especially in those with previous broad-spectrum antibiotic therapy and underlying renal disease. The most frequent mechanism of resistance was extended-spectrum β-lactamase (ESBL) production. Neonates with MDR GNB were more likely to develop infectious complications, which were independently associated with a higher overall case-fatality rate.
authors.affiliation: Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan;
authors.forename: Ming-Horng
authors.initials: MH
authors.lastname: Tsai
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Chu
authors.forename: Jen-Fu
authors.initials: JF
authors.lastname: Hsu
authors.forename: Reyin
authors.initials: R
authors.lastname: Lien
authors.forename: Hsuan-Rong
authors.initials: HR
authors.lastname: Huang
authors.forename: Ming-Chou
authors.initials: MC
authors.lastname: Chiang
authors.forename: Ren-Huei
authors.initials: RH
authors.lastname: Fu
authors.forename: Chiang-Wen
authors.initials: CW
authors.lastname: Lee
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
mesh_terms: D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology*; D015780:Carbapenems / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015780:Carbapenems
keywords: Gram-negative bacilli; bacteremia; extended-spectrum β-lactamase–producing bacteria; mortality; nosocomial infection