title: Clinical and Molecular Characteristics of Neonatal Extended-Spectrum β-Lactamase-Producing Gram-Negative Bacteremia: A 12-Year Case-Control-Control Study of a Referral Center in Taiwan.
abstract: Extended-spectrum β-lactamase (ESBL)-producing Gram-negative bacteremia (GNB) in the neonatal intensive care unit was characterized by comparison with two control groups: a susceptible control group and a general base population group over 2001 to 2012. The influence of ESBL production on mortality was studied in all study subjects and ESBL-GNB isolates were microbiologically characterized. We identified 77 episodes of ESBL-GNB (14.2% of all neonatal late-onset GNB), which were caused by Klebsiella spp. (62.3%), E. coli (20.8%) and Enterobacter spp. (16.9%). Most ESBL-GNB strains were genetically unrelated and the SHV-type ESBLs were the most prevalent (67% of isolates). Comparison with both control groups disclosed previous usage of 3rd generation cephalosporin (odds ratio [OR], 4.72; 95% confidence interval [CI], 2.03-10.97; P < 0.001), and underlying renal disease (OR, 4.07; 95% CI, 1.10-15.08; P = 0.035) as independent risk factors for ESBL-GNB. Inadequate empiric antibiotics, a higher illness severity, higher rates of infectious complications and sepsis-attributable mortality were more frequently seen in neonates with ESBL-GNB than those with non-ESBL GNB (20.8% and 15.6% vs. 9.2% and 7.9%, respectively; P = 0.008 and 0.049, respectively). Neonates with underlying secondary hypertension (OR, 7.22; 95% CI, 2.17-24.06) and infectious complications after bacteremia (OR, 6.66; 95% CI, 1.81-19.31) were identified as independent risk factor for in-hospital mortality. ESBL-GNB accounted for one-seventh of all neonatal gram-negative bacteremia, especially in neonates exposed to broad-spectrum cephalosporins. Neonates with ESBL-GNB bacteremia more frequently received inadequate empirical antibiotic therapy, which were associated with a higher rate of infectious complications and an adverse outcome.
authors: Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan.|Division of Pediatric Neonatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Chang Gung University of Science and Technology, Chiayi, Taiwan.
authors: Ming-Horng
authors: MH
authors: Tsai
authors: Department of Anatomy, College of Medicine, China Medical University, Taichung, Taiwan.
authors: I-Ta
authors: IT
authors: Lee
authors: Division of Pediatric Neonatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Shih-Ming
authors: SM
authors: Chu
authors: Division of Pediatric Neonatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Reyin
authors: R
authors: Lien
authors: Division of Pediatric Neonatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Hsuan-Rong
authors: HR
authors: Huang
authors: Division of Pediatric Neonatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Ming-Chou
authors: MC
authors: Chiang
authors: Division of Pediatric Neonatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Ren-Huei
authors: RH
authors: Fu
authors: Division of Pediatric Neonatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Jen-Fu
authors: JF
authors: Hsu
authors: Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Division of Pediatric Infectious Disease; Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors: Yhu-Chering
authors: YC
authors: Huang
mesh_terms: D016470:Bacteremia / Q000175:diagnosis*; D016022:Case-Control Studies; D005260:Female; D006090:Gram-Negative Bacteria / Q000378:metabolism* / Q000502:physiology; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D012017:Referral and Consultation; D012307:Risk Factors; D013624:Taiwan; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001618:beta-Lactamases