title: Intestinal carriage of multidrug-resistant gram-negative bacteria in preterm-infants during hospitalization in neonatal intensive care unit (NICU).
abstract: The prevalence and antibiotic susceptibility of intestinal carriage of Gram-negative bacteria among preterm infants admitted to the neonatal intensive care unit (NICU) in a tertiary teaching hospital in Malaysia were determined. A total of 34 stool specimens were obtained from preterm infants upon admission and once weekly up to two weeks during hospitalization. The presumptive colonies of Escherichia coli and Klebsiella pneumoniae were selected for identification, antibiotic susceptibility testing, and subtyping by using pulsed-field gel electrophoresis (PFGE). Out of 76 Gram-negative isolates, highest resistance was detected for amoxicillin/clavulanate (30.8%, n = 16), ceftriaxone (42.3%, n = 22), ceftazidime (28.8%, n = 15), cefoxitin (28.8%, n = 15), aztreonam (36.5%, n = 19), and polymyxin B (23.1%, n = 12). Three colistin resistant K. pneumoniae have also been detected based on E-test analysis. Thirty-nine isolates of K. pneumoniae and 20 isolates of E. coli were resistant to more than three antimicrobial classes and were categorized as multidrug resistant (MDR). PFGE analysis revealed a higher diversity in pulsotypes for K. pneumoniae (18 pulsotypes) in comparison to E. coli (four pulsotypes). In addition, a total of fifteen pulsotypes was observed from 39 MDR K. pneumoniae. The risk factors for antibiotic resistance were assessed using random forest analysis. Gender was found to be the most important predictor for colistin resistant while length, OFC, and delivery mode were showing greater predictive power in the polymyxin B resistance. This study revealed worrying prevalence rates of intestinal carriage of multidrug-resistant K. pneumoniae and E. coli of hospitalized preterm infants in Malaysia, particularly high resistance to polymyxins.
authors.affiliation: a Department of Medical Microbiology, Faculty of Medicine , University of Malaya , 50603 Kuala Lumpur , Malaysia.
authors.forename: Polly Soo Xi
authors.initials: PS
authors.lastname: Yap
authors.affiliation: b Department of Paediatrics, Faculty of Medicine , University of Malaya , 50603 Kuala Lumpur , Malaysia.
authors.forename: Azanna
authors.initials: A
authors.lastname: Ahmad Kamar
authors.affiliation: c Department of Life Sciences, School of Pharmacy , International Medical University , 57000 Kuala Lumpur , Malaysia.
authors.forename: Chun Wie
authors.initials: CW
authors.lastname: Chong
authors.affiliation: c Department of Life Sciences, School of Pharmacy , International Medical University , 57000 Kuala Lumpur , Malaysia.
authors.forename: Ivan Kok Seng
authors.initials: IK
authors.lastname: Yap
authors.affiliation: d Institute of Biological Sciences, Faculty of Science , University of Malaya , 50603 Kuala Lumpur , Malaysia.
authors.forename: Kwai Lin
authors.initials: KL
authors.lastname: Thong
authors.affiliation: b Department of Paediatrics, Faculty of Medicine , University of Malaya , 50603 Kuala Lumpur , Malaysia.
authors.forename: Yao Mun
authors.initials: YM
authors.lastname: Choo
authors.affiliation: a Department of Medical Microbiology, Faculty of Medicine , University of Malaya , 50603 Kuala Lumpur , Malaysia.
authors.forename: Mohd Yasim
authors.initials: MY
authors.lastname: Md Yusof
authors.affiliation: a Department of Medical Microbiology, Faculty of Medicine , University of Malaya , 50603 Kuala Lumpur , Malaysia.
authors.forename: Cindy Shuan Ju
authors.initials: CS
authors.lastname: Teh
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002353:Carrier State / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field / Q000379:methods; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007422:Intestines / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D008296:Malaysia; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D013048:Specimen Handling / Q000379:methods; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gram-negative enteric; Meconium; Multidrug resistant; PFGE; Preterm infants