Neonatal Hospital-Acquired Bloodstream Infection in a Single-Centre in Malaysia: Clinical Presentations, Pathogens and Immediate Outcome

Authors

  • Mohd Nizam Mat Bah Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor DT, Malaysia
  • Emieliyuza Yusnita Alias Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor DT, Malaysia
  • Sim Yeo Ting Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor DT, Malaysia
  • Hasliza Razak Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor DT, Malaysia
  • Foo Fang Han Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor DT, Malaysia
  • Noor Azlina Mustafa Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor DT, Malaysia
  • Azirawati Johari Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor DT, Malaysia
  • Nisah Abdullah Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor DT, Malaysia

DOI:

https://doi.org/10.51407/mjpch.v29i3.254

Keywords:

Developing country, Gram-negative, Hospital-acquired bloodstream infection, Mortality, Neonatal

Abstract

Objectives: To determine the epidemiology, clinical characteristics, pathogen, and outcome of hospital-acquired bloodstream infection (HABSI). Methods: This observational, retrospective cohort study of neonates with HABSI between 2013 and 2019 was retrieved from the Infection Surveillance System. The main outcome measure was mortality. Binary logistic regression was used to identify risk factors associated with mortality. Results: There were 278 neonates (27% < 1000gm birth weight and 26% < 29 weeks gestation) with 316 episodes of HABSI documented. The overall incidence of HABSI was 3.79 (95% CI: 3.35 to 4.24) per 1000 admissions and 1.9 per 1000 patients. HABSI was diagnosed at 18.5 days (IQR 11, 36) of hospitalization and 38% presented with severe signs and symptoms of sepsis. The most common pathogens were Klebsiella pneumoniae (29.4%), followed by coagulase-negative staphylococcus (13.9%) and Acinetobacter baumannii (10.1%). Multidrug-resistant (MDR) organisms were noted in 173 (54.7%) with a significant increase over time of extended-spectrum beta-lactamase-producing organisms. Gram-negative resistance to carbapenem was noted in 45% and associated with high mortality. The overall mortality was 25.5% (95% CI:19.6 to 31.5) with no significant changes over time. HABSI due to gram-negative, presented with severe sepsis and prolonged ventilation were associated with poor outcomes. Conclusion: Multidrug resistance is rising and has high mortality in our centre. Factors associated with high mortality were gram-negative organisms, severe sepsis, and prolonged ventilation. Hence, infection and prevention control programs need to be enhanced.

Downloads

Download data is not yet available.

References

Zaidi AKM, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet. 2005;365:1175–88.

Vilar-Compte D, Camacho-Ortiz A, Ponce-de-León S. Infection Control in Limited Resources Countries: Challenges and Priorities. Curr Infect Dis Rep. 2017;19:1–7.

Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388:3027–35.

Johnson J, Robinson ML, Rajput UC, Valvi C, Kinikar A, Parikh TB, et al. High Burden of Bloodstream Infections Associated With Antimicrobial Resistance and Mortality in the Neonatal Intensive Care Unit in Pune, India. Clin Infect Dis. 2021;73(2):271-80.

Gezmu AM, Bulabula ANH, Dramowski A, Bekker A, Aucamp M, Souda S, et al. Laboratory-confirmed bloodstream infections in two large neonatal units in sub-Saharan Africa. Int J Infect Dis. 2021;103:201–7.

Chaurasia S, Sivanandan S, Agarwal R, Ellis S, Sharland M, Sankar MJ. Neonatal sepsis in South Asia: Huge burden and spiralling antimicrobial resistance. BMJ. 2019;364:k5314.

Wu IH, Tsai MH, Lai MY, Hsu LF, Chiang MC, Lien R, et al. Incidence, clinical features, and implications on outcomes of neonatal late-onset sepsis with concurrent infectious focus. BMC Infect Dis. 2017;17:465.

Verstraete EH, Blot K, Mahieu L, Vogelaers D, Blot S. Prediction models for neonatal healthcare-associated sepsis: A meta-analysis. Pediatrics. 2015;135:e1002–14.

Bekhof J, Reitsma JB, Kok JH, Van Straaten IHLM. Clinical signs to identify late-onset sepsis in preterm infants. Eur J Pediatr. 2013;172(4):501–8.

Modi N, Doré CJ, Saraswatula A, Richards M, Bamford KB, Coello R, et al. A case definition for national and international neonatal bloodstream infection surveillance. Arch Dis Child Fetal Neonatal Ed. 2009;94(1):F8-13.

Carr JP, Burgner DP, Hardikar RS, Buttery JP. Empiric antibiotic regimens for neonatal sepsis in Australian and New Zealand neonatal intensive care units. J Paediatr Child Health. 2017;53(7):680–4.

Karam G, Chastre J, Wilcox MH, Vincent JL. Antibiotic strategies in the era of multidrug resistance. Crit Care. 2016;20(1):136.

Wattal C, Kler N, Oberoi JK, Fursule A, Kumar A, Thakur A. Neonatal Sepsis: Mortality and Morbidity in Neonatal Sepsis due to Multidrug-Resistant (MDR) Organisms: Part 1. Indian J Pediatr. 2020;87(2):117–21.

Litzow J, Gill C, Mantaring JBV, Fox M, Mendoza M, Mendoza S, et al. High frequency of multi-drug resistant Gram-negative rods in two neonatal intensive care units in the Philippines. Infect Control Hosp Epidemiol. 2009;30(6):543–9.

Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study. Lancet Glob Heal. 2016;4(10):e752-760.

Okomo U, Akpalu ENK, Le Doare K, Roca A, Cousens S, Jarde A, et al. Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines. Lancet Infect Dis. 2019;19(11):1219–34.

Ballot DE, Bandini R, Nana T, Bosman N, Thomas T, Davies VA, et al. A review of -multidrug-resistant Enterobacteriaceae in a neonatal unit in Johannesburg, South Africa. BMC Pediatr. 2019;19(1):320.

Laxminarayan R, Matsoso P, Pant S, Brower C, Røttingen JA, Klugman K, et al. Access to effective antimicrobials: A worldwide challenge. Lancet. 2016;387(10014):168–75.

Sands K, Carvalho MJ, Portal E, Thomson K, Dyer C, Akpulu C, et al. Characterization of antimicrobial-resistant Gram-negative bacteria that cause neonatal sepsis in seven low- and middle-income countries. Nat Microbiol. 2021;6(4):512–23.

Phan HT, Vo TH, Tran HTT, Huynh HTN, Nguyen HTT, Van Nguyen T. Enhanced infection control interventions reduced catheter-related bloodstream infections in the neonatal department of Hung Vuong Hospital, Vietnam, 2011-2012: A pre- And post-intervention study. Antimicrob Resist Infect Control. 2020;9(1):9.

Mwananyanda L, Pierre C, Mwansa J, Cowden C, Localio AR, Kapasa ML, et al. Preventing Bloodstream Infections and Death in Zambian Neonates: Impact of a Low-cost Infection Control Bundle. Clin Infect Dis. 2019;69(8):1360–7.

Gill CJ, Mantaring JBV, Macleod WB, Mendoza M, Mendoza S, Huskins WC, et al. Impact of enhanced infection control at 2 neonatal intensive care units in the Philippines. Clin Infect Dis. 2009;48(1):13–21.

Worth LJ, Daley AJ, Spelman T, Bull AL, Brett JA, Richards MJ. Central and peripheral line-associated bloodstream infections in Australian neonatal and paediatric intensive care units: findings from a comprehensive Victorian surveillance network, 2008–2016. J Hosp Infect. 2018;99(1):55–61.

Cailes B, Kortsalioudaki C, Buttery J, Pattnayak S, Greenough A, Matthes J, et al. Epidemiology of UK neonatal infections: The neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed. 2018;103(6):F547-533.

Zingg W, Hopkins S, Gayet-Ageron A, Holmes A, Sharland M, Suetens C, et al. Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey. Lancet Infect Dis. 2017;17(4):381–9.

Crivaro V, Bogdanović L, Bagattini M, Iula VD, Catania M, Raimondi F, et al. Surveillance of healthcare-associated infections in a neonatal intensive care unit in Italy during 2006–2010. BMC Infect Dis. 2015;15(1):152.

Hocevar SN, Edwards JR, Horan TC, Morrell GC, Iwamoto M, Lessa FC. Device-Associated Infections among Neonatal Intensive Care Unit Patients: Incidence and Associated Pathogens Reported to the National Healthcare Safety Network, 2006–2008. Infect Control Hosp Epidemiol. 2012;33(12):1200–6.

Mat Bah MN, Tan RYH, Razak H, Sapian MH, Abdullah N, Alias EY. Survival and associated risk factors for mortality among infants with persistent pulmonary hypertension of the newborn in Malaysia. J Perinatol. 2021;41(4):786–93.

Verstraete E, Boelens J, Coen K De, Claeys G, Vogelaers D, Vanhaesebrouck P, et al. Healthcare-Associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-Year Period (1992–2011): Trends in Incidence, Pathogens, and Mortality. Infect Control Hosp Epidemiol. 2014;35(5):511–8.

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(3):268–81.

Al-Taiar A, Hammoud MS, Cuiqing L, Lee JK, Lui KM, Nakwan N, Isaacs D. Neonatal infections in China, Malaysia, Hong Kong and Thailand. Arch Dis Child Fetal Neonatal Ed. 2013;98(3):F249-55.

Dramowski A, Madide A, Bekker A. Neonatal nosocomial bloodstream infections at a referral hospital in a middle-income country: Burden, pathogens, antimicrobial resistance and mortality. Paediatr Int Child Health. 2015;35(3):265–72.

Bolat F, Uslu S, Bülbül A, Cömert S, Can E, Baş EK, et al. Hospital acquired bloodstream infections in neonatal intensive care unit. Turkish Arch Pediatr. 2011;46(2):130–6.

Dhaneria M, Jain S, Singh P, Mathur A, Lundborg C, Pathak A. Incidence and Determinants of Health Care-Associated Blood Stream Infection at a Neonatal Intensive Care Unit in Ujjain, India: A Prospective Cohort Study. Diseases. 2018;6(1):14.

Wójkowska-Mach, Chmielarczyk, Strus, Lauterbach, Heczko. Neonate Bloodstream Infections in Organization for Economic Cooperation and Development Countries: An Update on Epidemiology and Prevention. J Clin Med. 2019;8(10):1750.

Pharande P, Lindrea KB, Smyth J, Evans M, Lui K, Bolisetty S. Trends in late-onset sepsis in a neonatal intensive care unit following implementation of infection control bundle: A 15-year audit. J Paediatr Child Health. 2018;54(12):1314–20.

Ballot DE, Nana T, Sriruttan C, Cooper PA. Bacterial Bloodstream Infections in Neonates in a Developing Country. ISRN Pediatr. 2012;2012:508512.

Scamardo MS, Dolce P, Esposito EP, Raimondi F, Triassi M, Zarrilli R. Trends, risk factors and outcomes of healthcare-associated infections in a neonatal intensive care unit in Italy during 2013-2017. Ital J Pediatr. 2020;46(1):34.

Downloads

Published

2023-11-20

How to Cite

Mat Bah, M. N. ., Alias, E. Y. ., Ting, S. Y. ., Razak, H. ., Han, F. F. ., Mustafa, N. A. ., Johari, A. ., & Abdullah, N. . (2023). Neonatal Hospital-Acquired Bloodstream Infection in a Single-Centre in Malaysia: Clinical Presentations, Pathogens and Immediate Outcome . Malaysian Journal of Paediatrics and Child Health, 29(3), 12-23. https://doi.org/10.51407/mjpch.v29i3.254

Issue

Section

Original Article