Third-generation cephalosporin resistant Enterobacteriaceae in neonates and young infants: impact and outcome

Abstract

Objective

Third-generation cephalosporins resistant Enterobacteriaceae (3GCR-EB) are a major threat in severely ill neonates hospitalized in Neonatal Intensive Care Units. Still, the particular impact of 3GCR-EB on outcomes in the wide neonatal population is not well-appreciated. We aimed to study the impact of 3GCR-EB on the length of hospital stay and mortality of a general population of neonates and young infants.

Study design

This was a retrospective cohort study of neonates and young infants born in eight Israeli hospitals between 2009 and 2013, with a culture taken within three months after birth that tested positive for Enterobacteriaceae (EB). Data for this study were taken from centralized electronic health records included inpatient, outpatient, socio-demographic, administrative and laboratory information. The main outcomes were length of stay and mortality. The main explanatory variable was an isolation of 3GCR-EB in any bacterial culture taken from a neonate or young infant.

Results

Cultures were taken for 31,921 neonates and young infants; 2647 (8.3%) tested positive for EB and 290 (11%) tested positive for 3GCR-EB. Length of stay for those who tested positive was 2.8 times longer (95%CI: 2.70–2.91, p ˂ .001) than patients who tested positive for 3GC-susceptible EB. 3GCR-EB were also associated with increased mortality (OR: 12.06, 95%CI: 4.92–32.29).

Conclusions

Neonates with third-generation cephalosporins resistant Enterobacteriaceae had extended hospitalization and increased mortality, which was mostly significant in normal gestational weight newborns.

Keywords:

• Neonates
• enterobacteriaceae infections
• outcomes
• third-generation cephalosporins resistant enterobacteriaceae
• extended-spectrum beta-lactamase (ESBL)

Acknowledgments

The authors would like to thank Sydney Krispin, MPH (Clalit Research Institute, Israel) and Carly Davis-Pask, MPH (Clalit Research Institute, Israel) for their assistance in editing and reviewing the manuscript.

Disclosure statement

All authors have no conflicts of interest to declare.