ReviewRisk factors for infection and/or colonisation with extended-spectrum β-lactamase-producing bacteria in the neonatal intensive care unit: a meta-analysis
Introduction
Neonates have recently been reported as a high-risk population for healthcare-associated infections (HCAIs) [1]. These infections are responsible for significant mortality and subsequent morbidity in the neonatal intensive care unit (NICU) [2]. The high incidence of bloodstream infections in neonates (0–28 days) leads to an increasing use of antibiotics [3], [4]. Owing to the high antibiotic pressure in the hospital environment, infection and/or colonisation with multidrug-resistant Gram-negative bacilli, in particular Klebsiella pneumoniae producing extended-spectrum β-lactamase (ESBL) enzymes, has been reported with increasing frequency in the NICU [5], [6].
Since ESBL-producing K. pneumoniae (ESBL-KP) was first isolated in Germany in 1983 [7], ESBL-producing bacteria have spread rapidly on a global scale, probably because of the extensive use of third-generation cephalosporins [8], [9]. ESBLs are enzymes produced by certain bacteria that can deactivate several antibiotics by hydrolysing the amide bond in the β-lactam ring of these antibiotics. The spectrum of enzyme activity towards penicillins, aztreonam and extended-spectrum cephalosporins such as ceftazidime, cefotaxime and ceftriaxone is extended because of mutations in the gene encoding ESBLs [10].
A previous study reported that the overall gastrointestinal colonisation rate of ESBL-producing Enterobacteriaceae (ESBL-E) in hospitalised patients is up to 52%, among which faecal ESBL-E carriage rates in neonates, children and adults were 74%, 59% and 46%, respectively [11]. Compared with adults, infection outbreaks of with multidrug-resistant ESBL-E in neonatal units with a high mortality rate (45%) have been reported [12].
In response to the growing trend of HCAIs caused by ESBL-producing bacteria in the NICU, determining risk factors for infection and/or colonisation for adoption of preventive strategies is important [13], [14]. To date, infections caused by ESBL-producing bacteria in adult and paediatric intensive care units have been well described [15], [16], [17]. However, clinical data regarding neonates in the NICU, particularly with respect to risk factors for infection and/or colonisation, are limited. The reported outcomes of previous studies regarding risk factors for infection and/or colonisation were inconsistent. To resolve these conflicting results, a larger sample size characteristic of meta-analyses is needed. Therefore, this meta-analysis was performed with the aim of identifying risk factors associated with infection and/or colonisation of ESBL-producing bacteria in the NICU.
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Data search and screening strategy
Electronic databases were searched for relevant studies published from 1 January 2000 to 1 July 2016. All literature related to risk factors for infection and/or colonisation with ESBL-producing bacteria in the NICU were identified via a systematic search (English and Chinese languages) in PubMed, Web of Science, EBSCO, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Chinese Biological Medical Database (CBM), China Science and Technology Journal
Literature search
A total of 168 potentially relevant references were systematically identified through searching the electronic databases; 62 duplicate studies were excluded. After screening of the titles and abstracts, 81 studies were not relevant to risk factors for infection and/or colonisation with ESBL-producing bacteria in the NICU; thus, 25 studies underwent full-text review. Among these studies, 11 studies were excluded because they failed to match the inclusion criteria or were reviews and reports.
Discussion
HCAIs caused by ESBL-producing bacteria are a growing concern in the NICU [11]. ESBL-producing bacteria, which are resistant to multiple antibiotics, are a potential important cause of HCAI outbreaks, and identifying risk factors for infection and/or colonisation with ESBL-producing bacteria in the NICU is critical [32]. Although the development of infection/colonisation is associated with the same risk factors as other healthcare-related infections, including low birthweight, premature,
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2020, Journal of Hospital InfectionCitation Excerpt :There are no international guidelines concerning surveillance cultures for these bacteria. Parenteral nutrition, mechanical ventilation, central venous catheter use, continuous positive airway pressure, endotracheal intubation, malformations and previous antibiotic use are risk factors for infection and/or colonization with ESBL-producing enterobacteriaceae in the NICU [24]. Although the status of rectal or perianal swab sampling for the monitoring of ESBL in neonates with the above-mentioned risk factors could not be investigated in the present survey, given the high cost associated with performing periodic surveillance cultures, it would be recommended that collection of such samples is limited to neonates with these risk factors.
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2018, International Journal of Infectious DiseasesCitation Excerpt :Among the Gram-negative bacteria, multidrug-resistant Enterobacteriaceae (in particular Escherichia and Klebsiella) have emerged as a serious health threat over the past two decades (Pitout and Laupland, 2008; Padmini et al., 2017). Resistance in Escherichia and Klebsiella is usually acquired via plasmid-mediated extended-spectrum beta-lactamase (ESBL) production (Padmini et al., 2017; Li et al., 2017). Infections caused by ESBL-producing multidrug-resistant bacteria are resistant to a broad range of beta-lactams, including third-generation cephalosporins (Pitout and Laupland, 2008; Padmini et al., 2017; Li et al., 2017).
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2019, Brazilian Journal of Infectious DiseasesCitation Excerpt :A meta-analysis conducted by Li et al. identified 13 risk factors for infection and colonization of ESBL in neonatal patients; among them are low birth-weight, parenteral nutrition and gestational age.29 In addition, transversal risk factors of intensive care units, such as length of hospital stay, previous antibiotic treatment, mechanical ventilation, catheter use, and previous colonization of ESBL-producing enterobacteria, make the neonatology service an area of great concern for these infections.29,30 Fecal carriage of ESBL-producing enterobacteria was another risk factor strongly related to infection by ESBL-producing bacteria in the present study.