Extended-spectrum β lactamase-producing gram-negative bacteria:: clinical profile and outcome in a neonatal intensive care unit

Background & aims: Multidrug-resistant extended-spectrum beta lactamase-producing bacteria (ESBL) have emerged as a common problem globally. However, data regarding clinical profile and outcome in neonates infected with ESBL-producing gram-negative bacteria are sparse. Methods: A retrospective study was undertaken of all neonates admitted between April 2002 and May 2003 to the neonatal intensive care unit, Safdarjang Hospital, New Delhi who had blood cultures positive for gram-negative bacteria. The clinical profile and outcome in each patient was obtained from the case notes. The mortality and morbidity of the ESBL (cases) and non-ESBL groups were compared. Data were analysed using the chi(2) and Student's t-tests. Results: There were 75 cases of gram-negative septicaemia, 46 newborns (61.3%) were infected with ESBL-producing strains and 63 case records were available. ESBL production was associated with prematurity (24/38 vs 9/25,p = 0.03), prolonged rupture of membranes (14/38 vs 2/25,p = 0.01) and previous antibiotic administration to the infant (15/38 vs 1/25, p = 0.002). Fifty per cent of infants with early-onset sepsis and 82.1% with late-onset sepsis were infected with ESBL strains. Newborns with ESBL sepsis were more likely to manifest persistent thermal instability (13/38 vs 3/25, p = 0.04) and pre-feed gastric aspirates (18/38 vs 3/25, p = 0.004). More than 90% of ESBL isolates were susceptible to carbapenems, cefperazone-sulbactam and piperacillin-tazobactam. The mean length of nursery stay (15.8 vs 10.7,p = 0.02) and mortality (23.6 vs 4.0%,p = 0.07) were higher in the ESBL group and onset of feeds was delayed (7.6 vs 3.9 days, p=0.007) in this group. Conclusions: Isolation of ESBL in cases of early-onset sepsis indicates that ESBL producers might have percolated into the community. Early suspicion of ESBL-producing isolates in cases of neonatal sepsis can facilitate prompt institution of appropriate empirical therapy and lead to an improved outcome.