Colistin use in a carbapenem-resistant Enterobacterales outbreak at a South African neonatal unit
Southern African Journal of Infectious Diseases
| Field | Value | |
| Title | Colistin use in a carbapenem-resistant Enterobacterales outbreak at a South African neonatal unit | |
| Creator | Abrahams, Ilhaam Dramowski, Angela Moloto, Kedisaletse Lloyd, Lizel Whitelaw, Andrew Bekker, Adrie | |
| Description | Background: Colistin is increasingly prescribed for neonates with carbapenem-resistant Enterobacterales (CRE) infections.Objectives: We described patient demographics, infection episodes, treatment and clinical outcomes, colistin related adverse events and relatedness of isolates in neonates with clinically confirmed or clinically suspected CRE infections.Method: The authors retrospectively reviewed culture-confirmed and clinically suspected culture-negative CRE infections at a South African neonatal unit during a CRE outbreak.Results: Fifty-three neonates (median gestational age 29 weeks and birth weight 1185 g) were included. Twenty-three of 53 neonates (43%) had culture-confirmed CRE (17 received colistin; 6 died without receiving colistin) and 30 (57%) received colistin for clinically suspected CRE infection but were ultimately culture-negative. Prior respiratory support and surgical conditions were present in 37/53 (70%) and 19/53 (36%) neonates, respectively. Crude mortality was high (20/53; 38%) with no significant difference between culture-confirmed CRE versus clinically suspected culture-negative CRE groups (10/23 [44%] vs 10/30 [33%]; p = 0.45). Hypomagnesaemia (10/38; 26%) and hypokalaemia (15/38; 40%) were frequent; acute kidney injury was rare (1/44; 2%). Three CRE infection clusters were identified by genotypic analysis of 20 available isolates (18 [90%] blaNDM-1 [New Delhi metallo-beta-lactamase], 2 [10%] blaOXA [oxacillinase]-48).Conclusion: Neonates receiving colistin therapy were predominantly preterm, with multiple risk factors for infection. Colistin-associated electrolyte derangement was frequent. Over one-third of neonates died. BlaNDM-1 was the most frequent carbapenemase gene identified in the outbreak isolates.Contribution: Colistin was safely used during an Enterobacterales outbreak in predominantly premature and surgical neonates. The mortality was high. | |
| Publisher | AOSIS Publishing | |
| Date | 2023-01-30 | |
| Identifier | 10.4102/sajid.v38i1.487 | |
| Source | Southern African Journal of Infectious Diseases; Vol 38, No 1 (2023); 8 pages 2313-1810 2312-0053 | |
| Language | eng | |
| Relation |
The following web links (URLs) may trigger a file download or direct you to an alternative webpage to gain access to a publication file format of the published article:
https://sajid.co.za/index.php/sajid/article/view/487/1158
https://sajid.co.za/index.php/sajid/article/view/487/1159
https://sajid.co.za/index.php/sajid/article/view/487/1160
https://sajid.co.za/index.php/sajid/article/view/487/1161
|
|
ADVERTISEMENT
