A comparison of multi-drug-resistant versus non-multi-drug-resistant serious bacterial infections in early infancy
Infants aged 0–90 days are more prone to serious bacterial infections (SBIs) than other paediatric groups. With the emergence of multi-drug-resistant organisms (MDROs) causing SBIs in children, this study reviewed the epidemiology and bacteriology of community-acquired SBIs in infants 0–90 days old and compared the clinical features, laboratory values and final outcomes when caused by MDROs versus non-MDROs.
- Retrospective review of culture-proven SBIs (bacteraemia, urinary tract infections [UTIs], or meningitis) with age at onset of 0–90 days in patients admitted to hospital during a 7-year period (2012 to 2018).
- Healthcare-associated infections (cultures collected >3 days after admission) were excluded.
- Among 94 episodes of SBI in 88 patients, UTI accounted for 54%, bacteraemia 43% and meningitis 3%.
- Median age at onset was 15 days, male gender predominated (73%) and most patients were full-term (74%).
- Gram-negative and gram-positive bacteria accounted for 67% and 33% of SBIs, respectively, with Escherichia coli the most common cause (30%) followed by Klebsiella species (25%) and group B streptococcus (16%).
- MDROs caused SBIs in 44% of patients, mostly extended-spectrum beta-lactamase (ESBL)-producing E. coli and ESBL-producing K. pneumoniae.
- Compared with non-MDROs, SBIs due to MDROs were associated with more delay in providing targeted antimicrobial therapy (74% vs 0%, p<0.001) but there was no difference in the case-fatality rate (13% vs 12%).
- There were no between-group differences in clinical features or laboratory values.
MDROs are a common cause of SBIs in the first 90 days of life and are associated with a delay in providing targeted antimicrobial therapy. Knowledge of local epidemiology is imperative if appropriate antibiotics are to be administered promptly.