Long-lasting effects of control measures on trends in incidence in neonatal late-onset sepsis due to multiresistant bacteria in a Brazilian neonatal unit - 14/09/24

Doi : 10.1016/j.ajic.2024.08.007

Ivan Gilberto Macolla Bazan, MD ^a,^⁎ , Barbara Barros Pereira Lobo, MD ^a, Angelica Zaninelli Schreiber, PhD ^b, Roseli Calil, PhD ^c, Sergio Tadeu Martins Marba, PhD ^d, Jamil Pedro de Siqueira Caldas, PhD ^d
^a School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
^b Pathology Department, Clinical Pathology Area, State University of Campinas (Unicamp), Campinas, Brazil
^c Women's Hospital, State University of Campinas (Unicamp), Campinas, Brazil
^d Department of Pediatrics, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil

^⁎Address correspondence to Ivan Gilberto Macolla Bazan, MD, Avenida Doutor Alexandre Martins Laroca, 930, apt 257, Santa Terezinha, Paulinia, SP 13140-770, Brazil.Avenida Doutor Alexandre Martins Laroca, 930, apt 257, Santa TerezinhaPauliniaSP13140-770Brazil

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 14 September 2024

Résumé

Background

In response to a 1995 outbreak of sepsis caused by multidrug-resistant (MR) Gram-negative bacteria (GNB), a Brazilian level III neonatal unit established a series of control and prevention measures. This study evaluated the long-term effects of these measures on late-onset neonatal sepsis (LONS) caused by MR bacteria from 2000 to 2020 and examined their impact on in-hospital mortality.

Methods

Newborns with LONS and positive cultures for Staphylococcus aureus, GNB, and Enterococcus sp were selected, adhering to Center for Desease Control and Prevention and local criteria. Joinpoint regression analysis was used to assess annual trends.

Results

Over the 21-year period, the overall LONS rate was 4.6%, showing a significant decline from 2000 to 2016 (P < .0001, slope -0.36). However, from 2016 to 2020, there was a non-significant increase in sepsis rates (slope +0.92, P = .08). MR sepsis were in 15.8% of sepsis cases and displayed a non-significant upward trend (slope +0.50, P = .08) with no major shifts. In-hospital mortality rates for MR and non-MR LONS showed no significant differences (P = .413).

Discussion

The study indicates a low prevalence of MR sepsis due to effective antimicrobial use and educational interventions.

Conclusions

MR sepsis prevalence remained low and stable, not increasing in-hospital mortality.

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Highlights

•	Multiresistant sepsis rates were low and stable throughout 21years.
•	Death rates was similar in sepsis caused by multiresistant or sensitive strains.
•	Infection prevention measures have persisted and have proven effective over time.

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Key Words : Bacterial, Death, Drug resistance, Infant, Infection control, Newborn

Plan

	Research developed at Women's Hospital (CAISM) through the Department of Pediatrics - State University of Campinas (Unicamp).
	Conflicts of interest: None to report.