Risk factors of diagnosis of and mortality from late onset neonatal sepsis caused by multidrug-resistant organisms - a case-control study at a tertiary Hospital in the UAE.

BACKGROUND

Neonatal sepsis caused by multidrug-resistant organisms (MDROs) is a significant cause of morbidity and mortality. Research on MDRO sepsis risk factors in the UAE is limited; hence, proper evaluation for targeted therapy is needed.

OBJECTIVE

This study aimed to identify risk factors for MDRO in late-onset neonatal sepsis.

METHODS

This case-control study was carried out in NICU of Tawam Hospital, and data from culture-positive LOS patients were collected between January 2015 and February 2019, including Patient demographics, clinical findings, and presence of antibiotic resistance. The cases were those neonates with late-onset sepsis (LOS) due to MDRO, and the controls were those non-MDRO. Antibiotic regimens for LOS management and mortality rates were collected. Chi-square, independent t-test, Kruskal-Wallis, and Logistic regression were performed as appropriate.

RESULTS

Of the 172 neonates with LOS episodes (29 cases and 143 controls), 49.0% were female, 82.0% were preterm, the median age was 24 days, IQR (10-75), and the median weight was 1,042.0 g; IQR(700-1860). Extended-spectrum beta-lactamases (45.0%) and cephalosporin-resistant Klebsiella spp. (17.0%) were the most common MDROs in our hospital. The incidence of resistance to empiric antibiotic regimens was 7.0% in the case group and 9.0% in the control group. The independent risk variables for MDRO sepsis were female sex (OR 2.67; 95% CI 1.13-6.25), necrotizing enterocolitis (OR 4.54; 95% CI 1.98-10.4), and the use of umbilical arterial catheters (OR 5.02; 95% CI 1.09-23.11). The overall mortality rates (41.0% vs. 40.0%) and 72-hour mortality rates (17.0% vs. 14.0%) exhibited no significant differences between the MDRO and non-MDRO cohorts.

CONCLUSION

The study identified extended-spectrum beta-lactamase Enterobacteriaceae as the predominant MDRO in the unit. It highlighted several independent risk factors associated with MDRO infections; hence, longer hospital stays, including female sex, NEC, and UAC. These results support the integration of risk-based empirical antibiotic regimens in NICUs.