Original Research

Colistin use in a carbapenem-resistant Enterobacterales outbreak at a South African neonatal unit

Ilhaam Abrahams, Angela Dramowski, Kedisaletse Moloto, Lizel Lloyd, Andrew Whitelaw, Adrie Bekker
Southern African Journal of Infectious Diseases | Vol 38, No 1 | a487 | DOI: https://doi.org/10.4102/sajid.v38i1.487 | © 2023 Ilhaam Abrahams, Angela Dramowski, Kedisaletse Moloto, Lizel Lloyd, Andrew Whitelaw, Adrie Bekker | This work is licensed under CC Attribution 4.0
Submitted: 27 September 2022 | Published: 30 January 2023

About the author(s)

Ilhaam Abrahams, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Angela Dramowski, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Kedisaletse Moloto, Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
Lizel Lloyd, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Andrew Whitelaw, Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
Adrie Bekker, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Abstract

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.


Keywords

Carbapenem-resistant Enterobacterales; antibiotic resistance; neonate; colistin; safety

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Crossref Citations

1. Genomic Characteristics of Carbapenem-Resistant Klebsiella pneumoniae Isolated from Neonatal Patients in Southwest China During 2017–2021
Wenjing Wu, Yongmei Jiang, Wei Zhou, Linghan Kuang
Infection and Drug Resistance  vol: Volume 16  first page: 6725  year: 2023  
doi: 10.2147/IDR.S426565