Infecciones en el torrente sanguíneo en pacientes pediátricos de la UCIN: análisis de patrones y factores de riesgo para su prevención y manejo
Date
Subject
BLEE
enterobacterales
infecciones del torrente sanguíneo
MRSA
programas de administración de antibióticos
antibiotic stewardship programs
bloodstream infections
enterobacterales
ESBL
MRSA
enterobacterales
infecciones del torrente sanguíneo
MRSA
programas de administración de antibióticos
antibiotic stewardship programs
bloodstream infections
enterobacterales
ESBL
MRSA
Language:
Journal Title
Journal ISSN
Volume Title
Publisher
Intituto Tecnológico de Santo Domingo (INTEC)
Introducción:
Las infecciones del torrente sanguíneo tienen un impacto significativo en la morbilidad y mortalidad neonatal, exacerbadas por factores como la prematuridad, procedimientos invasivos y estancias hospitalarias prolongadas. En las unidades de cuidados intensivos neonatales (UCIN), hasta un 72% de los bebés prematuros reciben antibióticos, a menudo de manera inapropiada, complicando el manejo debido a síntomas inespecíficos y una sensibilidad diagnóstica limitada. Como resultado, las infecciones neonatales, incluyendo sepsis de inicio tardío y candidiasis invasiva, están cada vez más asociadas con patógenos multirresistentes, resaltando desafíos críticos en el manejo de antimicrobianos.
La vigilancia de las tendencias de resistencia antimicrobiana en unidades pediátricas y los programas de administración responsable de antibióticos son cruciales para implementar medidas oportunas de control de infecciones y optimizar la terapia antibiótica.
Métodos:
A pesar de los esfuerzos para abordar la resistencia a los antibióticos actualmente, hay una falta de análisis exhaustivo sobre patrones y factores de riesgo específicos para pacientes neonatales en la UCIN en República Dominicana. De esta manera, este estudio se centró en la evaluación de aislamientos microbianos en el torrente sanguíneo de pacientes admitidos a la UCIN en un centro de salud en Santo Domingo, República Dominicana.
Resultados:
Basado en los hallazgos del período de estudio de seis años (2018-2024), se identificaron un total de 116 aislamientos microbianos en pacientes neonatales. Las especies predominantes fueron Enterobacterales (37.9%), seguidas de S. coagulasa (-) (37.1%) y A. baumannii (12.9%). Se identificaron BLEE en un 23.5% de Enterobacterales. Además, todos los aislamientos de S. aureus fueron resistentes a meticilina y clindamicina.
La mayoría de las Enterobacterales (37.9%) de las cuales el organismo más frecuente fue Klebsiella pneumoniae (24.1%), seguido de E. coli (7.8%). En segundo lugar, 37.1% eran de la familia Staphylococcaceae, más específicamente Staphylococcus coagulasa (-). En tercer lugar, se encontró A. baumanii (12.9%, 15/116). Dos aislamientos pertenecían a la familia Saccharomycetaceae, más específicamente Candida. Se identificaron BLEE en 23.5% Enterobacterales, más frecuentemente en Klebsiella pneumoniae (19.3%). Resaltando la presencia de K. pneumoniae resistente a carbapenémicos en esta población neonatal. La prevalencia de Staphylococcus aureus resistente a meticilina (SARM) y clindamicina entre los aislamientos de S. aureus fue del 100%.
Conclusiones:
Estos resultados subrayan la presencia significativa de patógenos multirresistentes en entornos de cuidado neonatal, destacando la urgente necesidad de estrategias efectivas de administración de antimicrobianos. La alta prevalencia de BLEE y MRSA entre las especies aisladas resalta la complejidad del tratamiento de las infecciones en neonatos y enfatiza la importancia crítica de la vigilancia continua y las medidas de control de infecciones para mitigar la propagación de cepas resistentes. Futuras investigaciones e intervenciones deben enfocarse en mejorar las prácticas de prescripción de antibióticos, mejorar los protocolos de prevención de infecciones y desarrollar estrategias terapéuticas novedosas adaptadas para combatir los patrones emergentes de resistencia en poblaciones neonatales.
Introduction: Bloodstream infections in neonatal intensive care units have a significant impact on morbidity and mortality among preterm infants. Contributing factors include prematurity, invasive medical interventions, and extended hospital stays. Inappropriate antibiotic use, occurring in up to 72% of preterm NICU patients, further complicates management due to the nonspecific nature of clinical symptoms and limited diagnostic sensitivity. As a result, neonatal infections, such as late-onset sepsis and invasive candidiasis, are increasingly associated with multidrug-resistant pathogens, presenting critical challenges for antimicrobial stewardship programs. Methods: This study aimed to evaluate bloodstream microbial isolates among neonatal patients admitted to the NICU of a healthcare facility in Santo Domingo, Dominican Republic. Analyzing antimicrobial resistance patterns and implementing responsible antibiotic stewardship programs are crucial for timely infection control and optimizing antibiotic therapy in pediatric units. However, there has been a lack of comprehensive analysis of the specific risk factors and epidemiological trends for neonatal patients in NICUs within the Dominican Republic. Results: The study identified a total of 116 microbial isolates from neonatal patients over a six-year period (2018–2024). The predominant species were Enterobacterales (37.9%), coagulase-negative Staphylococci (37.1%), and Acinetobacter baumannii (12.9%). Extended-spectrum beta-lactamase (ESBL) production was observed in 23.5% of the Enterobacterales isolates. Moreover, all Staphylococcus aureus isolates demonstrated resistance to methicillin and clindamycin. Among the Enterobacterales isolates (37.9%), the most frequent organism was Klebsiella pneumoniae (24.1%), followed by Escherichia coli (7.8%). The second most common group included the family Staphylococcaceae (37.1%), specifically coagulase-negative Staphylococci. Third, Acinetobacter baumannii accounted for 12.9% of isolates. Two isolates belonged to the family Saccharomycetaceae, specifically Candida. ESBL production was identified in 28/119 Enterobacterales isolates, most frequently in Klebsiella pneumoniae (19.3%), including carbapenem-resistant K. pneumoniae in this neonatal population. methicillin- and clindamycin-resistant Staphylococcus aureus prevalence was 100% among S. aureus isolates. Conclusions: These findings underscore the significant presence of multidrug-resistant pathogens in neonatal care settings, emphasizing the urgent need for effective antimicrobial stewardship strategies. The high prevalence of ESBL-producing Enterobacterales and methicillin-resistant Staphylococcus aureus (MRSA) among the isolates highlights the complexity of treating neonatal infections and stresses the critical importance of continuous surveillance and infection control measures to mitigate the spread of resistant strains. Future research and interventions should focus on improving antibiotic prescribing practices, enhancing infection prevention protocols, and developing novel therapeutic strategies tailored to combat emerging resistance patterns in neonatal populations.
Introduction: Bloodstream infections in neonatal intensive care units have a significant impact on morbidity and mortality among preterm infants. Contributing factors include prematurity, invasive medical interventions, and extended hospital stays. Inappropriate antibiotic use, occurring in up to 72% of preterm NICU patients, further complicates management due to the nonspecific nature of clinical symptoms and limited diagnostic sensitivity. As a result, neonatal infections, such as late-onset sepsis and invasive candidiasis, are increasingly associated with multidrug-resistant pathogens, presenting critical challenges for antimicrobial stewardship programs. Methods: This study aimed to evaluate bloodstream microbial isolates among neonatal patients admitted to the NICU of a healthcare facility in Santo Domingo, Dominican Republic. Analyzing antimicrobial resistance patterns and implementing responsible antibiotic stewardship programs are crucial for timely infection control and optimizing antibiotic therapy in pediatric units. However, there has been a lack of comprehensive analysis of the specific risk factors and epidemiological trends for neonatal patients in NICUs within the Dominican Republic. Results: The study identified a total of 116 microbial isolates from neonatal patients over a six-year period (2018–2024). The predominant species were Enterobacterales (37.9%), coagulase-negative Staphylococci (37.1%), and Acinetobacter baumannii (12.9%). Extended-spectrum beta-lactamase (ESBL) production was observed in 23.5% of the Enterobacterales isolates. Moreover, all Staphylococcus aureus isolates demonstrated resistance to methicillin and clindamycin. Among the Enterobacterales isolates (37.9%), the most frequent organism was Klebsiella pneumoniae (24.1%), followed by Escherichia coli (7.8%). The second most common group included the family Staphylococcaceae (37.1%), specifically coagulase-negative Staphylococci. Third, Acinetobacter baumannii accounted for 12.9% of isolates. Two isolates belonged to the family Saccharomycetaceae, specifically Candida. ESBL production was identified in 28/119 Enterobacterales isolates, most frequently in Klebsiella pneumoniae (19.3%), including carbapenem-resistant K. pneumoniae in this neonatal population. methicillin- and clindamycin-resistant Staphylococcus aureus prevalence was 100% among S. aureus isolates. Conclusions: These findings underscore the significant presence of multidrug-resistant pathogens in neonatal care settings, emphasizing the urgent need for effective antimicrobial stewardship strategies. The high prevalence of ESBL-producing Enterobacterales and methicillin-resistant Staphylococcus aureus (MRSA) among the isolates highlights the complexity of treating neonatal infections and stresses the critical importance of continuous surveillance and infection control measures to mitigate the spread of resistant strains. Future research and interventions should focus on improving antibiotic prescribing practices, enhancing infection prevention protocols, and developing novel therapeutic strategies tailored to combat emerging resistance patterns in neonatal populations.
Description
Type
info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
info:eu-repo/semantics/publishedVersion
Source
Science and Health; Vol. 9 No. 2 (2025): Science and Health, april-june; 7-18
Ciencia y Salud; Vol. 9 Núm. 2 (2025): Ciencia y Salud, abril-junio; 7-18
2613-8824
2613-8816
10.22206/cisa.2025.v9i2
Ciencia y Salud; Vol. 9 Núm. 2 (2025): Ciencia y Salud, abril-junio; 7-18
2613-8824
2613-8816
10.22206/cisa.2025.v9i2