Tsai et al identified risk factors for multidrug-resistant Gram-negative bacteremia for a patient in the NICU. The authors are from Chang Gung Memorial Hospital in Taiwan.
Patient selection: neonate or infant in the NICU
Most common mechanism for antibiotic resistance: extended-spectrum beta-lactamase
Most common pathogen: Klebsiella pneumoniae
Genera involved: Klebsiella, Pseudomonas, Acinetobacter, Stenotrophomonas, E. coli, Enterobacter, Chryseobacterium
Risk factors for acquisition:
(1) previous exposure to a third-generation cephalosporin
(2) previous exposure to carbapenem
(3) underlying renal disease
Consequences for the patient:
(1) suboptimal antibiotic therapy initially
(2) higher rate of infectious complications
(3) higher overall mortality
where:
• Infectious complications were (1) new focus of infection or (2) persistent organ dysfunction.
• Mortality was from any cause within 30 days of the onset of bacteremia.
