Incidence, Outcomes and Susceptibility Patterns of Escherichia coli and Klebsiella pneumoniae Producing Extended-Spectrum Beta-Lactamase to Antibiotic in Newborn at Phranakhon Si Ayutthaya Hospital-อุบัติการ อาการทางคลินิก และแบบแผนความไวของเชื้อ Escherichia coli และเชื้อ Klebsiella pneumoniae ที่ผลิตเอ็นซัยม์ เบต้าแลคแตมเม ต่อยาต้านจุลชีพในทารกแรกเกิด ในโรงพยาบาลพระนครศรีอยุธยา

บทคัดย่อ

        To determine the incidence, clinical outcomes and susceptibility to antibiotic patterns of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae in newborns, 54 medical records of those admitted at Phranakhon Si Ayutthaya hospital were analyzed retrospectively.  The incidences of ESBL E.coli and ESBL K.pneumoniae in 2006 were 18.2 percent, 56.3 percent but climbed up to 61.5 percent, 79.1 percent in 2007 respectively.  Most of them were male (2.4:1), aged less than four days (79.6%) and 42.6 percent were low birth weight neonates.  ESBL E.coli and ESBL K.pneumoniae were mostly isolated from the respiratory tracts (55.4%) and 53.7 percent were related to mechanical ventilations.  The pre-infection/colonization hospital stay was about 14 days during which 46.3 percent had received the third generation cephalosporin.  All ESBL E.coli completely resisted to the third and fourth generation cephalosporin to which less than 30 percent to ESBL K.pneumoniae were still sensitive.  For aminoglycoside, 80 percent sensitive of both ESBL E.coli and ESBL K.pneumoniae were to amikacin and netilmicin.  No effect of gentamicin (0% sentivity) on ESBL E.coli was found, yet some effects (31% sensitivity) on ESBL K.pneumoniae were reported.  More than 90 percent of these organisms were sensitive to imipenem and cefoperazone/sulbactam.  ESBL E.coli was barely sensitive to ciprofloxacin (35%) which still proved more effective on ESBL K.pneumoniae (93%).  Six patients (11.1%) with low birth weight died, including the two cases with septicemia plus meningitis and the other with only septicemia.  All the three patients had received imipenem and cefoperazone/sulbactam within 24 hours prior to their demises.  This report suggests that the incidence of multiple drug resistant bacteria increases in newborns and dictate a need for regular surveillance and proper empirical antibiotic therapy.

Key words:      extended-spectrum beta-lactamase, ESBL, Escherichia coli, Klebsiella pneumoniae, newborn, antibiotic resistance