Infecciones del torrente sanguíneo en pacientes pediátricos de la UCIN: Análisis de patrones y factores de riesgo para su prevención y manejoIntroduction: 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.
Keywords:
antibiotic stewardship programs; bloodstream infections; enterobacterales; ESBL; MRSA
