Abstract
BACKGROUND: Neonatal sepsis poses a great challenge for clinicians and infection control practitioners. Carbapenem-resistant Klebsiella pneumoniae (CRKP) is rapidly increasing and poses a major threat to neonates. Our research aim was to examine the phenotypes, genotypes, and genetic relatedness of CRKP in late-onset neonatal sepsis in the neonatal intensive care unit (NICU) at Cairo University Hospital. METHODS: Our study included 88 neonates diagnosed with sepsis; 58 with late-onset sepsis (LOS) and 30 with early-onset sepsis (EOS) admitted to the NICU between November 2015 and April 2016. Laboratory investigations included (vomplete blood count, C-reactive protein, serum interleukin-6 level by ELISA technique and blood culture). bacterial identification and antibiotic susceptibility testing were done by automated VITEK 2 compact system (BioMérieux, France). Detection of carbapenemases (OXA-48, NDM, IMP, KPC, and VIM) by multiplex PCR and pulsed-field gel electrophoresis (PFGE). RESULTS: K. pneumoniae was the most common encountered pathogen in the LOS group (37.9%) with a mean sepsis score of 6.39 when compared with the 33 EOS group (P < 0.005). The interleukin ratio, C-reactive protein, and interleukin-6 levels were significantly high in the K. group (P ˂ 0.001). The most prevalent 35 carbapenemase gene in the NICU, OXA-48, was identified in 14/23 (60.8%) 36 isolates followed by NDM-1 in 12/23 (52.2%) isolates as detected by multiplex 37 PCR. Coexistence of both carbapenemases was found in 52.2% (12/23). By investigating the genetic relatedness of CRKP by pulsed-field gel electrophoresis, 23 isolates of K. pneumoniae revealed various PFGE patterns, demonstrating that 40 the isolates were nonclonal. CONCLUSION: In conclusion, carbapenam-resistant Klebsiella pneumoniae remains the most frequent organism detected in neonatal sepsis. Our results revealed that CRKP isolates were not clonal. Extra data are required on the rates of birth asphyxia and microbiology of neonatal infection since reduced records of diseases sets gaps in understanding how to improve existing practices. Infection control actions including antibiotic stewardship programs with continuous surveillance to trace emerging CRKP infections in the early hours as possible particularly in units at risk as NICUs. DISCLOSURES: All authors: No reported disclosures.