Clinical outcome of neonates with Carbapenem-resistant Enterobacteriaceae infections at the King Edward VIII Hospital’s neonatal unit, Durban, South Africa

BACKGROUND: Carbapenem-resistant infections in neonates are increasing worldwide. These organisms are associated with poor outcomes because of the severity of the disease, lack of treatment options and impaired immune systems of premature neonates. These infections are associated with significantly higher morbidity, mortality and prolonged hospitalisations, especially in developing countries. METHODS: A retrospective study was conducted to evaluate the prevalence and clinical outcomes of neonates with Carbapenem-resistant Enterobacteriaceae (CRE) infection over 24 months, from January 2015 to December 2016. All charts for neonates with positive cultures were reviewed, including characteristics of neonates that acquired the infection, possible risk factors and outcomes. RESULTS: A total of 32 cases were included with a prevalence of 5/1000 admissions. The mortality rate was 0.6/1000, with case facility rate at 12.5%. Most neonates developed CRE infections within the first 7 days of admission. There was an equal distribution between early neonatal deaths (ENND) and late neonatal deaths (LNND). Neonates (34.4%) had prior exposure to Carbapenem, with a higher mortality rate of (75%). There was zero mortality in the HIV-exposed group. CONCLUSION: Neonates developed CRE much earlier than previously reported. Invasive procedures on admission carry an associated higher risk for developing CRE, more than the length of stay as previously stipulated. Prevalence of CRE seems to be high in middle-income countries with higher mortality. Thus, strict infection prevention and control (IPC) measures during admission and during the first weeks of life can decrease the incidence and outcome of CRE-related mortality and morbidity.