Epidemiology of Neonatal Bacteremia in Greece – Data from a European Surveillance Network

J. Kopsidas, C. Kortsalioudaki, K. Zannikos, K. Karachristou, G. Kοurlaba, F. Anatolitou, N. Lipsou, T. Siachanidou, A. Kent, D. Gkentzi, G. Dimitriou, TE. Zaoutis, PT. Heath, N. Spyridis; on behalf of the Neonatal Infection Surveillance Network (neonIN); Athens and Patras (Greece), London (UK) and Philadelphia (PA, USA)
4th International Congress of Union of European Neonatal and Perinatal Societies (UENPS)
December 11th-14th, 2014, Athens, Greece

BACKGROUND AND AIMS: Neonatal sepsis carries significant morbidity and mortality. Data on the epidemiology of bacteremia leading to sepsis in Greece is limited despite knowledge that the prevalence of healthcare-associated infections, antimicrobial consumption and multi-drug resistant organisms is among the highest in Europe. This study aims to describe the epidemiology of bacteremia in Greek neonatal-units (NNUs), patients’ characteristics and antibiotic-resistance profile as recorded in neonIN.

METHODS: NeonIN is a web-based surveillance database for culture proven neonatal infections. Cases of positive blood cultures between January 2012 and March 2014 were extracted. Repeated growth within 7 days was considered the same episode. Early-onset sepsis was defined as occurring within 48 hours of birth.

RESULTS: 107 pathogens were isolated from 90 infants (Tab. 1). The commonest pathogens were Coagulase-Negative Staphylococci (CoNS) (46, 43.0%) followed by Enterobacteriaceae (31, 29.0%), of which the most common were Klebsiella spp. (13, 41.9%) and E. coli (9, 29.0%).
11/14 (78.6%) of CoNS isolates were oxacillin resistant but there was no resistance to teicoplanin or vancomycin documented. Enterobacteriaceae resistance to 3rd generation cephalosporins was 29.0% (9/31), to carbapenems 9.7% (3/31) and 41.9% (13/31) to at least one aminoglycoside (23.3% [7/30] to gentamicin). Enterococcal resistance to vancomycin was 16.7% (1/6 cases).

CONCLUSIONS: CoNS and Enterobacteriaceae are the most common bacteria isolated from hospitalised infants in Greek-NNUs. We detected high rates of resistance to 3rd generation cephalosporins and carbapenems. Continuous robust surveillance data will enable better understanding of the local epidemiology which is of critical importance for the development of evidence-based guidelines for the empiric management of sepsis in Greek NNUs.

Table 1. Demographics at time of first documented infection.