Antibiotic Susceptibility, Virulome, and Clinical Outcomes in European Infants with Bloodstream Infections Caused by Enterobacterales
Laura Folgori,
Domenico Di Carlo,
Francesco Comandatore,
Aurora Piazza,
Adam A. Witney,
Ilia Bresesti,
Yingfen Hsia,
Kenneth Laing,
Irene Monahan,
Julia Bielicki,
Alessandro Alvaro,
Gian Vincenzo Zuccotti,
Tim Planche,
Paul T. Heath,
Mike Sharland
Affiliations
Laura Folgori
Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
Domenico Di Carlo
Paediatric Clinical Research Centre “Romeo and Enrica Invernizzi”, Department of Biosciences, University of Milan, Via Giovanni Battista Grassi 74, 20157 Milan, Italy
Francesco Comandatore
Paediatric Clinical Research Centre “Romeo and Enrica Invernizzi”, Department of Biosciences, University of Milan, Via Giovanni Battista Grassi 74, 20157 Milan, Italy
Aurora Piazza
Clinical-Surgical, Diagnostic and Pediatric Sciences Department, Unit of Microbiology and Clinical Microbiology, University of Pavia, Corso Str. Nuova 65, 27100 Pavia, Italy
Adam A. Witney
Institute of Infection and Immunity, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
Ilia Bresesti
Department of Paediatrics, Vittore Buzzi Children Hospital, University of Milan, Via Lodovico Castelvetro 32, 20154 Milan, Italy
Yingfen Hsia
Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
Kenneth Laing
Institute of Infection and Immunity, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
Irene Monahan
Institute of Infection and Immunity, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
Julia Bielicki
Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
Alessandro Alvaro
Paediatric Clinical Research Centre “Romeo and Enrica Invernizzi”, Department of Biosciences, University of Milan, Via Giovanni Battista Grassi 74, 20157 Milan, Italy
Gian Vincenzo Zuccotti
Department of Paediatrics, Vittore Buzzi Children Hospital, University of Milan, Via Lodovico Castelvetro 32, 20154 Milan, Italy
Tim Planche
Institute of Infection and Immunity, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
Paul T. Heath
Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
Mike Sharland
Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
Mortality in neonates with Gram-negative bloodstream infections has remained unacceptably high. Very few data are available on the impact of resistance profiles, virulence factors, appropriateness of empirical treatment and clinical characteristics on patients’ mortality. A survival analysis to investigate 28-day mortality probability and predictors was performed including (I) infants Escherichia coli had significantly more virulence genes identified compared with other species. A strong positive correlation between the number of resistance and virulence genes carried by each isolate was found. The cumulative probability of death obtained by the Kaplan-Meier survival analysis was 19.5%. In the descriptive analysis, early age at onset, gestational age at onset, culture positive for E. coli and number of classes of virulence genes carried by each isolate were significantly associated with mortality. By Cox multivariate regression, none of the investigated variables was significant. This pilot study has demonstrated the feasibility of investigating the association between neonatal sepsis mortality and the causative Enterobacterales isolates virulome. This relationship needs further exploration in larger studies, ideally including host immunopathological response, in order to develop a tailor-made therapeutic strategy.
