{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:51:49Z","timestamp":1791215509050,"version":"4.1.0"},"reference-count":38,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>To assess the risk factors antibiotic therapy and outcomes of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bacteremia in NICU patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Episodes of MDR GNB bacteremia were compared with a non-MDR GNB bacteremia group in an 8-year cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Of 1106 bacteremias, 393 (35.5%) were caused by GNB. Seventy (18.6%) were caused by an MDR strain. The most frequent mechanism of resistance was extended-spectrum \u03b2-lactamase production (67.1%), mainly by Klebsiella pneumoniae (59.6%). Previous antibiotic exposure to third-generation cephalosporin (odds ratio [OR]: 5.97; 95% confidence interval [CI]: 2.37\u201315.08; P &amp;lt; .001) and carbapenem (OR: 3.60; 95% CI: 1.26\u201310.29; P = .017) and underlying renal disease (OR: 7.08; 95% CI: 1.74\u201328.83; P = .006) were identified as independent risk factors for MDR GNB acquisition. Patients with MDR GNB bacteremia more likely received inadequate initial antibiotic therapy (72.9% vs 7.8%; P &amp;lt; .001) had higher rates of infectious complication (21.4% vs 10.5%; P = .011) and overall case fatality +rate (28.6% vs 10.5%; P &amp;lt; .001). Independent risk factors for overall mortality were presence of infectious complications after bacteremia (OR: 3.16; 95% CI: 1.41\u20137.08; P = .005) and underlying secondary pulmonary hypertension with or without cor pulmonale (OR: 6.19; 95% CI: 1.88\u201320.31; P = .003).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>MDR GNB accounted for 18.6% of all neonatal GNB bacteremia in the NICU, especially in those with previous broad-spectrum antibiotic therapy and underlying renal disease. The most frequent mechanism of resistance was extended-spectrum \u03b2-lactamase (ESBL) production. Neonates with MDR GNB were more likely to develop infectious complications, which were independently associated with a higher overall case-fatality rate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2013-1248","type":"journal-article","created":{"date-parts":[[2014,1,13]],"date-time":"2014-01-13T21:51:46Z","timestamp":1389649906000},"page":"e322-e329","source":"Crossref","is-referenced-by-count":182,"title":["Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU"],"prefix":"10.1542","volume":"133","author":[{"given":"Ming-Horng","family":"Tsai","sequence":"first","affiliation":[{"name":"Division of Neonatology and Pediatric Hematology\/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan;"},{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan;"},{"name":"Chang Gung University of Science and Technology, Chiayi, Taiwan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Ming","family":"Chu","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan;"},{"name":"Divisions of Pediatric Neonatology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jen-Fu","family":"Hsu","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan;"},{"name":"Divisions of Pediatric Neonatology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reyin","family":"Lien","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan;"},{"name":"Divisions of Pediatric Neonatology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsuan-Rong","family":"Huang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan;"},{"name":"Divisions of Pediatric Neonatology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Chou","family":"Chiang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan;"},{"name":"Divisions of Pediatric Neonatology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren-Huei","family":"Fu","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan;"},{"name":"Divisions of Pediatric Neonatology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiang-Wen","family":"Lee","sequence":"additional","affiliation":[{"name":"Chang Gung University of Science and Technology, Chiayi, Taiwan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yhu-Chering","family":"Huang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan, Taiwan;"},{"name":"Pediatric Infectious Disease, Department of Pediatrics, Chang Gung 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