Third-generation cephalosporin resistant Enterobacteriaceae in neonates and young infants: impact and outcome

J Matern Fetal Neonatal Med. 2022 Aug;35(16):3119-3123. doi: 10.1080/14767058.2020.1812572. Epub 2020 Sep 2.


Objective: Third-generation cephalosporins resistant Enterobacteriaceae (3GCR-EB) are a major threat in severely ill neonates hospitalized in Neonatal Intensive Care Units. Still, the particular impact of 3GCR-EB on outcomes in the wide neonatal population is not well-appreciated. We aimed to study the impact of 3GCR-EB on the length of hospital stay and mortality of a general population of neonates and young infants.

Study design: This was a retrospective cohort study of neonates and young infants born in eight Israeli hospitals between 2009 and 2013, with a culture taken within three months after birth that tested positive for Enterobacteriaceae (EB). Data for this study were taken from centralized electronic health records included inpatient, outpatient, socio-demographic, administrative and laboratory information. The main outcomes were length of stay and mortality. The main explanatory variable was an isolation of 3GCR-EB in any bacterial culture taken from a neonate or young infant.

Results: Cultures were taken for 31,921 neonates and young infants; 2647 (8.3%) tested positive for EB and 290 (11%) tested positive for 3GCR-EB. Length of stay for those who tested positive was 2.8 times longer (95%CI: 2.70-2.91, p ˂ .001) than patients who tested positive for 3GC-susceptible EB. 3GCR-EB were also associated with increased mortality (OR: 12.06, 95%CI: 4.92-32.29).

Conclusions: Neonates with third-generation cephalosporins resistant Enterobacteriaceae had extended hospitalization and increased mortality, which was mostly significant in normal gestational weight newborns.

Keywords: Neonates; enterobacteriaceae infections; extended-spectrum beta-lactamase (ESBL); outcomes; third-generation cephalosporins resistant enterobacteriaceae.

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Cephalosporins / pharmacology
  • Cephalosporins / therapeutic use
  • Enterobacteriaceae Infections* / drug therapy
  • Enterobacteriaceae Infections* / epidemiology
  • Enterobacteriaceae Infections* / microbiology
  • Enterobacteriaceae*
  • Humans
  • Infant
  • Infant, Newborn
  • Retrospective Studies
  • beta-Lactamases


  • Anti-Bacterial Agents
  • Cephalosporins
  • beta-Lactamases