ABSTRACT
Neonatal sepsis is responsible for 30 - 50% of total neonatal deaths each_year in developing countries. Our study aimed to determine the bacterial etiology of early onset sepsis [EOS] and late onset sepsis [LOS] and their antibiotic resistance patterns
This study was conducted at the Microbiology and Immunology department, and Neonatal Intensive Care Unit [NICU], Menoufia University Hospitals. 35 suspected cases of sepsis were included in our study [14 females and 21 males] aged from 1-28 days. They were screened for sepsis by modified clinical sepsis score and hematological sepsis scoring system [total score 7, score > 3 suggestive of sepsis ]
Cases within the first week of life were considered EOS and considered LOS if occurring after the first week. CBC, semi quantitative CRP, blood culture were done for all neonates
Antimicrobial susceptibility and ESfiLs detection were carried out for all isolates. Our results revealed that premature and low birth weight cases were more than full term and normal birth weight cases. Early onset sepsis group included 12 [34.3%] cases while late onset sepsis group included 23 [65.7%]
Total number of isolates were 26, Gram-negative bacteria were more frequent than Gram-positive with a frequency of 57.7% and 42.3% respectively. The most prevalent organism isolated from EOS cases was Klebsiella spp. [26.9%] . Gram negative organisms were seen mainly in early onset sepsis while gram positive organisms were seen in late onset sepsis with predominance of S. aureus. Klebsiella spp. and E. coli were highly sensitive to imipenem [100% each], however, high resistance was observed to penicillin, ampicillin and erythromycin [100% for each] . One out of 5 [20%] E. coli isolates and 2 out of 7 [28.6%] Klebsiella isolates were extended spectrum beta lactamase [ESfiL] producers . S. aureus showed high sensitivity to imipenem [100%], 100% resistant to amoxicillin-davulinic acid . Coagulase -ve staphylococci were highly sensitive to vancomycin [100%] 100% resistant to ampicillin, erythromycin, pipracillin, and penicillin. Gram-positive and negative bacteria have demonstrated high resistance against 3rd generation cephalosporins [more than 60%]. In conclusions, Gram negative bacteria [K. pneumoniae and E. coli] were the main cause of EOS in our study, while S. aureus and CoNS were most common in LOS cases. Emergence of multi-drug resistant strains especially for commonly used antibiotics is an important issue especially in NICU. Most isolates are highly resistant against commonly used antibiotics and are relatively more sensitive to less commonly used drugs like imipenem . Continuous surveillance should be carried out at regular intervals to find out the changing antibiotic susceptibility patterns and advice empirical therapy