ABSTRACT
Background: Neonatal sepsis is a major cause of neonatal mortality, accounts for nearly half of all the neonatal deaths in our country. The incidence of neonatal septicemia ranges from 1 to 10 per 1000 live births. In our country the incidence of culture proven neonatal sepsis is 8.6 per 1000 live births, intramural data. Antibiotics are rapidly losing their effectiveness, with some early reports going so far to suggest that we are approaching a post-antibiotic era. Aims of this study was to find out the incidence of culture proven neonatal sepsis and to analyze data collected for mortality and morbidity in culture proven neonatal sepsis and antibiotic sensitivity pattern in culture proven neonatal sepsis at Neonatal Intensive Care Unit of Santokba Durlabhji Memorial Hospital (SDMH), Jaipur.Methods: The study included 129 newborn fulfilling the inclusion criteria, admitted into NICU of SDMH, Jaipur from 01st January 2013 to 31st December 2013, were investigated using various hematological and biochemical test e.g. CBC, Serum CRP, Blood culture and sensitivity, CSF examination includes cell counts, gram staining, biochemistry, culture and sensitivity etc.Results: Overall 722 cases admitted in NICU during the period of one-year 2013. Out of which 129 cases had blood culture proven neonatal sepsis (17.87%). 14.88% cases in P.C.U. and 21.79% cases in I.P.U. had positive blood culture sepsis with statistically significant difference (p value 0.016, <0.05).Conclusions: Antibiotic resistance is an emerging problem requires justified use of antibiotics.
ABSTRACT
Aims and objectives: To identify the prevalence of bacteremia and the spectrum of antimicrobial sensitivity in our community, because it will guide the clinician to institute proper antimicrobial therapy. Background: Bacteremia originates from either intravascular sites or extraVascular sites. In case of bloodstream infection, either Gram-positive or Gram-negative bacteria are responsible. Of these bacterial isolates, Gram-negative bacteria are responsible for higher mortality and morbidity. Since 20 to 30 years, coagulase-negative Staphylococci are responsible for most infection. Materials and methods: In this retrospective study, blood samples were collected aseptically from 11,581 patients and were injected into the bottles containing bile-broth and brainheart infusion broth and allowed to be incubated at 37°. Then subculture was done on blood agar, chocolate agar, as well as MacConkey agar media and was kept for 7 days or till the appearance of growth of the organism. After identification of isolates, Kirby Bauer disk diffusion test on Mueller-Hinton agar II was performed to detect antimicrobial sensitivity. Results: Our study documented 8.58% positive cultures in the last 7 years. Gram-negative bacterial isolates were significantly higher than Gram-positive isolates (64.19% vs 34.80%, p = 0.00). Lowest number of positivity was seen in Morganella (0.40%) followed by Proteus (0.50%) and Enterococcus faecium (0.90%) in ascending order. Males were significantly more culture positive than females (549/994 vs 445/994, p = 0.00). Most common bacterial isolates were (coagulase negative Staphylococci) CoNS (239, 24.04%) followed by Klebsiella including ESBL (extended spectrum beta-lactamase), carbapenamase producer (234, 23.74%) and Escherichia coli (110, 11.06%). E. coli was >75% sensitive to imipenem group, polymyxin B (98.18%), colistin (96.36%), and amikacin (80.9%). Coagulase negativeStaphylococci showed more than 60% sensitivity to levofloxacin (76.98%), amikacin (82.84%), tigecycline (87.44%), vancomycin (94.45%), teicoplanin (91.63%), linezolid (91.21%), gentamicin (76.56%), netilmicin (74.47%), and tetracycline (75.31%). Klebsiella (non-ESBL and carbapenemase producer) was highly sensitive to polymyxin B (93.06%), colistin (91.90%), meropenem (65.31%), and imipenem (94.73%). Extended spectrum beta-lactamase-producing Klebsiella showed increased sensitivity to meropenem (89.47%), imipenem (94.73%), ertapenem (81.57%), polymyxin B, and colistin (97.36% each). Conclusion: Positive cultures were 8.58% in the last 7 years. Gram negative bacterial isolates were significantly higher. Males were more culture positive. Most common bacterial isolates were CoNS followed by Klebsiella species and E. coli. Gram-negative bacterial isolates were highly sensitive to piperacillin, cefoperazone, imipenem, meropenem, aminoglycoside group of antibiotics, tigecycline, polymyxin B and colistin. Gram-positive bacterial isolates were sensitive to piperacillin, cefoparazone, vancomycin, teicoplanin, linezolid and clindamycin. Salmonella typhi were sensitive to ampicillin, cefoparazone, cefepime, azithromycin, chloramphenicol, and fluoroquinolones. Acinetobacter showed > 50% sensitivity to cefepime and Pseudomonas showed > 50% sensitivity to cefotaxime and levofloxacin. So to prevent resistance of bacterial isolates, a proper antibiotic guideline should be maintained.