Incidence, bacteriological profile and risk factor analysis of neonatal sepsis in a peri urban set up of North India

Background: The high incidence and antimicrobial resistance among the pathogens causing neonatal sepsis is alarming. In addition to substantial immediate mortality, survivors of infections in the neonatal period are at increased risk of long-term disability. The present study was conducted to know the bacteriological profile and risk factors associated with culture proven neonatal sepsis in a peri urban population.Methods: This study was conducted over a period of 4 year (2015-2019). On clinical suspicion, blood culture specimens were sent to microbiology laboratory. The organisms isolated from blood cultures were identified and tested for antimicrobial susceptibility. As part of infection control practices, environmental samples from the neonatal intensive care units were tested.Results: Of 907 blood cultures of neonates received in the microbiology laboratory, 20.7% were culture positive. Majority of the episodes occurred at or before 72 hours of life (81.4%). 54.3% were Gram positive cocci including Coagulase negative Staphylococci, Staphylococcus aureus and Enterococcus spp. The common Gram-negative pathogens included Escherichia coli, Klebsiella spp. and Pseudomonas spp. Common risk factors involved were preterm birth, low birth weight, premature rupture of membrane, prolonged labour and iatrogenic causes.Conclusions: The early signs of sepsis are often subtle and nonspecific. Therefore, a high index of suspicion is needed for early diagnosis. Rapid, reliable detection and appropriate case management can save lives of many new-borns.

Neonatal Sepsis: Clinical Spectrum, Bacteriological Profile and Antibiotic Sensitivity Patterns in Neonatal Intensive Care Unit in a Tertiary Care Hospital

Introduction: Neonatologists face a perpetual challenge in managing neonatal septicaemia due to changing patterns of the microbial flora and their antibiotic sensitivity. The present study was designed to evaluate the clinical spectrum, bacteriological profile, antibiotic sensitivity patterns in neonates with suspected septicaemia in a tertiary care teaching hospital. Material and Methods: This prospective observational study was carried out in neonatal intensive care unit for a period of nine months. All the neonates with suspected septicaemia, were evaluated by sepsis screen (C- reactive protein). C-reactive protein positive neonates were subjected to blood culture for isolation of microorganisms. Antibiotic sensitivity testing was done with disc diffusion method. The data was analyzed using descriptive statistics. Results: Among 519 neonates, blood culture was positive in 183 (35.2%). Most of the neonates presented with early onset sepsis(65%), were preterm(59%) and of low birth weight (58.5%). Major clinical presentation was respiratory distress (31.2%). Gram negative bacteria were frequently isolated (68.3%). Most common isolates were Klebsiella pneumonia (34.70%) and staphylococcus aureus (21.8%) respectively. Gram negative organisms were sensitive to imipenem, followed by piperacillin tazobactam and amikacin. Gram positive organisms showed good sensitivity to vancomycin, teicoplanin and imipenem. High resistance was observed to ampicillin and ceftriaxone in both gram positive and gram negative organisms. Conclusions: Preterm and low birth weight neonates were more susceptible to neonatal sepsis. Gram negative organisms were frequently isolated. The present study would suggest rational use of empirical antibiotic therapy and to review the antibiotic policy periodically basing on the microbial flora detected in their region time to time.

Neonatal Septicaemia in a Rural Nigerian Hospital: Aetiology, Presentation and Antibiotic Sensitivity Pattern.

Background: Neonatal Septicaemia (NNS) remains a major cause of morbidity and mortality in neonates despite advances in antimicrobial therapy, life support measures and the early detection of risk factors. This study aimed at determining the risk factors, aetiologic agents and antibiotic sensitivity pattern of NNS in Wesley Guild Hospital, Ilesa. Methods: This was a prospective study involving 360 neonates admitted into Wesley Guild hospital, Ilesa over a period of seven months. Socio-demographic data and clinical characteristics of the neonates were collected using a standard proforma. Blood culture was done on admission and bacterial isolates were identified using standard procedures. Antibiotic susceptibility testing was done using disc diffusion method. Results: The prevalence of neonatal septicaemia (NNS) was 16.0% in this study. Multivariate regression model of significant risk factors revealed prolonged labour (AOR 2.2(1.036 - 4.912) p=0.041) as the only independent risk factor for NNS. Staphylococcus aureus was the predominant isolate (70%). The case fatality rate from the study was 25%. Ciprofloxacin (86.7%), Cefuroxime (82.7%) and Ceftriaxone (81.3%) were the antibiotics with the highest sensitivity, while the infective organisms were most resistant to Cloxacillin (80%) and Ampicillin (77.3%). Conclusion: Neonatal septicaemia remains a significant cause of neonatal mortality. S. aureus was the predominant bacterial isolate in this study. Cephalosporins should be considered as first-line antibiotics in its management. Prevention of preterm deliveries and encouraging good antenatal care and supervised deliveries will help in reducing the high incidence.

A bacteriological profile of neonatal septicemia(Study in tertiary care hospital, Rajkot).

Background: Neonatal septicemia is the major cause of Neonatal mortality. It might be possible to reduce these deaths by early diagnosis and proper management. Objectives: (1) To find out various bacteriological agents involved in neonatal septicaemia in PDU Medical college & Hospital Rajkot (2) to findout the organisms responsible for early onset and late onset neonatal sepsis. Methods: A hospital based prospective study was carried out in 100 clinically supsected cases of neonatal septisemia in New Born Intensive Care Unit (NICU) at P.D.U Medical College & Hospital Rajkot. Results: Out of 100 neonates with clinically suspected neonatal septicemia, 62(62%) were blood culture positive. Gram negative bacteria accounted for 50(80.65%) & Gram positive bacteria accounted for 12(19.35%) of all cases. Among Gram Negative bacteria Klebsiella spp 25(40.32%) being the most common organism & Staphylococcus aureus 8(12.90%) being the most common organism among Gram Positive bacteria. Late sepsis was most commonly associated with klebsiella spp19 (41.3%).Conclusion: Neonatal septicaemia should be diagnosed urgently to reduce the mortality. Suspected infection based on clinical criteria need to supported by microbial investigation to find causative organisms and their antibiotic sensitivity pattern.

Nosocomial outbreak of septicaemia in neonatal intensive care unit due to extended spectrum β-lactamase producing Klebsiella pneumoniae showing multiple mechanisms of drug resistance.

A total of 14 phenotypically similar clinical isolates of Klebsiella pneumoniae, resistant to multiple drugs including cefotaxime and ceftazidime, were isolated from blood of neonates admitted to neonatal intensive care unit (NICU) within a short span of 10 days. Alarmed at the possibility of occurrence of outbreak, a thorough investigation was done. Microbiological sampling of the NICU and labour room (LR) environment yielded 12 K. pneumoniae isolates. The presence of extended spectrum β-lactamase (ESBL) in the clinical and environmental strains was detected by double-disk synergy test (DDST), CLSI phenotypic confirmatory disk diffusion test (PCDDT) and E-test ESBL strips. Amp-C screen (disk) test was done to determine Amp-C β-lactamase production. 100% clinical strains, 57% NICU strains and 80% LR strains were ESBL positive. 57% clinical, 43% NICU and 20% LR strains were Amp-C screen positive. Polymerase chain reaction (PCR) of representative ESBL positive (10 clinical and 5 environmental) strains showed CTX gene and TEM and/or SHV gene in all. K. pneumoniae showing multiple mechanisms of drug resistance was responsible for the outbreak.