Extended spectrum B-lactamase producting klebsiella pneumoniae as a cause of neonatal infection in Al Galaa Teaching Hospital

ABSTRACT

Neonatal sepsis remains to have a major impact on morbidity and mortality in neonates, Klebsilla spp. has emerged as an important cause of hospital acquired infections especially among neonates in NICU. ESBL producing Kiebsilla pneumoniae has been frequently implicated in NICU showing increase rate of mortality and morbidity because of resistance to numerous antimicrobial agents. To evaluate the piesence and frequency of ESBL Klebsilla pneumoniae in different neonatal cultures and its frequency we screened 160 newborns, both term and preterm, all selected cases had two or more clinical signs of sepsis in addition to one or more positive sepsis screen laboratory results. Blood culture was done on Biphasic media followed by subculture and biochemical identification for Kl. Pneumoniae, all isolates are subjected for antibiotics sensitivity and double disc test to detect ESBL producers. The 160 cases included 116 [72.5%] premature [<36 weeks] and 44 full term [27.5%]. From 160 cases included in the study no growth was reported in blood cultures of 42 cases [26.25%]. From the 118 [73.75%] positive blood culture cases, 72 cases were gram negative organisms [61% of positive blood culture cases]. Klebsilla was recorded in 40 cases [33.9% of all positive blood cultures and 55.6% of gram negative organisms], 80% of them were ESBL producers. All the isolates were sensitive to imipenem and meropenem and were almost always resistant to ampicillin, ticracillin and piperacillin in addition to third generation cephalosporines and monobactams. Mortality were high in ESBL producers klebsilla infection [47% of premature] and [33.3% of full terms]. In conclusion, routine detection of ESBL producing Klebsilla is required to be done by reliable laboratory methods, and moreover the therapeutic strategies to control infections in NICUs must be carefully formulated