Epidemiology, microbiological profile, and outcome of culture positive sepsis among outborn neonates at a tertiary hospital in Northern India.

AIMS AND OBJECTIVES: To study the epidemiology, microbiological profile, and outcome of culture positive sepsis among outborn neonates at a tertiary care teaching hospital in Northern India. MATERIALS AND METHODS: Neonates (n = 406) with blood culture positive sepsis were enrolled prospectively over a period of 1 year (February 2018-January 2019). Demographic details, clinical features, microbiological profile, antibiotic sensitivity pattern, treatment, and outcome were recorded. RESULTS: The mean (±SD) age at presentation was 2.4 (±0.6) days and 2/3rd were males. The mean (±SD) gestation was 35.5 (±3.4) weeks, birth weight was 2215 (±219) g, and 42.4% were preterm. The proportion of neonates with early and late onset sepsis were 69% and 31%, respectively. Predominant isolates were Gram-negative (46.5%), Gram-positive (27.6%) organisms, and yeast (25.9%). Klebsiella pneumoniae (46.5%), Acinetobacter baumannii (17.5%), and Escherichia coli (8%) were common Gram-negative; and coagulase negative Staphylococcus (CONS) (70%), Staphylococcus aureus (13.4%), and Enterococcus (12.5%) were common Gram-positive organisms. Among Gram-negative organisms, the antibiotic sensitivity pattern was ciprofloxacin 45%, cephalosporins 15-40%, aminoglycosides 20-42%, piperacillin-tazobactam 49%, carbapenems 34-51%, tetracyclines 55-70%, doxycycline 55%, chloramphenicol 42%, and colistin 98%; and among Gram-positive organisms were methicillin 30%, clindamycin 52%, vancomycin 100%, teicoplanin 98%, and linezolid 99%. The survival rate was 60.3%. The neonates with Gram-negative sepsis had higher requirement of oxygen, mechanical ventilation, and vasoactive drugs; had more complications; and lower survival (50.3% vs. 72.3%, p= .003) when compared to Gram-positive sepsis. CONCLUSIONS: Gram-negative organisms were commonest cause of neonatal sepsis, had low sensitivity to commonly used antibiotics, and associated with poor outcome.

Acinetobacter Sepsis Among Out-born Neonates Admitted to Neonatal Unit in Pediatric Emergency of a Tertiary Care Hospital in North India.

OBJECTIVES: To study the clinical profile, complications, antibiotic resistance pattern, treatment, and outcome of out-born neonates with Acinetobacter spp. sepsis admitted in Pediatric emergency of a tertiary care hospital in North India. METHODS: In this subgroup analysis of a prospective study (conducted over 1 y, February 2018 through January 2019), neonates with Acinetobacter spp. sepsis were included. The data collection included demographic details, clinical features, pre-referral treatment, complications, antibiotic resistance pattern, treatment, and final outcome. RESULTS: Acinetobacter spp. accounted for 10.6% (43/406) of all isolates and 22.7% (43/189) of Gram-negative isolates. The median (IQR) age at presentation was 1 (1-2) d, 2/3rd were male, and 46.5% were preterm. All were admitted in peripheral hospitals before referral to authors' centre and all received intravenous antibiotics and fluids. The resistance to different antibiotics was: Ciprofloxacin 82%, cephalosporins 78-100%, amikacin 75%, pipercillin-tazobactum 62%, carbapenems 50-85%, chloramphenicol 83%, and tetracycline 50-60%. All isolates were sensitive to colistin. The survival rate was 37.2% (n = 16) and 62.8% (n = 27) had poor outcome [death and Left against medical advice (LAMA)]. Higher proportion of neonates with Acinetobacter sepsis had septic shock, multi-organ dysfunctional syndrome (MODS), and disseminated intravascular coagulation (DIC); and higher proportion required mechanical ventilation, vasoactive drugs, and had poor outcome compared to those with sepsis due to other organisms. CONCLUSIONS: Acinetobacter spp. accounts for high burden of sepsis among out-born neonates and is associated with alarmingly high resistance to cephalosporins, fluroquinolones, aminoglycosides, pipercillin-tazobactum, tetracyclines, and carbapenems. Neonates with Acinetobacter spp. sepsis had higher rates of complications, requirement of mechanical ventilation and vasoactive drugs, and poor survival.