DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20202146

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

Shalini Upadhyay, Anita Chakravarti, Tanisha Bharara, Priti Agarwal

Abstract


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.


Keywords


Antimicrobial resistance, Bacteraemia, Low birth weight, Neonatal septicaemia, Preterm

Full Text:

PDF

References


WHO. Global Health Observatory (GHO) data. Neonatal mortality, Situation and trends. Available at: https://www.who.int/gho/child_health/mortality/neonatal_text/en/ Accessed 25 January 2020.

UNICEF Data: Monitoring the situation of children and women. Neonatal mortality, September 2019. Available at: https://data.unicef.org/topic/child-survival/neonatal-mortality/. Accessed 19 December 2019.

Liu L, Oza S, Hogan D, Hogan D, Perin J, Rudan I, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2015;385:430-40.

Panigrahi P, Chandel DS, Hansen NI, Sharma N, Kandefer S, Parida S, et al. Neonatal sepsis in rural India: timing, microbiology and antibiotic resistance in a population-based prospective study in the community setting. J Perinatol. 2017;37(8):911-21.

Roy MP, Bhatt M, Maurya V, Arya S, Gaind R, Chellani HK. Changing trend in bacterial etiology and antibiotic resistance in sepsis of intramural neonates at a tertiary care hospital. J Postgrad Med. 2017;63(3):162-8.

Kaistha N, Mehta M, Singla N, Garg R, Chander J. Neonatal septicemia isolates and resistance patterns in a tertiary care hospital of North India. J Infect Dev Ctries. 2009;4:55-7.

Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance—the need for global solutions. Lancet Infect Dis. 2013;13:1057-98.

Wynn JL. Defining neonatal sepsis. Curr Opin Pediatr. 2016;28(2):135-40.

Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: A cohort study. Lancet Glob Health. 2016;4:e752-60.

CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 29th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standard Institute; 2019.

Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, et al. National Healthcare Safety Network (NHSN) Team and Participating NHSN Facilities. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol. 2013;34:1-14.

Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309-32.

Zea-Vera A, Ochoa TJ. Challenges in the diagnosis and management of neonatal sepsis. J Trop Pediatr. 2015;61(1):1-13.

Vergnano S, Menson E, Kennea N, Embleton N, Russell AB, Watts T, et al. Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed. 2011;96:F9-14.

Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatr. 2010;126(3):443-56.

Downie L, Armiento R, Subhi R, Kelly J, Clifford V, Duke T et al. Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO’s currently recommended antibiotics–systematic review and meta-analysis. Arch Dis Child. 2013;98:146-54.

Anwer SK, Mustafa S, Pariyani S, Ashraf S, Taufiq KM. Neonatal sepsis: an etiological study. J Pak Med Assoc. 2000;50:91-4.

Zakariya BP, Bhat V, Harish BN, Arun Babu T, Joseph NM. Neonatal Sepsis in a Tertiary Care Hospital in South India: Bacteriological Profile and Antibiotic Sensitivity Pattern. Indian J Pediatr. 2011;78:413-7.

Jajoo M, Manchanda V, Chaurasia S, Sankar MJ, Gautam H, Agarwal R, et al. Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India. PLoS One. 2018 Jun 28;13(6):e0180705.

Thakur S, Thakur K, Sood A, Chaudhary S. Bacteriological profile and antibiotic sensitivity pattern of neonatal septicaemia in a rural tertiary care hospital in North India. Indian J Med Microbiol. 2016;34:67-71

Bandyopadhyay T, Kumar A, Saili A, Randhawa VS. Distribution, antimicrobial resistance and predictors of mortality in neonatal sepsis. J Neonatal Perinatal Med. 2018;11(2):145-53.

Bangi VA, Devi SS. Neonatal sepsis: A risk approach. J NTR Univ Health Sci. 2014;3:254-8

Pavan Kumar DV, Mohan J, Rakesh PS, Prasad J, Joseph L. Bacteriological profile of neonatal sepsis in a secondary care hospital in rural Tamil Nadu, Southern India. J Family Med Prim Care. 2017 Oct-Dec;6(4):735-8.

Verma P, Berwal PK, Nagaraj N, Swami S, Jivaji P, Narayan S. Neonatal sepsis: epidemiology, clinical spectrum, recent antimicrobial agents and their antibiotic susceptibility pattern. Int J Contemp Pediatr. 2015 Aug;2(3):176-80

Rath S, Panda SK, Nayak MK, Pradhan DD. Blood culture positive sepsis and sensitivity pattern in a tertiary care neonatal centre in eastern India. Int J Contemp Pediatr. 2019 Mar;6(2):487-90.

Viswanathan R, Singh AK, Basu S, Chatterjee S, Sardar S, Isaacs D. Multi-drug resistant gram negative bacilli causing early neonatal sepsis in India. Arch Dis Child Fetal Neonatal Ed. 2012;97:F182-7.

Zaidi AKM, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet. 2005;365:1175-88.

Jajoo M, Kapoor K, Garg LK, Manchanda V, Mittal S K. To study the incidence and risk factors of early onset neonatal sepsis in an out born neonatal intensive care unit of India. J Clin Neonatol. 2015;4:91-5

Pathak S, Agarwal D, Singh P, Pathak M, Narayan S. Late-onset neonatal sepsis: Overview of risk factors and bacterial etiology in a tertiary care hospital in North India. J Mahatma Gandhi Inst Med Sci. 2018;23:69-72.

Sethi A, Srigade V, Dharmateja G. Neonatal sepsis: Risk factors, clinical and bacteriological profile, and antibiotic sensitivity. Indian J Child Health. 2019;5(6):432-7.

Agrawal A, Awasthi S, Ghanghoriya P, Singh S. Study of current status of bacteriological prevalence and profile in an inborn unit of SNCU in central India. Int J Contemp Pediatr. 2018 May;5(3):764-9.

Cantey JB, Wozniak PS, Sánchez PJ. Prospective surveillance of antibiotic use in the neonatal intensive care unit: results from the SCOUT study. Pediatr Infect Dis J. 2014.

Patel SJ, Oshodi A, Prasad P, Delamora P, Larson E, Zaoutis T, et al. Antibiotic use in neonatal intensive care units and adherence with Centers for Disease Control and Prevention 12 Step Campaign to Prevent Antimicrobial Resistance. Pediatr Infect Dis J. 2009;28:1047-51.

Tzialla C, Borghesi A, Perotti GF, Garofoli F, Manzoni P, Stronati M. Use and misuse of antibiotics in the neonatal intensive care unit. J Matern Fetal Neonatal Med 2012;25(Suppl 4):35-7.

Benitz WE, Gould JB, Druzin ML. 1999. Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatr.103:e77.

Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27(1):21-47.