Identification of the bacterial isolates in neonatal septicaemia and their antimicrobial susceptibility in a tertiary care hospital in Uttarakhand, India: a retrospective study
Keywords:Septicaemia, Neonate, Resistance, Antibiotics, Drugs
Background: Neonatal sepsis refers to systemic bacterial infection documented by positive blood culture in the first four weeks of life and is one of the four leading causes of neonatal mortality and morbidity in India. This study was a retrospective study to identify the bacterial isolates in neonatal septicaemia and their antimicrobial susceptibility in a tertiary care hospital in Uttarakhand, India from January 2013 to June 2015.
Methods: Blood culture in newborns with clinical sign of septicaemia was retrospectively studied. Antimicrobial susceptibility testing was performed by Kirbuay -bauer disc diffusion susceptibility method in accordance to clinical laboratory standard institute guidelines (CLSI).
Results: 10.3% (124 /1200) cases of septicaemia could be confirmed by blood culture. Of these Gram negative could be isolated in (62%) of cases and (38%) were of gram positive isolates. Kliebsiella was the predominant pathogen (42.8%) among the gram negative pathogens followed by E coli (18.1%). CONS (57.4%) was the predominant gram positive pathogen. Of the Gram positives isolates 6% were methicillin resistant S.aureus (MRSA). Polymyxin (77.8%) and tigecycline (72%) were most effective drugs against gram negative isolates were as gram positive organisms showed maximum sensitivity to vancomycin (90%) and linezolid (87%).
Conclusions: This study highlights the growing resistance to commonly used antibiotics; ampicillin, penicillin, ceftriaxone and ceftazidime and also highlights the importance of kleibsiella and Staphylococcus aureus as principal organism responsible for neonatal sepsis in tertiary care settings.
Tsering DC, Chanchal L, Pal R. Bacteriological profile of septicaemia and the risk factor in neonates and infants in Sikkim. Journal of global infectious diseases. 2011;3(1):42-5.
Jain A, Awasthi AK, Kumar M. Etiological and antimicrobial susceptibility profile of nosocomial blood stream infections in a neonatal intensive care unit. Indian journal of medical microbiology. 2007;25:299-300.
Kumbar GD, Ramachandran VG, Gupta P. Bacteriological analysis of blood culture isolates from neonates in tertiary care hospital in India. Journal of health population and nutrition. 2002;20:343-7.
Ducel G, Fabry J, Nicolle L. Prevention of hospital acquired infections. A Practical Guide. 2nd. Geneva,Switzerland. World Health Organisation. 2002.
Payne NR, Carpenter JH, Badger GJ, Horbar JD, Rogowski J. Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infection in surviving very low birth infants. Pediatrics. 2004;114(2):348-55.
Pennysylvania,USA. Clinical Laborotory and Standards Institutes;2011. Performance Standards for Antimicrobial Suseptibility Testings ;Twenty first informational supplement.M100-S21.
Robinson D, Kumar P, Cadichon S. Neonatal Sepsis in the Emergency Department. Pediatr Emerg Med. 2008;9(3):160-8.
Ahmed AS, Chowdary MA, Hoque M, Darmstadt GL. Clinical and bacteriological profile of neonatal septicaemia in a tertiary level pediatric hospital in Bangladesh. Indian Pediatri. 2002;39(11):1034-9.
Mathur M, Shah H, Dixit K, Khambadkone S, Chakrapani A, Irani S. Bacteriological profile of neonatal septicaemia cases (for the year 1990-91). J Post grad Med. 1994;40(1):18-20.
Loureiro MM, Moraes BA, Quadra MRR, Pinheiro GS, Asensi MD. Study of multi drug resistant microorganisms isolated from blood cultures of hospitalized newborns in Rio de janerio city,Brazil. Brazil J Microbiol. 2002;33(1):73-8.
Agnihotri N, Kaistha N, Gupta V. Antimicrobial susceptibility of isolates from neonatal septicaemia. Jpn J Infect Dis. 2004;57(6):273-5.
Wasant P, Srisimsapn C, Liammong-kolkul S, Svasti J. Urea cycle disorders in Thai infants: a report of 5 cases. J Med Ass Thailand. 2002;85(suppl 2):S720-31.
Lund AM, Christensen E, Skovby F. Diagnosis and acute treatment of inborn metabolic disease in infants. Ugeskrift for Laeger. 2002;164(48);5613-9.
Bansal S, Jain A, Agarwal J, Malik GK. Significance of caugulase negative staphylococci in neonates with late onset septicaemia. Indian J Pathol Microbiol. 2004;47:586-8.
Shresta P, Das BK, Bhatta NK, Jha DK, Das B, Setia A,et al. Clinical and bacteriological profile of blood culture positive sepsis in newborns. J Nepal Paediatr Soc. 2007;27(2):64-7.
Chow AW, Leake RD, Yamauchi T, Anthony BF, Guze LB. The significance of anaerobes in neonatal septicaemia :analysis of 23 cases and review of the literature. Pediatrics. 1974;54:736-45.
Thomas M, Padmini B, Srimathi G, Sunderrajan V, Raju BA. Microbiological profile of neonatal sepsis in Coimbatore .Indian J Pediatr. 1999;66:11-4.
Zaidi AKM, Knaut AL, Mirrett S, Reller LB.Value of routine of anaerobic blood culture for pediatric patients. J Pediatr. 1995;127:263-8.
Vergnano S, Sharland MWP, Mwansambo C. Health PT, Neonatal sepsis:An international perspective. Arch Dis Child Foetal Neonatal Ed. 2005;90:220-4.
Rajendraprasad BP, Basavaraj KN, Antony B. Bacterial spectrum of neonatal septicaemia with their antibiogram with refrence to various predisposing factors in a tertiary care hospital in southern India. Ann Trop Med Public Health. 2013;6:96-9.
Report of the National Neonatal Database .Report 2002 2003.NNPD Network. Assessed online from 2010.
Mane AK, Nagdeo NV, Thombare VR. Study of neonatal septicaemia in a tertiary care hospital in rural Nagpur. J Recent Advances Appl Sci. 2010;25:19-24.
Mustafa M, Ahmed SL. Bacteriological profile and antibiotic susceptibility patterns in neonatal septicaemia in view of emerging drug resistance. J Med Allied Sci. 2014;4:2-8.
Iregbu KC, Elegba OY, Babaniyi IB. Bacteriological profile of neonatal septicaemia in a tertiary care hospital in Nigeria .Afr Health Sci. 2006;66:151-4.
Huang YC, Su LH, Wu TL, Leu HS, Hsieh WS, Chang TM, et al. Outbreak of Acinetobacter baumanii bacteremia in a neonatal intensive care unit: clinical implications and genotyping analysis. Pediatr Infect Dis J. 2002;21(12):1105-9.
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in a very low birth weight neonates :the experience of the NICHD Neonatal Research Network. Pediatrics. 2002;110(2):285-91.
Tiskumara R, Fakhree SH, Liu CQ, Nuntnarumit P, Lui KM, Hammoud M, et al. Neonatal infections in Asia. Arch of Dis child fetal neonatal edition. 2009;94(2):144-8.
Urrea M, Iriondo M, Thio M, Krauel X, Serra M, LaTorre C, et al. A prospective incidence study of nosocomial infections in a neonatal care unit. American journal of Infection Control. 2003;31(8):505-7.
Kawagoe JY, Segre CAM, Pereira CR, Cardoso MFS, Silva CV, Fukushima JT. Risk factors for nosocomial infection in critically ill newborn: A 5 year prospective cohort study. American Journal Of Infection Control. 2001;29(2):109-14.
Karthikeyen G, Premkumar K. Neonatal sepsis: Staphylococcus as a predominant pathogen. Indian J Pediatr. 2001;68:715-7.