DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20222766
Published: 2022-10-27

Clinical and bacteriological profile of neonatal sepsis: a prospective hospital-based study in a tertiary care hospital in eastern zone of West Bengal

Mousumi Das, Ira Das, Sudip Saha, Saptadweepa Sanghamitra

Abstract


Background: Neonatal sepsis remains a leading cause of morbidity and mortality among neonates and clinical manifestations are non-specific. Delayed identification and inappropriate treatment remain as key factors causing high neonatal mortality. Increasing emergence of multidrug-resistant organisms reduces antibiotic options. Hence there is a need for institutional guidelines based on local microbial prevalence and their antibiotic susceptibility patterns.

Methods: Blood cultures were collected from all suspected cases prior to the initiation of antimicrobial therapy. Neonatal sepsis with positive blood culture cases is included in the study.

Results: Among 170 neonate blood culture was positive in 41 neonates (preterm - 71% and term neonate - 29%). Early onset neonatal sepsis (EONS) constituted 61% and Late onset neonatal sepsis (LONS) constituted 39%. Respiratory distress, hypoglycaemia, seizures, lethargy were more common presentations in EONS while cellulitis, sclerema, septic arthritis, loose stool, vomiting, blood in stool, hyperthermia and recurrent apnoea were more common presentations in LONS. Gram positive organisms constituted 51.2%, gram negative organisms were 46.3%, fungi were 9.8% of total pathogens. Among gram positive cons (43.9%) was most common while amongst gram negative Klebsiella (22%) was most common. Candida peliculosa was the most commonly isolated fungus. Cons, staphylococcus and enterococcus were seen to be 100% sensitive to linezolid. Enterococcus also showed 100% sensitivity to vancomycin, teicoplanin and tigecycline. Gram-positive bacteria showed the highest sensitivity to linezolid and vancomycin. Acinetobacter baumanii showed 80% sensitivity to gentamicin, 60% sensitivity to tigecycline and colistin. E. coli showed 66% sensitivity to tigecycline.

Conclusions: We were able to analyze common causative pathogens, associated risk factors, and the antibiotic susceptibility pattern of neonatal sepsis.


Keywords


Neonatal sepsis, Microorganisms, Antibiotic pattern

Full Text:

PDF

References


Gebremedhin D, Berhe H, Gebrekirstos K. Risk Factors for Neonatal Sepsis in Public Hospitals of Mekelle City, North Ethiopia, 2015: Unmatched Case Control Study. Plos One. 2016;11(5):e0154798.

Sindhura YS, Reddy RK. A study of neonatal thrombocytopenia in Neonatal Sepsis. Int J Contemp Med Res. 2017;4 2250-2.

Seale AC, Blencowe H, Manu AA, Nair H, Bahl R, Qazi SA, Zaidi AK, Berkley JA, Cousens SN, Lawn JE. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis. Lancet Infect Dis. 2014;14(8):731-41.

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

Wu JH, Chen CY, Tsao PN, Heseih WS, Chou HC. Neonatal sepsis a 6-year analysis in a neonatal care unit in Taiwan. Pediatr Neonatol. 2009;50(3):88-95.

Patel SJ, Saima I. Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact and prevention including antibiotic stewardship. Clin Perinatol. 2010;37(3):547-63.

Vaniya HV, Patel NM, Agrawal JM, Trivedi HR, et al. Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact and prevention including antibiotic stewardship. Int J Med Sci Publ Health. 2016;5:661-5.

English M, Ngama M, Mwalekwa L, Peshu N: Sign and Symptoms of illness in Kenyan Infants aged less than 60 days. Bulletin of the WHO. 2004;82:323-9.

Klingenberg C, Olomi R, Oneko M, Sam N, Langeland N: Neonatal morbidity and Mortality in Tanzanian tertiary care referral hospital. Ann of Trop Paediatr. 2003;23:293-9.

Iregbu KC, Elegba OY, Babaniyi IB. Bacteriological profile of neonatal septicemia in a tertiary Hospital in Nigeria. Afr Health Sci. 2006;6(3):151-4.

Mugalu J, Nakakeeto MK, Kiguli S, Kaddu-Mullindwa DH: Aetiology, risk factors and immediate outcome of bacteriologically confirmed neonatal septicaemia in Mulago hospital, Uganda. Afr Health Sci. 2006;120-6.

Belachew, A., Tewabe, T. Neonatal sepsis and its association with birth weight and gestational age among admitted neonates in Ethiopia: systematic review and meta-analysis. BMC Pediatr. 2020;20:55.

Benitz WE, Gould JB, Druzin ML. Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics. 1999;103(6):e77.

Chacko B, Sohi I. Early onset neonatal sepsis. Indian J Pediatrics. 2005;72:23-6.

Utomo MT, Sumitro KR, Etika R, Widodo ADW. Current-proven neonatal sepsis in Indonesian tertiary neonatal intensive care unit: a hematological and microbiological profile. Iran J Microbiol. 2021;13(3):266-73.

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

El-Din EMRS, El-Sokkary MMA, Bassiouny MR, Hassan R. Epidemiology of Neonatal Sepsis and Implicated Pathogens: A Study from Egypt. BioMed Res Int. 2015;509484.

Tania R, Anisur RM, Kamrunnahar A. Distribution of Microorganisms in Neonatal Sepsis and Possible Outbreak of Enterobacter spp. in Neonatal Intensive Care Unit. KYAMC J. 2020;11(1):14-20.

Shaw CK, Shaw P, Thapalial A. Neonatal sepsis bacterial isolates and antibiotic susceptibility patterns at a NICU in a tertiary care hospital in western Nepal: A Retrospective Analysis. KUMJ. 2007;5:153-60.

Shah AJ, Mulla SA, Revdiwala SB. Neonatal sepsis: High antibiotic resistance of the bacterial pathogens in a neonatal intensive care unit of a tertiary care hospital. J Clin Neonatol. 2012;1:72-5.

Ghotaslou R, Ghorashi Z, Nahaei MR. Klebsiella pneumoniae in neonatal sepsis: A 3- year study in pediatric hospital of Tabriz, Iran. JPN J Infect Dis. 2007;60:126-8.

Khatua SP, Das AK, Chatterjee BD, Khatua S, Ghose B, Shaha A. Neonatal septicaemia. Indian J Paediatr. 1986;53:509-14.

Klein JO, Marcy SM. Bacterial sepsis and meningitis. In: Klein, Remington JS eds. Infectious disease of the fetus and newborn infant. 4th ed. WB Saunders: Philadelphia. 1995.

Misra RN, Jadhav SV, Ghosh P, Gandham N, Angadi K, Vyawahare C. Role of sepsis screen in the diagnosis of neonatal sepsis. Med J Dr D.Y. Patil Vidyapeeth. 2013;6(3):254-7.

Hisamuddin E, Hisam A, Wahid S, Raza G. Validity of C-8 reactive protein (CRP) for diagnosis of neonatal sepsis. Pak J Med Sci. 2015;31(3):527-31.

Mair RJ, Joy AH, Finney H, Weaver A. Creating an algorithm for requesting C-reactive protein in the emergency department. Eur J Emerg Med. 2010;17(2):125-6.

Pepys MB. C reactive Protein. Fifty years on. Lancet. 1981;1:653-7.

Ain E, Cabata EE, Guzman DM. Serum CRP and problems of Newborn infant. J Pediatr. 1982;101:438-40.

Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Late onset sepsis in very low birth weight neonates. Report from National Institute of child health and human development Neonatal research Net work. J Pediatr. 1996;129(1):63-71.

Ogundare E, Akintayo A, Aladekomo T, Adeyemi L, Ogunlesi T, Oyelami O. Presentation and outcomes of early and late onset neonatal sepsis in a Nigerian Hospital. Afr Health Sci. 2019;19(3):2390-9.

Li X, Ding X, Shi P, Zhu Y, Huang Y, Li Q, Lu J, Li Z, Zhu L. Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital, 2013 to 2017. Medicine (Baltimore). 2019;98(12):e14686.

Almohammady MN, Eltahlawy EM, Reda NM. Pattern of bacterial profile and antibiotic susceptibility among neonatal sepsis cases at Cairo University Children Hospital. J Taibah Univ Med Sc. 2020;15(1):39-47.

Shehab El-Din EM, El-Sokkary MM, Bassiouny MR, Hassan R. Epidemiology of neonatal sepsis and implicated pathogens: a study from Egypt. BioMed Res Int. 2015;509484:11.

Yadav NS, Sharma S, Chaudhary DK, Panthi P, Pokhrel P, Shrestha A, et al. Bacteriological profile of neonatal sepsis and antibiotic susceptibility pattern of isolates admitted at Kanti Children's Hospital, Kathmandu, Nepal. BMC Res Notes. 2018;11:301.

Pokhrel B, Koirala T, Shah G, Joshi S, Baral P. Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal. BMC Pediatr. 2018;18(1):208.

Shrestha S, Shrestha NC, S. Dongol, R.P.B. Shrestha, S. Kayestha, M. Shrestha.Bacterial isolates and its antibiotic susceptibility pattern in NICU. Kathmandu Univ Med J. 2013;4.1(1):66-70.

Ahmed F, Raj AY, Nahar L, Hasan Z. Antimicrobial resistance of bacterial pathogens in a neonatal intensive care unit. BSMMU J. 2018;11:25-8.

Sharma CM, Agrawal RP, Sharan H, Kumar B, Sharma D, Bhatia SS. Neonatal Sepsis: bacteria & their susceptibility pattern towards antibiotics in neonatal intensive care unit. J Clin Diagn Res. 2013;7(11):2511-3.