Blood culture and drug sensitivity in neonatal sepsis and its outcome
DOI:
https://doi.org/10.18203/2349-3291.ijcp20251470Keywords:
Multidrug resistant, Culture positive, NICU, Neonate, SepsisAbstract
Background: Nearly one-third of neonatal mortality in India is due to neonatal sepsis and death occurs in 30% of culture-positive neonates. Pathogens such as Klebsiella pneumoniae and Escherichia coli are the most common bacteria responsible for neonatal sepsis in India and South Asia.
Methods: It was a retrospective study conducted in newborn intensive care units (NICUs) of J. K. Lon Hospital, Government Medical College, Kota, Rajasthan from January 2024 to May 2024. All neonates (<28 days of life) with – symptoms of sepsis or presence of maternal risk factors of sepsis were included in this study. Blood was collected in a BACT/ALERT® culture bottle. Blood culture was done by an automated method in BD BACTEC FX40.
Results: Blood cultures were sent for 733 neonates out of which 209 were culture positive. Most common organism isolated was Klebsiella, second most common organism isolated was E. coli, third most common organism isolated was Staphylococcus aureus. Fourth most common organism was Pseudomonas and the rest were Acinetobacter, coagulase-negative Staphylococci (CoNS), Enterococcus and yeast. Mortality due to sepsis is 22%.
Conclusions: Klebsiella followed by E. coli was found to be the most common cause of sepsis in present study NICU. A high degree of resistance of organisms to Aminoglycosides and penicillin group particularly Amoxyclav calls for a re-evaluation of antibiotic policy and protocols for empirical treatment in neonatal sepsis.
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References
Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, 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(9966):430-40.
Chaurasia S, Sivanandan S, Agarwal R, Ellis S, Sharland M, Sankar MJ. Neonatal sepsis in South Asia: huge burden and spiralling antimicrobial resistance. BMJ. 2019;364:k5314.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81.
Jajoo M, Manchanda V, Chaurasia S, Sankar MJ, Gautam H, Agarwal R, et al; Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration, New Delhi, India. Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India. PLoS One. 2018;13(6):e0180705.
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(10):e752-60.
Hamer D, Young Infants Clinical Signs Study Group. Clinical signs that predict severe illness in children under age 2 months: a multi centre study. Lancet. 2008;371:135-42.
Jyothi P, Basavaraj MC, Basavaraj PV. Bacteriological profile of neonatal septicemia and antibiotic susceptibility pattern of the isolates. J Nat Sci Biol Med. 2013;4:306-9.
M100Ed32 | Performance Standards for Antimicrobial Susceptibility Testing. Clinical & Laboratory Standards Institute. Available at: https://www.clsi.org/standards/products/microbiology/documents/m100/2021. Accessed on 25 March 2025.
Pillai MM, Latha R, Sarkar G. Detection of methicillin resistance in Staphylococcus aureus by polymerase chain reaction and conventional methods: a comparative study. J Lab Phys. 2012;4:83-8.
Yadav SK, Agrawal SK, Singh SK, Giri A, Singh GK, Ghimire R, et al. Antimicrobial resistance in neonates with suspected sepsis. Public Health Action. 2021;11(1):6-12.
Sorsa A, Früh J, Stötter L, Abdissa S. Blood culture result profile and antimicrobial resistance pattern: a report from neonatal intensive care unit (NICU), Asella teaching and referral hospital, Asella, South East Ethiopia. Antimicrob Resist Infect Control. 2019;8:42.
Yadav SK, Giri A. Bacteriological profile of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Eastern Nepal. J Coll Med Sci Nepal. 2019;15:93-7.
Jatsho J, Nishizawa Y, Pelzom D, Sharma R. Clinical and bacteriological profile of neonatal sepsis: a prospective hospital-based study. Int J Pediatr. 2020;2020:1835945.
Pandit BR, Vyas A. Clinical symptoms, pathogen spectrum, risk factors and antibiogram of suspected neonatal sepsis cases in tertiary care hospital of Southern part of Nepal: a descriptive cross-sectional study. J Nepal Med Assoc. 2020;58:976-82.
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.
Darmstadt GL, Zaidi AKM, Stoll BJ. Infectious Diseases of the Fetus and Newborn Infant. Neonatal infections: a global perspective. Philadelphia: Elsevier. 2011;24-51.
Shaikh M, Hanif M, Gul R, Hussain W, Hemandas H, Memon A. Spectrum and antimicrobial susceptibility pattern of micro-organisms associated with neonatal sepsis in a hospital in Karachi, Pakistan. Cureus. 2020;12:10.
Karthikeyan G, Premkumar K. Neonatal sepsis: Staphylococcus aureus as the predominant pathogen. Indian J Pediatr. 2001;68:715-7.
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;6:735-8.
Basnyat B, Pokharel P, Dixit S, Giri S. Antibiotic Use, Its Resistance in Nepal and Recommendations for Action: A Situation Analysis. J Nepal Health Res Counc. 2015;13(30):102-11.
Rath S, Panda S, Nayak M, Pradhan DD. Blood culture positive sepsis and sensitivity pattern in a tertiary care neonatal centre in eastern India. Int J Contemp Pediatr. 2019;6:487.
Viswanathan R, Singh AK, Ghosh C, Dasgupta S, Mukherjee S, Basu S. Profile of neonatal septicaemia at a district-level sick newborn care unit. J Health Popul Nutr. 2012;30:41-8.
Network NNPD. New Delhi, India: Department of Pediatrics, All India Institute of Medical Sciences. National neonatal-perinatal database (report 2002-2003). 2005.
Panda SK, Nayak MK, Jena P, Rath S, Gudu R, Pugulia R, et al. Nonfermenting, Gram-negative bacilli causing neonatal sepsis in Odisha, India: four-year surveillance. Cureus. 2022;14:10.
Agnihotri N, Kaistha N, Gupta V. Antimicrobial susceptibility of isolates from neonatal septicemia. Jpn J Infect Dis. 2004;57:273-5.
Ansari S, Nepal HP, Gautam R, Shrestha S, Neopane P, Chapagain ML. Neonatal septicemia in Nepal: early-onset versus late-onset. Int J Pediatr. 2015;2015:379806.
Li X, Ding X, Shi P, Zhu Y, Huang Y, Li Q, et al. 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.
Thapa B, Thapa A, Aryal DR, Thapa K, Pun A, Khanal S, et al. Neonatal sepsis as a major cause of morbidity in a tertiary center in Kathmandu. JNMA J Nepal Med Assoc. 2013;52(192):549-56.