A study of infections in neonatal intensive care unit at a tertiary care hospital


  • Hemangi D Ingale Department of Microbiology, B.J. Govt. Medical College and Sassoon General Hospital, Pune, Maharashtra, India
  • Vaishali A. Kongre Department of Microbiology, B.J. Govt. Medical College and Sassoon General Hospital, Pune, Maharashtra, India
  • Renu S. Bharadwaj Department of Microbiology, B.J. Govt. Medical College and Sassoon General Hospital, Pune, Maharashtra, India




Neonatal infection, Meningitis, Pneumonia, Risk factors, Septicemia


Background: As infection is a major cause of morbidity and mortality in neonates, early diagnosis and prompt treatment can prevent its serious consequences. The present study was conducted to determine the prevalence of infections in neonatal intensive care unit (NICU) of a tertiary care hospital and to study their risk factors, causative organisms and antimicrobial susceptibility pattern.

Methods: Appropriate samples were collected from all neonates with clinical signs and symptoms of infections. Isolation of microorganisms, their identification and antimicrobial susceptibility was done according to standard microbiological techniques.

Results: Among 1210 neonates admitted in the NICU, 393 (32.4%) were clinically suspected infections. The prevalence of Septicemia, Pneumonia, and Meningitis were 6%, 1.5%, 0.7% respectively. The predominant organisms causing neonatal infection were Gram negative bacteria followed by fungi and Gram positive bacteria. Among Gram negative bacteria, the antimicrobial resistance was highest for third generation Cephalosporins [Ceftazidime (81.1%), Cefotaxime (60.3%)]. In Gram positive bacteria highest resistance was observed for Penicillin and Ampicillin (91.3%). Methicillin resistance was observed in 91.6% of Coagulase negative Staphylococci (CoNS). All isolates of Candida parapsilosis were sensitive to Fluconazole, Voriconazole but resistant to Amphotericin B. Predominant risk factors were low birth weight (87.7%) and prematurity (75%). Maternal risk factors were pregnancy induced hypertension (13.4%) and premature rupture of membranes (PROM) (10.1%). The case fatality rate was 20.7%.

Conclusions: There is a need of strict infection control measures and rational antibiotic policy to reduce the economic burden of hospital and community due to neonatal infections. 


Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002 Aug; 110(2 Pt 1):285-91.

Koneman EW, Allen SD, Janda WN, Schreckenberger PC, Winn WC. Colour atlas and textbook of Dignostic Microbiology.6th ed. Philadelphia: Lippincott; 2006.

Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty Third Informational Supplement. CLSI document M 100-S23.Wayne, PA: Clinical and Laboratory Standard Institute; 2013.

Yong D, Lee K, Yum JH, Shin HB, Rossolini GM, Chong Y. Imipenem-EDTA disk method for differentiation of metallo-beta-lactamases producing clinical isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol. 2002 Oct;40(10):3798-801.

Clinical and Laboratory Standards Institute (CLSI). Methods for Antifungal Disk Diffusion Susceptibility Testing of Yeasts; Approved Guideline- Second Edition. CLSI document M44-A2. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.

Clinical and Laboratory Standards Institute (CLSI). Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts; Approved Standard - 3rd Ed. CLSI document M27-A3. Wayne, PA: Clinical and Laboratory Standards Institute; 2008.

Ghai OP, Gupta P, Paul VK. Ghai Essential Pediatrics. 6th Ed. New Delhi: CBS publishers; 2004.

Shah M, Desai P. Clinical and Microbiological profile of neonatal infections in the neonatal intensive care unit. Int Res J Medical Sci. 2013 Sept;1(8):15-8.

Mehar V, Yadav D, Somani P, Bhatambare G, Mulye S, Singh K. Neonatal sepsis in tertiary care center in central India: Microbiological profile, antimicrobial sensitivity pattern and outcome. J neonatal Perinatal Med. 2013;6(2):165-72.

Nayak S, Rai R, Kumar VK, Sanjeev H, Pai AKB, Ganesh HR. Distribution of microorganisms in neonatal sepsis and antimicrobial susceptibility pattern in a tertiary care hospital. Arch Med Health Sci. 2014;2(2):136-9.

Swarnkar K, Swarnkar M. A study of early onset neonatal sepsis with special reference to sepsis screening parameters in a tertiary care centre of rural India. Internet J Infect Dis. 2012;10(1).

Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungal sepsis in very low birth weight infants. Clin Microbiol Rev. 2004 Jul;17(3):638-80.

Movahedian AH, Moniri R, Mosayebi Z. Bacterial culture of neonatal sepsis. Iranian J Publ Health. 2006;35(4):84-9.

Kuruvilla KA, Pillai S, Jesudason M, Jana AK. Bacterial profile of sepsis in a neonatal unit in south India. Indian Pediatr. 1998 Sep;35(9):851-8.

Dennehy PH. Respiratory infections in the newborn. Clin Perinatol. 1987 Sept;14(3):667-82.

Garenne M, Ronsmans C, Campbell H. The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries. World Health Stat Q. 1992;45(2-3):180-91.

Bentlin MR, Ferreira GL, Rugolo LM, Silva GH, Mondelli AL, Rugolo JA. Neonatal meningitis according to the microbiological diagnosis: A decade of experience in a tertiary center. Arq Neuropsiquiatr. 2010 Dec;68(6):882-7.

Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Pediatr Infect Dis J. 2009 Jan;28(1):S3-9.

Tallur SS, Kasturi AV, Nadgir SD, Krishna BV. Clinico-bacteriological study of neonatal septicemia in Hubli. Indian J Pediatr. 2000 Mar;67(3):169-74.

West BA, Tabansi PN. Prevalence of neonatal septicemia in the University of Port Harcourt Teaching hospital,Nigeria. Niger J Pead, 2014;41(1): 33-7.

Gosalia E, Mistry M, Goswami Y, Gosalia V, Vasa P. A bacteriological profile of neonatal septicaemia (Study in tertiary care hospital, Rajkot). NJIRM. 2013;4(2):44-7.

Ibrahim SA, Rahma S. Microbiological profile of neonatal septicemia. The Iraqi Postgraduate Med J. 2012;11(1):13-8.

Desai KJ, Malek SS. Neonatal septicaemia. Bacterial isolates and their antibiotic susceptibility pattern. NJIRM. 2010;1(3):12-5.

Ballot DE, Nana T, Sriruttan C, Cooper PA. Bacterial bloodstream infections in neonates in a developing country. ISRN Pediatr. 2012:508512.

Vinodkumar CS, Kalappaanavar NK, Patil U, Basavrajappa KG. Change in spectrum of microbial etiology in relation to gestational age and birth weight and emergence of ESBL in tertiary neonatal intensive care units. Int J Biol Med. Res. 2011;2(3):727-34.

Premlatha DE, Koppad M, Halesh LH, Siddesh KC, Prakash N. The bacterial profile and antibiogram of neonatal septicemia in a tertiary care hospital. International J Recent Trends Science and Technology (IJRTSAT). 2014;10(3):451-5.

Schuchat A, Zywicki SS, Dinsmoor MJ, Mercer B, Romaguera J, O’Sullivan MJ et al. Risk factors and opportunities for the prevention of early - onset neonatal sepsis: a multicenter case-control study. Paediatrics. 2000 Jan;105(1 pt 1):21-6.

Ahmed A, Lutfi S, PV Rouf A, Hail MA, Rahman S, Kassim WE, et al. Incidence of bacterial isolates from blood culture in the neonatal intensive care unit of tertiary care hospital. Int J Drug Dev Res. 2012 Oct- Dec;4(4):359-67.

Agarwal J, Bansal S, Mailk GK, Jain A. Trends in neonatal septicemia: Emergence of non-albican Candida. Indian Pediatr. 2004 Jul;41(7):712-5.

Goel N, Ranjan PK, Aggarwal R, Chaudhary U, Sanjeev N. Emergence of non albicans Candida in neonatal septicemia and antifungal susceptibility: Experience from a tertiary care center. J Lab Physicians. 2009 Jul;1(2):53-5.

Tripathi S, Malik GK, Jain A, Kohli N. Study of ventilator associated pneumonia in neonatal intensive care unit: Characteristics, risk factors and outcome. Internet J Med Update. 2010 Jan;5(1):12-9.

Mathur NB, Garg K, Kumar S. Respiratory distress in neonates with special reference to Pneumonia. Indian Pediatr. 2002 Jun;39(6):529-37.

Webber S, Wilkinson AR, Lindsell D, Hope PL, Dobson SR, Isaacs D. Neonatal pneumonia. Arch Dis Child. 1990 Feb;65(2):207-11.

Garges HP, Moody MA, Cotton CM, Smith PB, Tiffany KF, Lenfestey R, et al. Neonatal meningitis: What is the correlation among cerebrospinal fluid cultures, blood cultures and cerebrospinal fluid parameters? Pediatrics. 2006 Apr;117(4):1094-100.

Aletayeb MH, Ahmad FS, Masood D. Eleven-year study of causes of neonatal bacterial meningitis in Ahvaz, Iran. Pediatr Int. 2010 Jun;52(3):463-6.

Aurangzeb B, Hameed A. Neonatal sepsis in hospital-born babies:bacterial isolates and antibiotic susceptibility patterns. J Coll Physicians Surg Pak 2003 Nov;13(11):629-32.

Mane AK, Nagdeo NV, Thombare VR. Study of neonatal septicemia in a tertiary care hospital in rural Nagpur. JRAAS. 2010;25:19-24.

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. Kathmandu univ Med J (KUMJ). 2007Apr-Jun;5(2):153-60.

Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Meis JF, Gould IM, et al. Results from the ARTEMIS DISK global antifungal surveillance study, 1997 to 2005: An 8.5- year analysis of susceptibilities of Candida species and other yeast species to Fluconazole and Voriconazole determined by CLSI standardized disk diffusion testing. J Clin Microbiol. 2007 Jun;45(6):1735-45.

Ostrosky-Zeichner L, Rex JH, Pappas PG, Hamill RJ, Larsen RA, Horowitz HW, et al. Antifungal susceptibility survey of 2,000 bloodstream Candida isolates in the United States. Antimicrob Agents Chemother. 2003 Oct;47(10):3149-54.

Jumah DS. Hassan MK. Predictors of mortality outcome in neonatal sepsis. MJBU. 2007;25(1):12-8.






Original Research Articles