The Indian Journal of Pediatrics

, Volume 78, Issue 4, pp 413–417

Neonatal Sepsis in a Tertiary Care Hospital in South India: Bacteriological Profile and Antibiotic Sensitivity Pattern

  • Bambala Puthattayil Zakariya
  • Vishnu Bhat
  • Belgode Narasimha Harish
  • Thirunavukkarasu Arun Babu
  • Noyal Mariya Joseph
Original Article

Abstract

Objective

To identify the common bacterial pathogens associated with neonatal sepsis and their antibiotic susceptibility pattern.

Methods

This prospective observational cohort study was done in a tertiary care teaching hospital located in South India for a period of 2 years. All the admitted inborn and out born neonates during this study period were screened for sepsis based on the clinical features and septic screening. All infants satisfying the criteria for sepsis were subjected to blood culture. Growths, if any, were noted and standard antibiotic sensitivity testing was done by Kirby-Bauer disk diffusion method. The Chi-square test or Fisher’s exact test was used to compare two groups.

Results

Out of the 120 clinically suspected and positive screening test cases of neonatal sepsis, 41.6% (50 of 120) were culture-proven cases of neonatal sepsis. Klebsiella pneumoniae was isolated from 66% of culture positive cases followed by Coagulase-negative staphylococci in 12% of cases. Klebsiella pneumoniae was resistant to most of the antibiotics tested except amikacin and meropenem. Of the total 33 Klebsiella pneumoniae isolates, 16 (32.0%) were ESBL producers. The prevalence of ESBL producing Klebsiella pneumoniae during two month outbreak and rest of the study period was 83.3% (15 of 18) and 20% (3 of 15) respectively (P value 0.0010).

Conclusions

Klebsiella pneumoniae was the most common agent causing both early-onset and late-onset sepsis and significantly associated with sepsis in inborn babies. Amikacin should be used along with the third-generation cephalosporins for empirical treatment of gram-negative neonatal sepsis.

Keywords

Neonatal sepsis Bacteriological profile Klebsiella pneumoniae Antibiotic sensitivity 

References

  1. 1.
    Schaffner J, Chochua S, Kourbatova EV, et al. High mortality among patients with positive blood cultures at a children’s hospital in Tbilisi, Georgia. J Infect Dev Ctries. 2009;3:267–72.PubMedGoogle Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 3.
    Sundaram V, Kumar P, Dutta S, et al. Blood culture confirmed bacterial sepsis in neonates in a North Indian tertiary care center: changes over the last decade. Jpn J Infect Dis. 2009;62:46–50.PubMedGoogle Scholar
  4. 4.
    National Neonatal Perinatal Database. [Internet]. NNPD report 2002-03 [cited 2010 Sep 22]. Available from: http://www.newbornwhoccorg/pdf/nnpd_report_2002-03PDF; 2005.
  5. 5.
    Anderson-Berry AL, Bellig LL, Ohning BL. Neonatal sepsis. [Internet]. emedicine Pediatrics: Cardiac Disease and Critical Care Medicine 2010; 978352 [Updated 2010 Feb 23; Cited 2010 Sep 22]. Available from: http://emedicine.medscape.com/article/978352-overview.
  6. 6.
    Edmond K, Zaidi A. New approaches to preventing, diagnosing, and treating neonatal sepsis. PLoS Med. 2010;7:e1000213.PubMedCrossRefGoogle Scholar
  7. 7.
    Maayan-Metzger A, Barzilai A, Keller N, Kuint J. Are the “good old” antibiotics still appropriate for early-onset neonatal sepsis? A 10 year survey. Isr Med Assoc J. 2009;11:138–42.PubMedGoogle Scholar
  8. 8.
    Sanghvi KP, Tudehope DI. Neonatal bacterial sepsis in a neonatal intensive care unit: a 5 year analysis. J Paediatr Child Health. 1996;32:333–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Stoll BJ, Hansen N, Fanaroff AA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med. 2002;347:240–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Iregbu KC, Elegba OY, Babaniyi IB. Bacteriological profile of neonatal septicaemia in a tertiary hospital in Nigeria. Afr Health Sci. 2006;6:151–4.PubMedGoogle Scholar
  11. 11.
    Kuruvilla KA, Pillai S, Jesudason M, Jana AK. Bacterial profile of sepsis in a neonatal unit in south India. Indian Pediatr. 1998;35:851–8.PubMedGoogle Scholar
  12. 12.
    Chacko B, Sohi I. Early onset neonatal sepsis. Indian J Pediatr. 2005;72:23–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet. 2005;365:1175–88.PubMedCrossRefGoogle Scholar
  14. 14.
    Mackie TJ, McCartney JE. Practical medical microbiology. 14th ed. New York: Churchill Livingstone; 1996.Google Scholar
  15. 15.
    Clinical Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests. Approved standard, 9th ed. CLSI document M2-A9. Wayne, PA: CLSI; 2006.Google Scholar
  16. 16.
    Thomson KS, Sanders CC. Detection of extended-spectrum beta-lactamases in members of the family Enterobacteriaceae: comparison of the double-disk and three-dimensional tests. Antimicrob Agents Chemother. 1992;36:1877–82.PubMedGoogle Scholar
  17. 17.
    Sankar MJ, Agarwal R, Deorari AK, Paul VK. Sepsis in the newborn. Indian J Pediatr. 2008;75:261–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Rasul CH, Hassan MA, Habibullah M. Neonatal sepsis and use of antibiotic in a tertiary care hospital. Pak J Med Sci. 2007;23:78–81.Google Scholar
  19. 19.
    van den Hoogen A, Gerards LJ, Verboon-Maciolek MA, Fleer A, Krediet TG. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Neonatology. 2010;97:22–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Banerjee M, Sahu K, Bhattacharya S, Adhya S, Bhowmick P, Chakraborty P. Outbreak of neonatal septicemia with multidrug resistant Klebsiella pneumoniae. Indian J Pediatr. 1993;60:25–7.PubMedCrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2010

Authors and Affiliations

  • Bambala Puthattayil Zakariya
    • 1
  • Vishnu Bhat
    • 1
  • Belgode Narasimha Harish
    • 1
  • Thirunavukkarasu Arun Babu
    • 1
  • Noyal Mariya Joseph
    • 1
  1. 1.Departments of Pediatrics and MicrobiologyJawaharlal Institute of Post graduate, Medical Education and Research (JIPMER)PuducherryIndia

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