Microbial profile of neonatal sepsis and antibiotic resistance from a tertiary care hospital in South India
Authors: Arunava Kali,Kalaivani Ramakrishnan*,Pravin Charles M. V,Sreenivasan Srirangaraj,Seetha K.S
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Introduction: Neonatal sepsis is a major cause of neonatal mortality, the clinical outcome of which depends on early diagnosis and initiation of appropriate antibiotics. The emergence of multi-drug resistant strains has limited the choice of available antibiotics. Thus, antibiotic resistance pattern of pathogens iscritical for both therapy and infection control.
Objective: To determine the etiological agents of neonatal sepsis and their antibiotic resistance pattern.
Materials and Methods: In this study, all neonates with suspected sepsis, admitted to neonatal intensive care unit during January to December, 2014 were included. Aerobic blood culture was done using BACTEC FX system. Identification and antibiotic susceptibility testing of isolates from positive cultures was carried out.
Results: Out of 522 neonates who developed clinical sepsis, 64 grew pathogens on blood culture. The most common organisms were coagulase negative Staphylococcus species (CONS)(32.8%), Klebsiella pneumoniae (18.7%), Escherichia coli (9.4%), Enterococcus faecalis (7.8%) and Candida species (7.8%). The gram negative isolates showed high resistance to ampicillin (90%), gentamicin (70%), ceftriaxone (66.7%), cotrimoxazole (56.7%), amikacin (53.3%) and ciprofloxacin (43.3%). In contrast, imipenem (16.7%), piperacillin-tazobactam (26.7%) and cefepime-tazobactam (0%) were effective with lower resistance rates. A large majority of the Enterobactericeae isolates (66.7%) were extended spectrum beta-lactamase producers. Among the gram positive isolates, resistance to penicillin, erythromycin and ciprofloxacin were 93.1%, 62.1%and 51.7% respectively. These strains showed uniform sensitivity to vancomycin, teicoplanin and linezolid.
Conclusion: While CONS were the predominant isolate, gram negative bacilli and Enterococcus sp have shown high resistance to commonly used antibiotics. Low resistance was observed with Cefepime-tazobactam, imipenem (for gram-negative isolates) and vancomycin, teicoplanin and linezolid (for gram-positive isolates) in our study.