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Indian Pediatr 2015;52: 158-159 |
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Bacteriological Profile of Neonatal Sepsis in
a Tertiary-care Hospital of Northern India
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Poonam Marwah, Deepak Chawla,
#Jagdish
Chander, Vishal Guglani and *Ashish Marwah
From Department of Pediatrics GMCH, Chandigarh and *BPS
GMC for women, Khanpur Kalan,
Sonepat, Haryana; and #Department of Microbiology, GMCH, Chandigarh,
India.
Email: [email protected]
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With an objective to study
the bacteriological profile of neonatal sepsis a retrospective study was
conducted in the neonatal unit of a referral teaching hospital in
Northern India. Among neonates born over 5-year period (n=22363)
incidence of culture-positive sepsis was 7.5/1000 live births (7.5%).
Staphylococcus aureus (47.3%), Klebsiella pneumonia (14.9%)
and Acinetobacter (14.9%) were most common organisms isolated.
Sensitivity pattern of isolated organisms is presented.
Key words: Antibiotics, Neonate, Sepsis.
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Systemic infections cause 1.6 million neonatal deaths every year,
majority in middle and low income countries [1]. South-east Asian
studies report high resistance to antibiotics used commonly for
empirical treatment of neonatal sepsis [2]. Widespread use of
third-generation cephalosporins and lack of reliance on blood culture
reports could be a major cause for this resistance. This study was
planned to evaluate causative organisms of neonatal sepsis and their
antibiotic sensitivity pattern in a setting with negligible
third-generation cephalosporin use.
After approval from Institute ethics committee, blood
culture records of inborn neonates born from January 2008 to December
2012 in a tertiary care hospital were screened. Detailed information was
extracted from case records of neonates with positive blood culture.
Neonates with perinatal risk factors or clinical features suggestive of
sepsis were investigated for bacterial sepsis. Standard procedures were
followed for sample collection, studying bacterial growth and antibiotic
sensitivity patterns [3,4].
For empirical treatment of early-onset sepsis (EOS) intravenous
ciprofloxacin and amikacin, and for nosocomial late-onset sepsis (LOS),
intravenous piperacillin-tazobactam and vancomycin, were administered.
Antibiotic policy was based on periodic review of the culture
sensitivity pattern. Cephalosporins were not used unless identified as
solitary antibiotic to which isolated bacteria were sensitive.
Among 22363 live births, 883 were screened for sepsis
and 167 (7.5/1000 live birth) had culture proven sepsis. Of these, 142
(85%) had EOS and 25 (15%) had LOS. Staphylococcus aureus (47.3%)
was commonest isolated organism followed by Klebsiella pneumoniae
(14.9%) and Acinetobacter (14.9%). EOS was caused by S. aureus
(50.7%) followed by K. pneumoniae (14.8%) and Acinetobacter
(12.7%). LOS was caused by S. aureus (28%), Acinetobacter
(28%), E. coli (16%) and K. pneumoniae (16%). The
antibiotic sensitivity pattern for common organisms is shown in
Table I.
TABLE I Sensitivity Pattern of Main Organisms Isolated in the Study
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S. aureus (n=79) |
K. pneumoniae (n=25) |
Acinetobacter (n=25)
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E. coli (n=11)
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Penicillin G |
4/37 |
0/1
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0/1 |
0/1 |
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Oxacillin |
35/68 (51.5) |
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Ampicillin |
3/8 (37.5) |
2/3 (66.7) |
1/5 (20) |
0/2 (0) |
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Piperacillin |
1/4 (25) |
6/13 (44.5) |
6/12 (50) |
3/5 (60) |
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Imipenem
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13/14 (92.8) |
5/10 (50) |
6/7 (85.7) |
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Cefotaxime |
3/3 (100) |
2/3 (66.7) |
4/8 (50) |
2/3 (66.7) |
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Ceftazidime |
0/3 (0) |
3/13 (23) |
4/15 (26.7)
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3/5 (60) |
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Gentamicin |
37/43 (86) |
1/4 (25) |
1/4 (25) |
3/4 (75) |
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Amikacin |
4/8 (50) |
17/22 (77.2)
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7/19 (36.8) |
8/10 (80) |
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Ciprofloxacin |
32/48 (66.7) |
9/17 (53) |
8/19 (42.1) |
4/11 (36.3) |
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Vancomycin |
39/39 (100) |
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1/1 (100)
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Linezolid |
35/35 (100) |
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Colistin |
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4/4 (100) |
8/9 (88.9) |
0/1 (0) |
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Polymyxin B |
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3/3 (100) |
6/6 (100) |
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Incidence of blood culture proven sepsis was
comparable to the largest dataset reported from tertiary care hospitals
of India [5]. EOS constituted majority (85%) of culture-proven cases in
our study as we included only intramural babies. The spectrum of
pathogens in India and south-east Asian countries is different from
Western data where group B streptococci and coagulase negative
staphylococci (CONS) are the predominant pathogens [6].
Gram-negative bacilli are predominant pathogens in
developing countries with K. pneumoniae being the most common
[5,7]. Recently, S. aureus has emerged as predominant pathogen in
studies from developing countries [8-10]. This changing pattern of
organisms from gram negative to gram positive has been attributed to
prolonged stay, improved intensive care facilities and invasive
procedures [9]. The higher
rates of S. aureus sepsis in both EOS and LOS and a similar
profile of isolated bacteria indicate that majority of EOS in inborn
babies may be hospital-acquired rather than maternally acquired [7]. We
observed high resistance to oxacillin but good sensitivity to
aminoglycosides, vancomycin and linezolid among S. aureus
isolates. Low cephalosporin resistance was noticed in this study,
probably due to uncommon use of this drug in our unit [7].
Limitations of our study include its retrospective
nature, and not testing sensitivity of all organisms against similar set
of antibiotics. Of all isolates, 58% were sensitive to either
ciprofloxacin or amikacin which are our units first line antibiotics
for EOS. Although not approved for use in neonates, ciprofloxacin is
widely used and is the cornerstone for empirical treatment of neonatal
sepsis in regions with high degree of resistance to cephalosporins.
Contributors: DC: conceived the study,
analyzed data and revised the manuscript for important intellectual
content. He will act as the guarantor; PM: data collection, literature
search and manuscript writing; JC, VG: data analysis and review of the
literature; AM: reviewed the literature, manuscript writing.
Funding: None; Competing interests:
None stated.
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