Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary care medical institute of Eastern India: A retrospective cross-sectional study

Sunil Kishore, Rizwan Ahmar, Manish Kumar, Richa Gupta, Anand Kumar Gupta, Rakesh Kumar, Shambhavi Sharan, Jayant Prakash

Abstract


Background: According to WHO neonatal sepsis is the most important reason for morbidity and mortality in the neonatal period. By the knowledge of bacteriological flora and their antibiotic susceptibility pattern, we can decrease the mortality and morbidity. Multidrug antibiotic resistance is also increasing day by day in neonatal intensive care units. So our aim of the study was to find out the bacteriological profile and antibiotic susceptibility pattern in the NICU of Indira Gandhi Institute of Medical Sciences, a tertiary teaching hospital in Bihar.
Materials and Methods: A retrospective analysis of all blood culture positive sepsis cases among neonates admitted to the neonatal intensive care unit of Indira Gandhi Institute of Medical Sciences Patna Bihar from Feb16, 2019, and Feb 15, 2020, was attempted. Neonate with a risk factor of sepsis having positive blood culture was analyzed bacteriologically and antibiotic sensitivity pattern was identified.
Results: Out of 168 neonates admitted in the NICU, Blood culture reports were positive in 60 cases (35.71%). Among the culture-positive cases, there were 34 (56%) males and 26 (44%) females. Lateonset sepsis (LOS, 56%) higher than Early-onset sepsis (EOS, 44%). Organism isolated were Gramnegative
bacilli (19/60, 31.6%), Gram-positive cocci (34/60, 56.6%), and yeast-like fungi (7/60, 11.6%). Klebsiella spp. was the most common cause of early-onset sepsis (8/26, 30.7%) and coagulase-negative staphylococci (CoNS) was the most common cause of late-onset sepsis (n= 12/34; 35%). Gram-negative
bacteria (GNB) showed the highest resistance to ampicillin (89.47%), All the Gram-negative bacteria isolates were 100% sensitive to colistin. Methicillin resistance was detected in 44% (n=8/18) of coagulasenegative staphylococci and 62% (n=8/13) of Staphylococcus aureus. Vancomycin is sensitive to almost all the isolates of coagulase-negative staphylococci, Staphylococcus aureus, and enterococci.
Conclusions: In our study CoNS and Klebsiella were the most common causes of neonatal sepsis. Most isolated pathogens showed a high degree of antimicrobial resistance, not only to commonly used antibiotics but also to reserve antibiotics such as extended-spectrum cephalosporins and carbapenems. It is also concluded that indiscriminate use of third-generation cephalosporins, may be responsible for the selection of ESBL-producing multi-drug resistant strains in the neonatal intensive-care unit (NICU). Preventive strategies are necessary to decrease the emergence of antibiotic resistance. 

Keywords: Bacteriological profile, Antibiotic susceptibility, Klebsiella, Multidrug resistance, Neonatal sepsis.


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