Abstract

TO STUDY THE BACTERIOLOGICAL PROFILE OF COMMUNITY ACQUIRED AND HOSPITAL ACQUIRED NEONATAL SEPSIS AND TO STUDY THE SENSITIVITY OF THE CAUSATIVE ORGANISMS TO ANTIBIOTICS

Sheikh Quyoom Hussain*, Irfan Qayoom and Adil Ramzan

Abstract

Background: Neonatal septicemia or sepsis neonatorum refers to systemic infection of the new born. It is a clinical syndrome of systemic illness accompanied by bacteremia occurring in the first month of life. Prompt recognition, appropriate antimicrobial therapy and judicious supportive care are the key determinants of positive outcome in this serious pediatric emergency. Sepsis is the commonest cause of neonatal mortality and is probably responsible for 30% - 50% of the neonatal deaths each year in developing countries. The reported incidence of neonatal sepsis is 38 per 1000 live births in Asia. The incidence is lower in western countries. According to Neonatal Perinatal Database (NNPD) last reported data collected in 2002-2003 from 18 various parts of India, the incidence of neonatal sepsis has been reported to be 29 per 1000 live births. According to WHO estimates, there were about 5 million deaths in 1995, 98% of them occurred in developing countries. The number of deaths decreased to 4 million in 2005, but among them 98% still occurred in developing countries. In developing countries neonatal mortality from all the causes are about 34 per 1000 live births, most of the deaths occurring in the first week of life and most of them on the first day. In contrast in the developed world it is only five per 1000 live births. Methods: This study was a prospective observational study in neonatology section of Post Graduate Department of Pediatrics at GB Panth hospital, an associated tertiary care pediatric hospital of Government Medical College Srinagar, Northern India, from1st April 2018 to May 30 2019. Results: A total of 5128 neonates were admitted in our neonatology during this study period. Out of these a total of 414 neonates presenting with a wide spectrum of clinical signs and symptoms were diagnosed with neonatal septicemia. Among these 414 neonatal septicemia cases 265 neonates were inflicted with community acquired sepsis and 149 neonates developed Nosocomial sepsis. Furthermore refusal of feeds, feeding intolerance, hypothermia and Tachypnea were observed to be the predominant presenting features in neonatal septicemia. Low birth weight and preterm gestation were observed to be the leading risk factors in inflicting neonatal sepsis. Meanwhile 76 neonates among 265 community acquired sepsis cases were observed to have positive blood culture results. Furthermore 122 neonates among 149 Nosocomial sepsis cases were observed having positive blood culture results. Klebsiella was found to be the predominant organism isolated overall and also the predominant gram negative organism isolated. Enterococcus was found as the predominant gram positive organism isolated. Furthermore gram positive organisms showed 100% sensitivity to vancomycin. However among gram negative organisms an important observation was that these organisms showed significant resistance to quinolones, beta-lactam, amino glycosides and other class of antibiotics. As a result, driven by sensitivity profile of these organisms, we had to change antibiotics and upgrade to colistin sulphate and tigecycline in a large number of neonates for the better management of neonatal septicemia Conclusions: Clinical assessment using a combination of symptoms and signs are useful guides to provisional diagnosis of neonatal sepsis. Prevalence of sepsis is inversely related to birth weight and gestational age. High degree of culture positivity is noted in neonatal sepsis. There is increasing incidence of gram negative organisms. High degree of antibiotic resistance pattern is seen in neonatal sepsis. Time has come where a multifaceted approach needs to be put in action for reducing the incidence of community acquired and Nosocomial sepsis.

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