Abstract
About 20 % of neonates develop sepsis and among them approximately 1% die due to sepsis-related causes. Bacterial pathogens are the commonest cause of neonatal sepsis which is either early-onset (<72 hours of age) or late-onset (>72 hours). Little is known about the epidemiology and antimicrobial susceptibility pattern of sepsis causing bacterial pathogens in Nepal. A prospective study was carried out among neonates suspected to have sepsis and admitted to Tribhuwan University Teaching Hospital from January to December 2016. Clinical suspicion of sepsis was made based on clinical findings and laboratory parameters, later confirmed by isolation of organisms in blood culture. Drug resistance pattern of Gram-positive and Gram-negative bacteria were studied by standard methods. Meropenem resistant Gram-negative bacteria were processed for the detection of β-lactamases and resistant genes were detected by X-pert Carba-R (Cepheid) Assays. Of 372 neonates with clinically suspected sepsis, 132 (35.4%) had blood culture positivity, with 47% early-onset and 53% late-onset sepsis. Coagulase-negative Staphylococcus aureus (CONS) was the most common (37.9%) etiological agent followed by Klebsiella pneumoniae (12.9%). Of all 132 isolates, 81 (61.3%) were Gram-positive of which 22 (27.2%) were multi-drug resistant (MDR), three (3.7%) were methicillin-resistant S. aureus (MRSA), and 14 (17.2%) were methicillin-resistant CoNS; and 50 (37.8%) were Gram-negative of which 26 (52%) were MDR and 29 (58%) were resistant to β-lactamases. The blaKPC gene was detected in four isolates of K. pneumoniae, two of E. coli, one ABC (Acinetobacter baumanii complex), and one Enterobacter aerogenes whereas blaNDM gene was detected in one isolate of K. pneumoniae, two of E. coli, two Pseudomonas aeruginosa, one Acinetobacter baumanii complex, and one Enterobacter aerogenes. Overall mortality due to sepsis-related causes was 7.6% (10 of 132). One-third of clinically suspected neonatal sepsis cases were culture positive. Late-onset sepsis was more common than early onset. CoNS was the predominant bacterial isolate followed by Klebsiella pneumoniae, with high rates of multi-drug resistance.
Highlights
Neonatal sepsis (NS) is a clinical syndrome presented with clinical features of infection with or without underlying bacteremia in the first month of life.[5]
Organisms that tested positive for Modified Hodge test were processed for the detection of Metallo-β-lactamase (MBL), Klebsiella pneumonia carbapenemase type β-lactamases (KPCs), and Oxacillinase type β-lactamases (OXA) drug resistance patterns according to the standard guidelines.[7,9]
In this study, just above one-third of clinically suspected sepsis cases were culture positive and coagulase-negative Staphylococcus aureus (CoNS) was the predominant isolate followed by Klebsiella pneumoniae
Summary
Neonatal sepsis (NS) is a clinical syndrome presented with clinical features of infection with or without underlying bacteremia in the first month of life.[5] It is a leading cause of neonatal morbidity and mortality worldwide.[1] About 3050% of total neonatal deaths are due to NS in developing countries.[2,3] According to the World Health Organization (WHO) reports, about 20% of all neonates develop sepsis and approximately 1% die due to sepsis-related causes.[3] Those who survive are prone to short and long-term morbidity (neurodevelopmental).[4] Sepsis-related morbidity and mortality is largely preventable with the prevention of sepsis itself, with timely recognition of the disease and by appropriate and aggressive antimicrobial therapy and supportive care
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