Abstract
Introduction: Neonatal septicemia is one of the commonest reasons for neonatal morbidity and mortality in developing countries. Knowledge of microbial flora and their susceptibility will help paediatricians decide on empirical treatment of neonatal sepsis. Objective: To determine the antimicrobial susceptibility of blood culture isolates from patients with suspected neonatal sepsis in a tertiary care hospital in Pakistan. Study design: A laboratory based prospective study was carried out in the Department of Pathology, Combined Military Hospital, Sialkot, from March 2017 to February 2019. Methods: Blood culture and sensitivity testing was carried out on patients admitted for suspected neonatal sepsis from March 2017 to February 2019. Antimicrobial susceptibility testing of blood culture isolates was carried out by disk diffusion method using the Clinical Laboratory Standard Institute (CLSI) guidelines. Results: During the study period, 345 blood cultures from 345 neonates (age range 1 day-28 days; mean age 13 days) were received by the laboratory, of which76 were culture positive. Gram negative bacilli were isolated from 44 cultures and Gram positive cocci from the remaining 32. Staphylococcus aureus was the commonest isolate (n=28) followed by Escherichia coli (n=10), Klebsiella pneumoniae (n=9) and Acinetobacter spp. (n=8). Methicillin resistant S. aureus (MRSA) constituted (n=19) 25% of culture positive isolates. Pseudomonas aeruginosa was isolated from six patients. Serratia spp., Enterobacter spp. and Enterococcus spp. from four patients each and Proteus spp. isolated from three patients. Linezolid was the most effective antimicrobial against the isolated Gram positive cocci, with 93.7% sensitivity demonstrated by MRSA, methicillin sensitive S. aureus and enterococcus spp. followed by sensitivity to clindamycin at 92.8%. Among Gram negative isolates, more than 80% of E. coli, K. pneumonia and Acinetobacter spp. were multidrug resistant. Susceptibility to polymyxin-B and tigecycline was shown by 88% and 71% of these isolates. Conclusion: A high degree of antibiotic resistance was observed in both Gram positive and Gram negative isolates which reflects a dire need for culture facilities and antimicrobial susceptibility testing in hospitals in Pakistan. No group B β hemolytic streptococci were isolated, most likely due to predominantly late onset neonatal sepsis in this cohort.
Highlights
Neonatal septicemia is one of the commonest reasons for neonatal morbidity and mortality in developing countries
A high degree of antibiotic resistance was observed in both Gram positive and Gram negative isolates which reflects a dire need for culture facilities and antimicrobial susceptibility testing in hospitals in Pakistan
This study highlights the high rate of antimicrobial resistance among bacterial pathogens isolated from blood cultures of neonates admitted to the neonatal intensive care units (NICU) and confirms that Sialkot and surrounding area is no exception to progressive antimicrobial resistance in major bacterial pathogens
Summary
Neonatal septicemia is one of the commonest reasons for neonatal morbidity and mortality in developing countries. Microorganisms causing neonatal sepsis may show diversity in different countries and in hospitals of the same region and are of concern due to the presence of multidrug resistance.[7] Antibiotics are among the most frequently used medications in the NICU.[8] Use of antibiotics varies in different NICUs which necessitates implementation of antibiotic stewardship.[9,10] Pediatricians and neonatologists must be made aware that starting antibiotics in certain circumstances may be more harmful than beneficial.[11] While prompt antibiotic therapy for possible infections in this vulnerable population is crucial for a good outcome, inadequate or inappropriate use of antibiotics results in a rising trend of multidrug resistant bacteria.[12,13] Antibiotic susceptibility patterns vary geographically depending upon the prevalent local pathogens and common antibiotics being used in neonatal units.[14] Emergence of antimicrobial resistance has become an alarming public health concern with non-responsiveness to available antibiotics
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
