Bacterial etiology and antibiotic resistance pattern of neonatal sepsis: a study in a tertiary care hospital, in Bangladesh

Abstract

Background: Neonatal sepsis is a leading cause of neonatal mortality and morbidity. The objective of the study was to detect causative microorganisms of neonatal sepsis and their antimicrobial resistance patterns.Methods: This prospective cross-sectional study was conducted from July 2017 to June 2018 in the Department of Neonatal Medicine and NICU of Dhaka Shishu (Children) Hospital (DSH). Neonates diagnosed with probable sepsis were studied. After enrollment, 1 mL blood was taken and sent to Microbiology department of DSH for culture and sensitivity. With baseline characteristics, clinical examination findings and outcome, were also recorded.Results: Rate of isolation of single organism was 9.2% (84/913). Out of 84 isolates, gram negative bacteria were 77.4% with Klebsiella pneumonae being the commonest (35, 41.7%), gram positive bacteria were 11.9% with Staphylococcus aureus and Streptococcus were equal (5, 5.95% each) and the remaining (9, 10.7%) isolated organism was Candida. Most of the isolated gram-negative bacteria were resistant to ampicillin, gentamicin, and ceftazidime; but gram-positive bacteria preserved 20-80% sensitivity. Klebsiella was more resistant than Acinetobacter to amikacin, netilmicin, ciprofloxacin and levofloxacin. Around 45-65% of gram-negative bacteria were resistant to imipenem and meropenem but gram-positive bacteria showed lesser resistance. Among the gram-negative bacteria, Klebsiella and Acinetobacter were resistant to piperacillin as same as carbapenem group, but gram-positive bacteria were 100% sensitive to piperacillin. All the gram-negative bacteria showed more resistance to 4th generation cephalosporin, cefepime than carbapenem. Out of culture positive 84 neonates, 63 (75.0%) were cured but 21 (25.0%) died. Among the 21 expired neonates, 47.6% (10/21) were infected with Klebsiella.Conclusion: This study observed that gram-negative bacteria causing neonatal sepsis predominantly, with emergence of Candida. All the isolated gram-positive and gram-negative organisms were mostly resistant to available antibiotics