Neonatal sepsis – Microbiological spectrum, antimicrobial sensitivity, and risk factors for mortality in newborn unit of rural teaching hospital: A retrospective study

Abstract

Background: Neonatal sepsis (NS) is one of the leading cause of neonatal mortality. In order to decrease the morbidity and mortality associated with neonatal sepsis, treating pediatrician/neonatologist should have a keen knowledge of the existing microbiological flora and their drug-susceptibility pattern. Hence, the present study was conducted with the objective to investigate the etiological agents, pattern of antimicribial sensitivity, and risk factors for mortality in neonates with culture-proven neonatal sepsis. Methods: A retrospective/cross-sectional study was conducted over a period of 24 months in teaching Rural Hospital, Maharashtra, India. Demographic data, type of isolates, and its sensitivity pattern were recorded. Results: Of the 343 blood samples sent during the study period from neonatal intensive care unit, 84 (24.5%) samples grew organisms. Early-onset sepsis (EOS) occurred in 58.1% of cases. Of the 74 bacterial isolates, 55.4% were Gram-positive organisms and 44.6% were Gram-negative pathogen. Candida species were identified in 11.9% neonates. Staphylococcus aureus (21.6%) and coagulase-negative Staphylococcus (CONS) (21.6%) were predominant Gram-positive pathogen. Klebsiella pneumoniae was the main Gram-negative pathogen (29.7%) followed by pseudomonas (6.76%). Gram-positive organisms (Staphylococcus and CONS) showed maximum sensitivity to vancomycin and linezolid. Survival rate among neonates with culture-positive sepsis was 78.6%. Conclusions: This study highlights growing resistance to commonly used antibiotics/antifungal agents posing a great threat to neonatal survival and thereby warrants the modification of existing empirical therapy. Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed.