Drug Resistant Gram Research Articles

Low Efficiency of the Commonly Prescribed Drugs against <i>Klebsiella pneumonia</i>, <i>Escherichia coli</i> and <i>Acinetobacter</i> Species as the Causative Agents of Blood Stream Infection in Malabo, Equatorial Guinea

The prevalence of multi drug resistant gram-negative bacteria to commonly first line drugs in blood is a serious problem in Equatorial Guinea and other world. This is the first study describing antibiotic resistance analysis of blood stream infection in Equatorial Guinea. Our study presents alarming rate of inefficiency of the most commonly prescribed drugs to treatment Klebsiella pneumoniae, Escherichia coli and Acinetobacter species isolates as the most frequency etiologic agents in blood stream infection. Out of 1849 blood culture the bacterial etiological agents were isolated from 196 (10.6%) samples. E. coli (n = 22), K. pneumonia (n = 39) and Acinetobacter (n = 17) represent 71.6% of all gram negative bacterial isolates. Almost all isolates of K. pneumonia and Acinetobacter sp. (92.1% and 100%, respectively) and about 50% of E. coli strains possessed extended-spectrum β-lactamase activity. Alarming level of multi drug resistant gram negative strains was observed. E. coli and K. pneumonia and Acinetobacter isolates demonstrated low sensitivity to all commonly prescribed drugs such as Ampicillin, Trimethoprim/Sulfamethoxazole, Doxycycline, Gentamycin Amoxicicline/Clavulanic Acid, Cefuroxime, Ciprofloxacine. It is especially worth noting the low efficiency of third generation cephalosporins (Cefrtiaxon) against Acinetobacter and Klebsiella with their resistance rate of 94.7% and 100% respectively. Moreover, the alarming level of low sensitivity to Piperacilin/Tazobactam of K. pneumonia (22%) and Acinetobacter (29.4%) was been found. The 17.6% of Acinetobacter isolated was carbomenem resistant. Just Imipenem and Amikacin were the most sensitive drug against these bacterial strains.

食品あるいはその製造環境から分離されたグラム陰性桿菌の薬剤耐性状況

食品あるいはその製造環境から分離されたグラム陰性桿菌の薬剤耐性状況

NMR Structures and Interactions of Antimicrobial Peptides with Lipopolysaccharide: Connecting Structures to Functions.

Antimicrobial peptides (AMPs) establish the first line of host defense mechanism against invading microorganisms including bacteria, viruses, fungi and parasites. In recent years, emergence and spread of antibiotic resistance bacterial pathogens have dawn considerable interest in investigations of AMPs. The ability of AMPs to exert lethality against multiple drug-resistant (MDR) bacteria has incited promising avenues for antibiotic development. As a mode of action, most AMPs perturb the membrane organization of bacterial cells. The outer membrane lipopolysaccharide (LPS) of Gram-negative bacteria establishes a superior permeability barrier, in contrast to the peptidoglycan layer of Gram-positive bacteria. Due to LPS barrier, development of antibiotics for drug resistant Gram- negative bacteria are more complicated, with only fewer compounds in the pipeline. Recent studies have demonstrated that LPS actively regulate mode of action of AMPs on the lethality of Gram-negative bacteria. LPS, also known as endotoxin, is the primary agent for septic shock syndromes in intensive care unit killing over 120,000 people in the USA. Currently, anti-sepsis therapies are greatly lacking. Therefore, LPS has been considered as a target for the development of antimicrobial and antisepsis drugs. In recent and past few years, 3-D structures and interactions of a number of AMPs have been determined in complex with LPS micelles. These studies have generated molecular insights towards mode of action and synergistic activity of AMPs in the outer membrane. In this review, atomic resolution structures and interactions of potent AMPs with LPS are discussed providing novel insights of their mode of action.

Evaluation of a Commercial Multiplex PCR for Rapid Detection of Multi Drug Resistant Gram Negative Infections.

Introduction: Community and healthcare associated infections caused by multi-drug resistant gram negative organisms (MDR GN) represent a worldwide threat. Nucleic Acid Detection tests are becoming more common for their detection; however they can be expensive requiring specialised equipment and local expertise. This study was done to evaluate the utility of a commercial multiplex tandem (MT) PCR for detection of MDR GN. Methods: The study was done on stored laboratory MDR GN isolates from sterile and non-sterile specimens (n=126, out of stored 567 organisms). Laboratory validation of the MT PCR was done to evaluate sensitivity, specificity and agreement with the current phenotypic methods used in the laboratory. Amplicon sequencing was also done on selected isolates for assessing performance characteristics. Workflow and cost implications of the MT PCR were evaluated. Results: The sensitivity and specificity of the MT PCR were calculated to be 95% and 96.7% respectively. Agreement with the phenotypic methods was 80%. Major lack of agreement was seen in detection of AmpC beta lactamase in enterobacteriaceae and carbapenemase in non-fermenters. Agreement of the MT PCR with another multiplex PCR was found to be 87%. Amplicon sequencing confirmed the genotype detected by MT PCR in 94.2 % of cases tested. Time to result was faster for the MT PCR but cost per test was higher. Conclusion: This study shows that with carefully chosen targets for detection of resistance genes in MDR GN, rapid and efficient identification is possible. MT PCR was sensitive and specific and likely more accurate than phenotypic methods.

The costs of nosocomial resistant gram negative intensive care unit infections among patients with the systemic inflammatory response syndrome- a propensity matched case control study.

BackgroundInfections due to multi-drug resistant gram negative bacilli (RGNB) in critically ill patients have been reported to be associated with increased morbidity and costs and only a few studies have been done in Asia. We examined the financial impact of nosocomial RGNB infections among critically ill patients in Singapore.MethodsA nested case control study was done for patients at medical and surgical ICUs of a tertiary university hospital (August 2007-December 2011) matched by propensity scores. Two groups of propensity-matched controls were selected for each case patient with nosocomial drug resistant gram negative infection: at-risk patients with no gram negative infection or colonization (Control A) and patients with ICU acquired susceptible gram negative infection (SGNB) (Control B). The costs of the hospital stay, laboratory tests and antibiotics prescribed as well as length of stay were compared using the Wilcoxon matched-pairs signed rank test.ResultsOf the 1539 patients included in the analysis, 76 and 65 patients had ICU acquired RGNB and SGNB infection respectively. The median(range) total hospital bill per day for patients with RGNB infection was 1.5 times higher than at-risk patients without GNB infection [Singapore dollars 2637.8 (458.7-20610.3) vs. 1757.4 (179.9-6107.4), p0.0001]. The same trend was observed when compared with SGNB infected patients. The median costs per day of antibiotics and laboratory investigations were also found to be significantly higher for patients with RGNB infection. The length of stay post infection was not found to be different between those infected with RGNB and SGNB.ConclusionThe economic burden of RGNB infections to the patients and the hospital is considerable. Efforts need to be taken to prevent their occurrence by cost effective infection control practices.

English

Background: Worldwide diabetic foot is a major medical problem leading to disability and economic instability to family and country. Objectives: To assess the clinical and bacteriological profile of diabetic foot ulcer among rural Indian residents. Also to know the prevalent pattern of antimicrobial resistance of most commonly isolated organisms to various currently in use antimicrobial agents. Methodology: From 78 cases of diabetic foot ulcer, identification of isolates was done using standard microbiological techniques. Antibiotic sensitivity testing were carried out followed by detection of ESBL, MRSA, AmpC and MBL producing strains as per the CLSI guidelines. Results: In our study, a total of 78 specimens were cultured and 97.4% ulcer showed growth of organisms (76/78). Of the total 139 isolates, 134 (96.4%) were aerobes and only 5 (3.6%) isolates were anaerobes. An average of 1.8 organisms per lesion was isolated. Among the aerobes, 93 (69.4%) gram negative and 41 (30.6%) gram positive organisms were isolated. Pseudomonas aeruginosa 23.9% was predominant organism followed by Klebsiella species (20.9%). A total 41 (30.6%) aerobic gram positive bacteria were isolated. Staphylococcus aureus was the most common gram positive organism 28.4% in which Methicillin resistant S. aureus (MRSA) was 57.9%. Among gram negative organisms 46(49.5%) isolates showed ESBL production. Among ESBL producing strains Escherichia coli 68.3% isolates recorded highest ESBL activity followed by Pseudomonas aeruginosa 62.5 % and Klebsiella species 53.6 %. Conclusion: The present study has shown that diabetic foot infections are polymicrobial in nature and commonly caused by multi drug resistant gram negative organisms.

In Vitro Antimicrobial Activity of Natural Essence and Distilled Extract of Bergamot against Drug Resistance Clinical Isolates

Bergamot (Citrus bergamia) belongs to the Citreae tribe in the Aurantioideae subfamily of the Rutaceae plant family cultivated almost exclusively along the coast of the Calabria region, Southern Italy. Bergamot essential oil is widely employed in cosmetics such as in aromatherapy and its antimicrobial effects against bacteria, yeasts and virus are also demonstrated. This study evaluates the “in vitro” antimicrobial activity of natural essence and distilled extract of bergamot on drug resistance pathogens isolated from clinical specimens of patients admitted to University Hospital of Catanzaro, Italy. Bactericidal and fungicidal activity was analyzed using a micro well dilution assay and the efficacy of tested substances was verified by alcidine orange staining procedures and co focal microscopy. Data revealed that the distilled extract of bergamot possessed greatest antimicrobial efficacy when compared with essential oil particularly against drug resistant Gram negative bacteria such as Acinetobacter Baumann, Stenotrophomonas maltophilia, Escherichia coli and Klebsiella pneumoniae responsible for nosocomial infections representing a worldwide public health problem. This study suggests that alternative antimicrobial substances as well as distilled extract of bergamot could be of great utility to prevent microbial contamination on hospital devices and healthcare personnel hand skin.

In Vitro Susceptibility Pattern of Tigecycline against MRSA, ESBL Producing Escherichia coli, Klebsiella Species and Acinetobacter Isolates in a Rural Tertiary Care Hospital

Background: Tigecycline is the first commercially available glycycline, derivatives of the tetracycline antibiotics, having enhanced activity against various pathogens. In vitro activity has been demonstrated against multi drug resistant Gram positive and Gram negative pathogens like MRSA, ESBL producing Esch.coli and Klebsiella spp. and Acinetobacter. Objective: To determine Tigecycline in vitro susceptibility pattern in MRSA, ESBL producing Esch.coli and Klebsiella spp. and Acinetobacter spp. Material and Methods: Investigations were carried out from August 2012-January 2014 to detect MRSA,ESBL producing Escherichia coli and Klebsiella spp. as well as Acinetobacter spp. by using a standard protocols and Tigecycline in-vitro susceptibility testing was done by Kirby Bauer Disc diffusion method and it's MIC value against resistant isolates was evaluated.Statistical analysis was done by Fishers extract method. Result: Out of 107 Staphylococcus aureus isolates 52(48.59%) were MRSA, none of them showed resistance to Tigecycline. Out of 82 Esch.coli isolates 14 (i.e 17.07%) were ESBL producers, none of them showed resistance to Tigecycline.Out of 67 Klebsiella isolates 21 (i.e 31.34%) were ESBL producers out of which only 1 (i.e 4.76%) was resistant to Tigecycline.Out of 19 Acinetobacter spp.isolated 3 (i.e 15.78%) were resistant to Tigecycline. The MIC range for ESBL producing Eschcoli, Klebsiella spp., MRSA and acinetobacter spp were 0.14-0.45 μg/ml,0.25-2.4 μg/ml,0.12-0.26 μg/ml, 1-3.2 μg/ml respectively. Conclusion: The results of the study confirm the excellent in vitro activity of Tigecycline against Gram positive and Gram negative multidrug resistant pathogens.

Alternative empiric therapy to carbapenems in management of drug resistant gram negative pathogens: a new way to spare carbapenems

Abstract Background: Increasing prevalence of carbapenem resistance in Gram negative bacteria due to excessive and indiscriminate use of carbapenems has forced the medical fraternity to find out ways to spare

Detection of Carbapenem Resistance in Extended Spectrum Beta Lactamase Producing Eshcherichia Coli Isolates in a Tertiary Care Hospital

Background: Carbapenems are β-lactam antibiotics, presently considered as the most potent agents for the treatment of multi drug resistant gram negative bacterial infection. Their clinical usage is under threat due to growing incidence of resistance due to production of Carbapenemases which belong to Class B β-lactamases. Knowledge of resistance patterns for Carbapenems will help to guide appropriate and judicious antibiotic use. Hence this study was conducted to detect the resistance to Carbapenems in ESBL producing isolates of E. coli, as the growing incidence of Carbapenem resistance is a major concern to public health. Objectives: 1. Screening and phenotypic confirmation of ESBL production in E. coli isolates. 2. Screening for Carbapenem resistance in ESBL producing E. coli isolates. Materials and Methods: Clinical samples consisting of all exudates, sterile body fluids and urine samples were included in our study. Samples were processed and E. coli identified as per routine laboratory protocol. ESBL screening and phenotypic confirmation, followed by screening for Carbapenem resistance was done as recommended by CLSI guidelines 2014. Results: We isolated 100 ESBL producing E. coli from the samples which were further screened for Carbapenem resistance. Among 100 ESBL producing E. coli isolates, 4(4%) showed Carbapenem resistance, out of which 2 were isloated from urine, 1 each from pus and stool. Co-resistance was observed to other antibiotics including other Cephalosporins(91%), Ampicillin(100%), Piperacillin(95%) and Fluoroquinoles(70%). Conclusion: Our study highlights an increase in resistance pattern in ESBL producing E. coli isolates towards Carbapenems, which is an alarming situation to microbiologists and clinical physicians of our country. Hence, there is a need to emphasize on rational use of antimicrobials and prevent their misuse which is harmful to both patient and community. Keywords: Carbapenemase, β-lactam, ESBL, E. coli, C

English

OBJECTIVE: To assess the bacterial profile of endotracheal (ET) tube aspirates in ventilated patients and to know their drug sensitivity pattern. SETTING: A tertiary care teaching facility situated in Kerala, South India. All patients were on ventilator in the medical, surgical, trauma or neuro intensive care units of the hospital. Isolation of the organisms was done by inoculation of sample on agar medium, and after 24 hours of incubation each organism was identified. Antibiotic sensitivity testing was carried out by Disc Diffusion Method. The results were analyzed. RESULTS: A predominance of multi drug resistant (MDR) gram negative microbes is evident in this analysis of endotracheal sample cultures. Of the 434 samples inoculated, 145 Acinetobacter, 100 pseudomonas aeruginosa and 92 klebsiella pneumonia were isolated. These lethal strains needed high end antibiotics mostly Inj. Colistin for their eradication. Prevention of pneumonia in ventilated patients is of paramount importance for obvious reasons. CONCLUSIONS: For these 3 major microbes mentioned, colistin was the best bet, and all 3 were uniformly resistant to ceftazidime and aminoglycosides. Piperacillin / tazobactam combination holds some promise in case of E.coli, non- fermenting Gram Negative Bacilli and Serratia. Staphylococcus aureus was 45% sensitive to cloxacillin. The remaining resistant (MRSA) strains were sensitive to vancomycin and linezolid.

Prevalence of extensively drug-resistant gram negative bacilli in surgical intensive care in Egypt.

IntroductionThe prevalence of extensively drug resistant gram negative bacilli (XDR-GNB) is rapidly progressing; however in Egypt data are sparse. We conducted the present study to quantify the incidence, risk factors and outcome of patients harboring XDR-GNB.MethodsA one year prospective study was done by collecting all the bacteriological reports for cultures sent from the surgical intensive care unit, Cairo university teaching hospital. XDR-GNB were defined as any gram negative bacilli resistant to three or more classes of antimicrobial agents. Patients with XDR-GNB compared with those sustaining non extensively drug-resistant infection. A multivariate logistic regression model was created to identify independent predictors of multi-resistance.ResultsDuring one-year study period, a total of 152 samples (65%) out of 234 gram negative bacilli samples developed extensively drug resistant infection. XDR strains were significantly higher in Acinetobacterspp (86%), followed by Pseudomonas (63%), then Proteus (61%), Klebsiella (52%), and E coli (47%). Fourth generation cephalosporine (Cefipime) had the lowest susceptibility (10%) followed by third generation cephalosporines (11%), Quinolones (31%), Amikacin (42%), Tazobactam (52%), Carbapinems (52%), and colistin (90%). Relaparotomy was the only significant risk factor for acquisition of XDR infection.ConclusionExtensively drug-resistant gram negative infections are frequent in our ICU. This is an alarming health care issue in Egypt which emphasizes the need to rigorously implement infection control practices.

Detection of extended spectrum beta-lactamases (ESBLS) producers in clinical isolates

Background: Treatment of extended Spectrum β-lactamase (ESBL) producing gram negative bacilli is an increasing problem in hospitalized patients. Increasing resistance to third generation cephalosporins among gram negative bacilli has important therapeutic and clinical implications. ESBL producers significantly affect the course and outcome of infection and are associated with increased morbidity and mortality. The high proportion of ESBL producers and the outbreak of multi drug resistant gram negative bacilli are quite alarming and need expensive control measures. Appropriate laboratory detection is important to avoid inappropriate antimicrobial therapy. Aims & Objectives: The present study was undertaken to investigate the high incidence of extended Spectrum β-lactamases (ESBLS) producers and their antibiotic susceptibility pattern. Materials and Methods: A total of 228 GNB isolates, were studied for ESBL production. The isolates were screened for ESBL production by the double disc synergy test (DDST) as recommended by the Clinical Laboratory Standards Institute (CLSI). Antimicrobial susceptibility testing was done along with screening for ESBL production for commonly used antibiotics. Isolates which showed positive results were confirmed by phenotypic confirmatory disc diffusion test (PCDDT). Results: Out of 228 GNB isolates studied, 102 (44.73%) isolates were positive for ESBL production by presumptive screening test, of which 84 (36.84%) isolates were confirmed by PCDDT. The isolates of Escherichia coli (71.6%) were the most common ESBL producers, followed by K. pneumoniae (22.6%) and others. Imipenem (94.45%) was the most active and reliable agent for the treatment of the infections which were caused by the ESBL producing organisms. Conclusion: ESBL detection and antibiotic sensitivity testing should be undertaken routinely to avoid misuse of antibiotics and also prevent spread of these strains.

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Introduction: Rampant misuse with irregular antibiotic regimen for management of preoperative sepsis in patients with congenital heart disease, is a harsh reality in developing nations. Inconsistent compliance with antimicrobial stewardship programs in emerging economies has resulted in a surge of XDR (carbapenem resistant) gram negative organisms with enhanced morbidity and mortality Methods: This single center retrospective observational study included patients operated for congenital heart disease in the duration, April 2012-March 2013. All the cases identified as positive for (XDR)gram negative blood stream infection(BSI), ventilator associated pneumonia (VAP ), surgical site infection (SSI), catheter associated urinary tract infection(CAUTI) and peritonitis were included . The analysis centered on the patient associated risk factors, microbiological profile, impact of preoperative hospitalization with ventilation and final outcome. Results: Of the total 310 cultures positive in 452 cases operated over a year, 172 episodes of XDR sepsis requiring IV Colistin therapy were identified in 129 cases. The median Aristotle risk factor score in the study population (129 cases) was ≥8. The most commonly isolated organisms were Klebsiella Pneumoniae (39%) and Acinetobacter baumanii(29%).BSI (56%) and VAP(30%) were recorded and 12 % cases had evidence of multiple site involvement with recurrent cultures positive . Among 129 patients, 70 (54.3%) had evidence of preoperative sepsis and hospitalization, and of these 21(30%) required preoperative ventilation. Preoperative multi drug resistant (MDR) gram negative BSI was reported in 15 cases (21%) and 4 cases had fungal sepsis. 40 (57%) cases received preoperative Carbapenem therapy . IV Colistin, was used at a dosage of 7.5 to 10 mg per kg per day, for an average duration of 10 days for an individual cycle, and nephrotoxicity was reported in 4 (3.2%) patients . Of the 17 cases (13%) expired in this series, nine had infection related mortality. Conclusions: XDR gram negative sepsis, is a grim reality in developing nations and stringent antimicrobial stewardship programs at the primary and secondary health care levels, with timely referral mechanisms,deserve attention. Timely surgical intervention, in a ventilated patient, while it is recovering from preoperative sepsis, is the key to better outcome.

Synthesis and antibacterial activity of doxycycline neoglycosides.

A set of 37 doxycycline neoglycosides were prepared, mediated via a C-9 alkoxyamino-glycyl-based spacer reminiscent of that of tigecycline. Subsequent in vitro antibacterial assays against representative drug-resistant Gram negative and Gram positive strains revealed a sugar-dependent activity profile and one doxycycline neoglycoside, the 2'-amino-α-D-glucoside conjugate, to rival that of the parent pharmacophore. In contrast, the representative tetracycline-susceptible strain E. coli 25922 was found to be relatively responsive to a range of doxycycline neoglycosides. This study also extends the use of aminosugars in the context of neoglycosylation via a simple two-step strategy anticipated to be broadly applicable for neoglycorandomization.

Antibacterial activity of Andrographis paniculata (Burm. f.) Wall ex Nees leaves against clinical pathogens

Background/aimsPresent study evaluates the potential of three different Indian plants against drug resistant clinical pathogens, which are already known to provide relief in microbial infections. MethodsA total of nine extracts from leaves of Arum maculatum, Tinospora cardifolia and Andrographis paniculata were investigated to evaluate their antibacterial activities against two reference strains of human pathogenic bacteria. The antibacterial activities of the extracts were assessed by agar well diffusion method and minimal inhibition concentration (MIC). The efficacy of the extracts was compared to commercially prepared antibiotic (Streptomycin) discs. The extract showing antibacterial activity was fractionated by TLC and the purified active fraction was chemically characterized by different phytochemical tests. ResultsMethanol extract of A. paniculata leaves exhibited strong in vitro antibacterial activity against Gram positive bacteria including clinical isolates of Mycobacterium tuberculosis, Enterococcus faecalis and methicillin resistant Staphylococcus aureus. Phytochemical investigations of TLC purified active fraction from this extract showed the presence of terpenoids in it. ConclusionThe study concludes that the terpenoids present in methanol extract of A. paniculata leaves have enough potential to kill drug resistant Gram positive bacteria.

English

BACKGROUND: Infections contribute to major morbidity and mortality in the developing countries. Antimicrobial resistance is another major problem with the increasing infections and non availability of ideal antimicrobial agent. Despite the advances in antimicrobial therapy, infections remain a serious burden. This study was designed t o assess the increasing infection rates and antimicrobial susceptibility patterns in neurosurgical and neuropsychiatric patients. Over a period of three years and six months from January 2009 to June 2012, various samples were processed, isolated the infectious agent and identified. The different samples included samples like CSF, urine, pus, tracheal aspirates, shunt & catheter tips, tissue and blood. These were assessed for antimicrobial susceptibility patterns by conventional and automated culture and sensitivity systems. The results were then statistically analyzed. This study found that in general, there is a trend towards increased rates of infections, the majority of which were caused by Multi Drug Resistant Gram Negative Bacilli (MDRGNB), followed by Candida species and Cryptococcus species, Methicillin Resistant Staphylococcus aureus (MRSA), and Mycobacterium tuberculosis. The infection rates, from January 2009 to June 2012, were 3.7% to 5.1% for MDRGNB, 2.89% to 4.24% for Candida, 2.93% to 3.13% for Cryptococcus, 2.8% to 2.1%(till June 2012) for MRSA and 1.3% to 5.7% for Mycobacterium tuberculosis. Also, a trend towards increasing resistance among the isolates to the carbapenem antibiotics was observed. The increasing trend of infections is a cause for concern throughout the country. Indiscriminate use of antibiotics, hospital personnel not adhering to safety precautions etc are the main reasons for the increased infection rates. Newer therapeutic agents and strict antibiotic policies are required to effectively control the issue of emerging infections.

A prospective cohort on nosocomial sepsis with drug resistant gram negative organisms from South India

A prospective cohort on nosocomial sepsis with drug resistant gram negative organisms from South India

Antibiotic impregnated tablets for screening ESBL and AmpC beta lactamases

Antibiotic resistance is a growing threat. Fifty non repetitive multi drug resistant gram negative bacterial isolates were screened for ESBL, AmpC, ESBL-AmpC co-production using antibiotic tablets. Of these 56% were Escherichia coli, 16% were Klebsiella spp., 39.6% produced ESBLs, 17.2% AmpC and 13.8% showed co-production. Antibiotic tablets sensitivity for ESBL detection was 93.9% compared to filter paper discs. We emphasize that even small and medium level laboratories should screen for ESBL and AmpC production to check the burden of antibiotic resistance. Use of antibiotic tablets, though costlier can be used especially in tropical countries given their stability during transit from manufacturer to user.

Case reports

Stenotrophomonas maltophilia, a multi drug resistant non fermenting Gram negative bacillus is an increasingly common nosocomial pathogen, especially in intensive care units. Comparatively few cases of infection have been reported in neonatal population. We present two cases of early onset neonatal sepsis due to S.maltophilia and a brief review of documented isolation in neonates.