An audit of colistin use in neonatal sepsis from a tertiary care centre of a resource-limited country

Jasani, Bonny; Sridharan, Kannan; Nanavati, Ruchi; Gogtay, Nithya J; Thatte, Urmila M

doi:10.4103/0971-5916.198682

Cited by 21 publications

(19 citation statements)

References 19 publications

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“…As expected, small for GA and low birthweight babies had higher mortality. These findings are consistent with several other studies globally 27 32. The absence of deteriorating clinical signs and laboratory parameters was significantly associated with survival, findings which are consistent and biologically plausible 33.…”

Section: Discussionsupporting

confidence: 92%

Efficacy of colistin in multidrug-resistant neonatal sepsis: experience from a tertiary care center in Karachi, Pakistan

Gul

Salat²,

Hussain

et al. 2020

Arch Dis Child

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ObjectiveInfections with multidrug-resistant organisms (MDROs) such as Gram-negative bacteria have high morbidity and mortality with limited treatment options. Colistin, an antibiotic active against MDRO, was rarely used due to frequent adverse effects, but its use has now been recommended among adults. In this study, we determined the efficacy of colistin for the treatment of sepsis in neonates.Design/setting/patients/outcomesWe conducted a retrospective record review of all neonates admitted to the neonatal intensive care unit of Aga Khan University Hospital, Karachi, Pakistan, between June 2015 and June 2018, who had sepsis and received colistin by intravenous, inhalation and/or intrathecal routes. Predictors of colistin efficacy, for neonatal survival and microbial clearance, were assessed using multiple logistic regression.Results153 neonates received colistin; 120 had culture-proven sepsis; and 93 had MDR-GNB (84 colistin-sensitive). 111 (72.5%) neonates survived and were discharged from hospital; 82.6% had microbial clearance. Neonates with colistin-sensitive bacteria (adjusted OR (AOR)=3.2, 95% CI 2.8 to 4.0), and those in which colistin therapy started early (AOR=7.2, 95% CI 3.5 to 13.6) were more likely to survive. Neonates with increased gestational age (AOR=1.9, 95% CI 1.5 to 3.0), higher weight (AOR=5.4, 95% CI 3.3 to 11.8) and later onset of sepsis (AOR=4.3, 95% CI 2.0 to 9.0) had higher survival. Adverse events included nephrotoxicity in 5.2%; 13.7% developed seizures and 18.3% had electrolyte imbalance.ConclusionsColistin therapy was associated with survival among neonates suffering from MDR-GNB sepsis. The frequency of side effects was moderate.

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Section: Discussionsupporting

confidence: 92%

Efficacy of colistin in multidrug-resistant neonatal sepsis: experience from a tertiary care center in Karachi, Pakistan

Gul

Salat²,

Hussain

et al. 2020

Arch Dis Child

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“…Both gram-positive and gram-negative organisms showed high susceptibility to Carbapenems, a similar finding to other studies conducted both inside and outside Nepal [11,12,17]. Similarly, gram-negative organisms showed high susceptibility to Colistin, which is consistent with the findings of Jessan Bonny et al [20].…”

Section: Discussionsupporting

confidence: 90%

Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal

et al. 2018

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BackgroundNeonatal sepsis, one of the leading causes of mortality in neonatal intensive care units (NICU) of developing countries like Nepal, is often not extensively studied. In order to decrease the morbidity and mortality associated with neonatal sepsis, neonatologists should have a keen knowledge of the existing bacteriological flora and their antibiotic susceptibility pattern. In this study, we aim to determine the bacteriological profile and antibiotic susceptibility pattern of culture positive neonatal sepsis in the NICU of a tertiary teaching hospital in Nepal.MethodsThis was a retrospective cross-sectional study of all blood culture positive sepsis cases among neonates admitted to the neonatal intensive care unit of Patan Hospital, Nepal between April 15, 2014 and April 15, 2017. All neonates with a clinical suspicion of sepsis with a positive blood culture were identified. Patient demographics, clinical details, maternal risk factors, and laboratory data including bacteriological profiles and antimicrobial susceptibilities were recorded and analyzed.ResultsOf the 336 neonates admitted in the NICU, 69 (20.5%) had culture-positive sepsis. The majority were early-onset sepsis (n = 54, 78.3%) and were among the preterm babies (n = 47, 68.1%). Most bacterial isolates were gram-negative, predominantly the Klebsiella species (n = 23, 33.3%). Klebsiella showed high resistance to commonly used antibiotics such as; Cefotaxime (90.5%), Gentamicin (75%), Ciprofloxacin (76.2%), Ofloxacin (72.2%) and Chloramphenicol (65%). However, they showed good susceptibility to Carbapenems (100%), Colistin (88.8%) and Tigecycline (81.8%). Among cultures with gram-positive species, Coagulase-negative Staphylococci (CONS) (n = 14, 20.3%) predominated. CONS showed high resistance to Oxacillin (80%), Cefotaxime (66.7%) and Meropenem (80%) but good susceptibility (100%) to Vancomycin and Linezolid. Prevalence of multidrug-resistant strain was 73.9%.ConclusionsKlebsiella species and CONS were the most common causes of neonatal sepsis in our study. A significant proportion of the isolates were multidrug resistant strains, which pose a great threat to neonatal survival, and thereby, warrant modification of existing empirical therapy. Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed. We recommend a combination of Piperacillin-Tazobactam and Ofloxacin as the first line therapy and combination of Vancomycin and Meropenem as the second line empirical therapy in our NICU.

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“…The decreased microbial diversity in the patients with sepsis is consistent with reports from studies involving adult ICU patients in critical condition [34]. Sepsis caused by drug-resistant A. baumannii and other Gram-negative bacilli is a common challenge for clinicians and microbiologists [35]. Similar to the findings reported here, previous studies have found that certain species of Acinetobacter from the environment and hospitals were closely associated with lung infections [36,37].…”

Section: Discussionsupporting

confidence: 89%

Septic Patients in the Intensive Care Unit Present Different Nasal Microbiotas

et al. 2019

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Aim: The primary objective of this study was to evaluate correlations among mortality, intensive care unit (ICU) length of stay and airway microbiotas in septic patients. Materials & methods: A deep-sequencing analysis of the 16S rRNA gene V4 region was performed. Results: The nasal microbiota in septic patients was dominated by three nasal bacterial types ( Corynebacterium , Staphylococcus and Acinetobacter ). The Acinetobacter type was associated with the lowest diversity and longest length of stay (median: 9 days), and the Corynebacterium type was associated with the shortest length of stay. We found that the Acinetobacter type in the >9-day group was associated with the highest mortality (33%). Conclusion: Septic patients have three nasal microbiota types, and the nasal microbiota is related to the length of stay and mortality.

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An audit of colistin use in neonatal sepsis from a tertiary care centre of a resource-limited country

Cited by 21 publications

References 19 publications

Efficacy of colistin in multidrug-resistant neonatal sepsis: experience from a tertiary care center in Karachi, Pakistan

Efficacy of colistin in multidrug-resistant neonatal sepsis: experience from a tertiary care center in Karachi, Pakistan

Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal

Septic Patients in the Intensive Care Unit Present Different Nasal Microbiotas

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