Extended-spectrum β-lactamase-producing Gram-negative bacteria causing neonatal sepsis in India in rural and urban settings

Abstract

Extended-spectrum b-lactamase (ESBL)-producing Gram-negative bacilli (GNB) are of increasing clinical concern in all age groups worldwide. Whilst sepsis continues to be the leading cause of morbidity and mortality in Indian neonates in the community, identification of microbiological attributes in this population is lacking. This population-based study enrolled 1738 infants with a diagnosis of clinical sepsis at four participating centres in India. Each study site conducted Bactec blood culture, identified bacterial species by API test and stored isolates at "70 6C. From 252 GNB isolates, 155 (113 Klebsiella species, 21 Escherichia coli and 21 other) were subjected to drug susceptibility testing, ESBL phenotyping and testing for clonal relatedness of ESBL strains by PFGE. The results demonstrated that Klebsiella species and E. coli are the most common GNB causes of neonatal sepsis in India, and over one-third are ESBL producers in both community and hospital settings. ESBL-producing strains exhibited frequent co-resistance to aminoglycosides and ciprofloxacin, but remained susceptible to imipenem. PFGE analysis revealed extensive genetic diversity within the ESBL-producing isolates, showing multiple profiles (total of 23). Over 40 % of all ESBL-producing isolates formed three pulsed-field profiles (PFP I-III), with PFP-II being the largest cluster (.20 % of all ESBL-producing isolates), sharing strains from two distant locations. Identification of a common clone at two geographically distant centres indicated that predominant clones with increased virulence may exist, even in the absence of any clear outbreak. The presence of ESBL-producing strains in community infants with no prior history of hospitalization or antibiotic use dictates heightened vigilance and further studies on the ecology of these organisms.

Neonatal septicemia: isolates and their sensitivity pattern with emergence of Citrobacter septicemia

“…In present study blood culture positivity rate of clinical neonatal sepsis cases were 43.55%. Similar rates were also found by Desai et al and also by Jain et al, Chandel et al [7][8][9] In present study gram negative organisms constitutes a major portion which correlates with findings of Kamble et al and Jain et al 8,10 Among gram negative organisms most frequently isolated organism was Klebsiella species similar results were also found by Jyothi et al 11 A total 24.48% of gram positive organisms were isolated in our study similar to Desai et al 7 In this group streptococcus species was predominant organism.…”

“…In recent past due to widespread misuse and over the counter medication, resistance to antibiotics like cefixime, piperacillin+tazobactam, cephoperazone+sulbactam have emerged as a big threat in patient care and to society and many a times leads to treatment failures. Similar results on resistance also obtained by Chandel et al, Bhat et al 9,13 Among gram positive isolates Staphylococcus was sensitive to vancomycin and linezolid. No organism showed resistance to these agents.…”

Isolation of MRSA, ESBL and AmpC – β -lactamases from Neonatal Sepsis at a Tertiary Care Hospital

“…In our study, the most common pathogen identified was Klebsiella pneumoniae 31(28%). This is similar to study by Zakariya et al, [4], and Chandel et al, [6]. NNPD [3] data [2002][2003] shows that Klebsiella pneumoniae is the commonest pathogen isolated in neonatal sepsis both in babies born within the institution (intramural) and in babies referred from community and other hospitals (extramural).…”

“…Recent study involving four different centres in India showed that Klebsiella species and Escherichia coli are the most common GNB causing neonatal sepsis in India and one-third are ESBL producers in both community and hospital settings and is associated with very high mortality rate (33%) in these patients [1,6]. MRSA has become one of the most common pathogens in NICU with 33% prevalence as per a recent Indian study [7].…”

Expression of ESBL, MBL and AmpC β lactamases by extra intestinal Escherichia coli isolates: correlation with treatment and clinical outcome

“…Several studies have also reported similar results. 11,12 Previous studies have shown that ESBL producing organisms were frequently resistant to non β-lactam antibiotics such as fluoroquinolones, cotrimoxazole and aminoglycosides. 5,13 In our study we found a high degree of resistance to multiple classes of antibiotics among ESBL producing isolates.…”