Neonatal gram-negative bacteremia

Abstract

A 22 months prospective study of neonatal gram-negative bacteremia was undertaken in a 15 bed NICU to find out the incidence and antibiotic resistance patterns. Clinically suspected 1326 cases of neonatal sepsis were studied during this period. More than 25% of the cases were microbiologically positive for sepsis. Among 230 (67.2%) cases of gram-negative bacteremia, the predominant isolates were Pseudomonas aeruginosa (38.3%), Klebsiella pneumoniae (30.4%), Escherichia coli (15.6%) and Acinetobacter sp. (7.8%). Fifty-nine per cent of the neonates were born in hospital while 41% were from community and referral cases. Lower respiratory tract infection, umbilical sepsis, central intravenous line infection and infection following invasive procedures were the most commonly identified sources of septicemia. Prematurity and low birth weight were the main underlying conditions in 60% of the neonates. Total mortality was 32%. Increased mortality was mainly associated with neutropenia, nosocomial infection and inappropriate antibiotic therapy. Resistance was increasingly noted against many antibiotics. The isolates were predominantly resistant to extended spectrum cephalosporins (25%-75%), piperacillin (68%-78%), and gentamicin (23%-69%). The commonest microorganisms causing gram-negative bacteremia were Pseudomonas aeruginosa followed by Klebsiella pneumoniae. The community-acquired bacteremia was mainly due to E. coli. The proportion of preterm and low birth weight babies was significantly high, and the major contributing factor in total mortality. Sensitivity to different antibiotics conclusively proved that a combination of ampicillin + sulbactam with amikacin or ampicillin + sulbactam with ciprofloxacin is most effective.

Antibiotic Use in Neonates of Birth-weight < 2000 G Surviving to Discharge

“…We wish to emphasize the point that almost three quarters of infants < 2000 g at birth were not administered antibiotics in our unit. Lower birth weight and lower gestational age were significantly associated with antibiotic use as in other studies [2][3][4][5][6][7]. In our study, 70% of infants < 1250 g received antibiotics while this proportion marginally decreased to 61.5% when all infants < 1500 g were considered.…”

“…Prematurity and low birth-weight (<2000g) are known risk factors for neonatal infection [2][3][4][5][6][7] and studies from across the world have reported varying rates of infection and antibiotic use. We decided to include infants <2000g at birth as all such infants in our institution are admitted to the Neonatal Intensive Care Unit (NICU) for observation.…”

“…Apart from predisposing maternal risk factors for infection, intrinsic immunological immaturity and underdevelopment of various general systems like skin and mucosa predispose neonates to infection [2]. The risk of infection increased with decreasing birth weight and prematurity [3][4][5][6]. Difficulty in diagnosis of neonatal bacterial infection leads to widespread use of antibiotics [7][8][9].…”

A Study on the Pattern of Bacterial Pathogens Isolated in Neonatal Septicemia

“…The differences in the culture positivity rates noticed in different studies could be attributed to geographical distribution and also type of study-for instance retrospective or prospective and also whether the patients were on antibiotics or not before obtaining blood sample for culture. (Kuruvilla et al, 1986) However, (Joshi et al, 2000) and coworkers reported isolation of GNBs more predominantly that was reported in 67.2% cases in their study. (Kaistha et al, 2009) recorded gram negative septicemia in 80.4% of neonates.…”

Evaluation of hypoglycemic status and causative factors in neonatal sepsis

“…17 Gram-negative bacteria remain to be the major cause of neonatal sepsis in developing countries. 18,19 Increased drug resistances have developed by these organisms over the last two decades and become a major problem to manage of neonatal sepsis. 20,21 Besides, frequent used of group B Streptococcus (GBS) as ethological agent of neonatal sepsis in developed countries, being responsible for high morbidity and death rates.…”