Study of Antibiotic Susceptibility among Bacterial Isolates in Neonatal Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Abstract

Introduction: Neonatal sepsis is a major cause of neonatal morbidity and mortality worldwide, especially in developing countries like Nepal. Antibiotic resistance among microorganisms poses new challenges in the treatment of neonatal sepsis. The present study is conducted with the objectives of determining clinico-bacteriological profile and antibiotic susceptibility among isolated bacteria in a neonatal intensive care unit.
 Methods: A descriptive cross-sectional study was conducted from January 1, 2017, to December 31, 2019, in the neonatal intensive care unit of a tertiary care hospital after obtaining ethical clearance from Institutional Review Committee (Reference Number: 2020-064). The sample size was calculated and 77 neonates with culture-proven sepsis were included in the study. The antibiotic susceptibility tests of the isolates were done by Kirby-Bauer disc diffusion method. Data entry was done in Statistical Packages for the Social Sciences version 20.
 Results: Of the 841 specimens (blood, cerebrospinal fluid, urine, tracheal aspirate and pus) processed for culture, bacteria were isolated in 84 (10.0%) specimens. Among the 84, gram-negative bacilli were the predominant isolates 76 (90.5%); of which Acinetobacter baumannii was the most common 27 (32.1%). Both the Gram-negative and the Gram-positive bacteria showed high resistance to Penicillin and Cephalosporins. Gram-negative bacteria showed maximum sensitivity to Colistin, Carbapenems, Tigecycline and Fluoroquinolones. Gram-positive bacteria showed maximum susceptibility to Amikacin, Vancomycin and Carbapenems.
 Conclusions: Judicious use of antibiotics based on the updated knowledge of prevalent organisms in the local hospital setting and their antibiotic sensitivity pattern is of utmost importance for the effective treatment of neonatal sepsis.

Neonatal Sepsis in a Resource-Limited Setting: Causative Microorganisms and Antimicrobial Susceptibility Profile

“…This confirms reports from a related study among neonates where Staphylococcus epidermidis and Staphylococcus haemolyticus showed poor sensitivity (13.5%) to ampicillin [ 33 ]. High resistance exhibited by Gram-positive organisms to ampicillin and penicillin corroborates other similar studies [ 34 – 39 ]. Further analysis showed that Klebsiella isolates were resistant to cefotaxime, a commonly used second-line antibiotic.…”

Neonatal Bacteraemia and Antibiotic Resistance at the Angre University Hospital, Abidjan, 2020

“…This is in accordance with findings from Saudi Arabia (27/40; 67.5%) [24], and China (57,49%) [25]. However, Gram-negative bacilli were the predominant bacteria isolatedin anothers countries like Congo [15], Nigeria [9], Cameroun [26], and Nepal [27]. CoNS (28.04%) was the predominant bacteria identified in our study followed by Klebsiella pneumoniae (26,83%).…”

“…This rate is comparable to a study performed in Dessie (Ethiopia) [36]. Higher rates were found by Chaudhary [27], Agarwal [38], and Pokhrel [39].…”

“…Elsewhere, the prevalence of MRSA is much higher. This is the case in Nepal, where Chaudhary et al found a prevalence of MRSA of 60% [27]. In a study in Ethiopia, MRSA was found in 66.7% of cases [36].…”

Assessment of four in vitro phenotypic biofilm detection methods in relation to antimicrobial resistance in aerobic clinical bacterial isolates

“…Another study from Nepal performed among 71 CoNS strains also reported similar resistance rates of the isolates toward penicillin (90%), co-trimoxazole (60%), and azithromycin (60%), and absolute sensitivity to vancomycin and linezolid [30]. Such higher occurrences of antibiotic-resistant isolates in these studies, including ours, could be attributable to the biofilm-forming tendency of the isolates or the dissemination of plasmids carrying antibiotic-resistant genes via the quorum sensing phenomenon [29,31].…”