Abstract
Background: Neonatal sepsis is one of the major causes of neonatal morbidity and mortality in developing countries like Nepal. In order to lower the morbidity and mortality of newborns in Neonatal Intensive Care Unit (NICU), it is essential to study the bacteriological profile and antibiotic sensitivity.
Objective: This study aimed to identify the common bacteriological profile and their antibiotics susceptibility pattern in the NICU of medical college of western Nepal.
Methodology: A descriptive cross-sectional study was conducted in NICU of Devdaha Medical College and Research
Institute, Nepal among all blood culture positive neonates admitted between April 2020 to September 2020. Convenient
sampling was done. All clinically suspected neonates were identified and laboratory data including bacteriological profile
and antibiotic sensitivity were recorded and analyzed using Statistical Package for the Social Sciences (SPSS) version 20.
Results: Among 215 neonates admitted in the NICU, 45 (20.9%) had culture positive sepsis. Most isolates were early onset
sepsis (62.22%) and low birth weight (57.78%). The majority of isolates were Gram positive, predominantly Staphylococcus
aureus (37.78%). Staphylococcus aureus showed higher resistance to Cloxacillin (57.1%) and had higher sensitivity to
Vancomycin and Linezolid (100%). Similarly, Gram negative isolates, Escherichia coli and Klebsiella sps, showed higher
resistance to Ceftriaxone (100%) and Cefoperazone, and were highly sensitive to Imipenem (100%) and Colistin (100%).
Conclusion: Staphylococcus aureus was the most common organism causing neonatal sepsis in current study with
increasing resistance to commonly used Cloxacillin and Ampicillin and highly sensitive to Vancomycin and Linezolid.
There is higher risk of emergence of antibiotic resistance. Thus, rational use of empirical antibiotics is necessary to prevent
drug resistant sepsis.
References
Singh M, Gray CP. Neonatal Sepsis. StatPearls.2020. [PubMed]
Seale AC, Blencowe H, Manu AA, Nair H, Bahl R, Qazi SA, Zaidi AK, Berkley JA, Cousens SN, Lawn JE. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis. The Lancet infectious diseases. 2014 Aug 1;14(8):731-41. [PubMed | Full Text | DOI]
Mukhopadhyay S, Puopolo KM. Neonatal early- onset sepsis: epidemiology and risk assessment. NeoReviews. 2015 Apr 1;16(4):e221-30. [ Full Text | DOI ]
Hug L, Alexander M, You D, Alkema L, for Child UI. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. The Lancet Global Health. 2019 Jun 1;7(6):e710-20. [ PubMed | Full Text | DOI ]
World Health Organization. World health statistics 2019: monitoring health for the SDGs, sustainable development goals. [ Full Text ]
Ministry of Health, Nepal; New ERA; and ICF.2017. Nepal Demographic and Health Survey 2016. Kathmandu, Nepal: Ministry of Health, Nepal. [ Full Text ]
Yadav NS, Sharma S, Chaudhary DK, Panthi P, Pokhrel P, Shrestha A, Mandal PK. Bacteriological profile of neonatal sepsis and antibiotic susceptibility pattern of isolates admitted at Kanti Children’s Hospital, Kathmandu, Nepal. BMC research notes. 2018 Dec 1;11(1):301. [PubMed | Full Text | DOI ]
Chapagain RH, Acharya R, Shrestha N, Giri BR, Bagale BB, Kayastha M. Bacteriological Profile of Neonatal Sepsis in Neonatal Intermediate Care Unit of Central Paediatric Referral Hospital in Nepal. Journal of Nepal Health Research Council. 2015;13(31):205. [PubMed | Full Text ]
Pokhrel B, Koirala T, Shah G, Joshi S, Baral P. Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal. BMC pediatrics. 2018 Dec 1;18(1):208. [ PubMed | Full Text | DOI ]
Prabhu K, Bhat S, Rao S. Bacteriologic profile and antibiogram of blood culture isolates in a pediatric care unit. Journal of laboratory physicians. 2010 Jul;2(2):85.[ PubMed | Full Text | DOI ] 11. Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, Nisar MA, Alvi RF, Aslam MA, Qamar MU, Salamat MK. Antibiotic resistance: a rundown of a global crisis. Infection and drug resistance. 2018;11:1645. [PubMed | Full Text | DOI ]
Acharya KP, Wilson RT. Antimicrobial resistance in Nepal. Frontiers in medicine. 2019 May 24;6:105. [PubMed | Full Text | DOI ]
Shrestha S, Adhikari N, Rai BK, Shreepaili A. Antibiotic resistance pattern of bacterial isolates in neonatal care unit. Journal of the Nepal medical Association. 2010 Oct 1;50(180). [ PubMed | Full Text | DOI ]
Kurma VR, Raju MS, Manchu T, Manchu K. Neonatal sepsis: Clinical spectrum, bacteriological profile and antibiotic sensitivity patterns in neonatal intensive care unit in a tertiary care Hospital. Int J Contemp Med Res. 2019;6(6):F1-48. [ Full Text | DOI ]
Lakhey A, Shakya H. Role of sepsis screening in early diagnosis of neonatal sepsis. Journal of Pathology of Nepal. 2017 Mar 30;7(1):1103-10. [ Full Text | DOI ]
Shrestha S, Shrestha NC, Singh SD, Shrestha RP, Kayestha S, Shrestha M, Thakur NK. Bacterial isolates and its antibiotic susceptibility pattern in NICU. Kathmandu university medical journal. 2013;11(1):66-70. [ PubMed | Full Text | DOI ]
Thapa S, Sapkota LB. Changing trend of neonatal septicemia and antibiotic susceptibility pattern of isolates in Nepal. International journal of pediatrics. 2019 Feb 6;2019. [ PubMed | Full Text | DOI ]
Fahmey SS. Early-onset sepsis in a neonatal intensive care unit in Beni Suef, Egypt: bacterial isolates and antibiotic resistance pattern. Korean journal of pediatrics. 2013 Aug;56(8):332. [ PubMed | Full Text | DOI ]
Peterside O, Pondei K, Akinbami FO. Bacteriological profile and antibiotic susceptibility pattern of neonatal sepsis at a teaching hospital in Bayelsa state, Nigeria. Tropical medicine and health. 2015 Sep;43(3):183-90. [ PubMed | Full Text | DOI ]
Sharma P, Kaur P, Aggarwal A. Staphylococcus aureus-the predominant pathogen in the neonatal ICU of a tertiary care hospital in Amritsar, India. Journal of clinical and diagnostic research: JCDR. 2013 Jan;7(1):66. [ PubMed | Full Text | DOI ]
Mahmood A, Karamat KA, Butt T. Neonatal sepsis: high antibiotic resistance of the bacterial pathogens in a neonatal intensive care unit in Karachi. J Pak Med Assoc. 2002 Aug;52(8):348-50. [ PubMed | Full Text ]
Muley VA, Ghadage DP, Bhore AV. Bacteriological profile of neonatal septicemia in a tertiary care hospital from Western India. Journal of Global Infectious Diseases. 2015 Apr;7(2):75. [ PubMed | Full Text | DOI ]
Shah AJ, Mulla SA, Revdiwala SB. Neonatal sepsis: high antibiotic resistance of the bacterial pathogens in a neonatal intensive care unit of a tertiary care hospital. Journal of clinical neonatology. 2012 Apr;1(2):72. [ PubMed | Full Text | DOI ]
Yusef D, Shalakhti T, Awad S, Algharaibeh HA, Khasawneh W. Clinical characteristics and epidemiology of sepsis in the neonatal intensive care unit in the era of multi-drug resistant organisms: a retrospective review. Pediatrics & Neonatology. 2018 Feb 1;59(1):35-41. [ Full Text | DOI ]
Thapa B, Thapa A, Aryal DR, Thapa K, Pun A, Khanal S, Mahat K. Neonatal sepsis as a major cause of morbidity in a tertiary center in Kathmandu. Journal of Nepal Medical Association. 2013;52(192). [ PubMed | Full Text | DOI ]