NEONATAL INTENSIVE CARE UNIT – EMERGING PATHOGENS AND PATIENT OUTCOMES
DOI:
https://doi.org/10.69723/njms.04.02.0566Keywords:
Antibiogram, Antimicrobial susceptibility, Neonatal intensive care unit, Neonatal sepsisAbstract
Background: In developing countries, neonatal sepsis is one of the main reasons for morbidity and mortality. The development of local antibiograms and knowledge about microbial flora and its antibiotic susceptibility pattern will help pediatricians when starting empirical treatment.
Objective: To determine the bacteriological profile of organisms in the neonatal intensive care unit and their susceptibility pattern.
Methodology: This was a cross-sectional study. Pathogens were identified using standard microbiological techniques of Gram stain, colony morphology, and biochemical tests. Specimens were processed according to the standard guidelines of the Clinical Microbiology Procedures Handbook, 4th edition. The Kirby-Bauer disc diffusion method was used to determine antibiotic susceptibility, which was interpreted according to the Clinical and Laboratory Standards Institute guidelines for 2024 testing. For fungal septicemia, the Vitek 2 system (bioMérieux) was used to determine the susceptibility profile. Their minimum inhibitory concentrations (MIC) were performed and breakpoints were evaluated. Data was analyzed using a statistical package for social sciences and qualitative and quantitative variables were determined. P value less than 0.05 was taken as significant.
Results: In our study 208 blood cultures were positive. The culture Positivity rate was 40% in the neonatal Intensive care unit. Septicemia due to Gram-negative organisms was 79 (37.9%) followed by fungal septicemia 68(32.6%) and Gram-positive septicemia was around 61(29.3%).
-resistant Acinetobacter baumannii 38 (18.26%) was the most common Gram-negative isolate responsible for sepsis in neonates whereas Methicillin-resistant Coagulase-negative Staphylococcus and Candida parapsilosis were also causing septicemia in neonates.
Gram-negative MDROs are the leading cause of neonatal septicemia in our setting. Necessitating local antibiogram and infection control practices are the need of hour
Keywords: Antibiogram, Antimicrobial susceptibility, Neonatal intensive care unit, Neonatal sepsis
References
Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390(10104):1770–80. https://doi.org/10.1016/S0140-6736(17)31002-4
Buthelezi PF, Naby F, Kannigan Y. Retrospective review of bacteriological profiles and antibiogram in a tertiary neonatal unit. S Afr J Infect Dis. 2023;38(1). https://doi.org/10.4102/sajid.v38i1.439
Salman O, Procter SR, McGregor C, Paul P, Hutubessy R, Lawn JE, et al. Systematic review on the acute cost-of-illness of sepsis and meningitis in neonates and infants. Pediatr Infect Dis J. 2020;39(1):35–40. https://doi.org/10.1097/INF.0000000000002472
Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018;6(3):223–30. https://doi.org/10.1016/S2213-2600(18)30063-8
Harrison ML, Dickson BFR, Sharland M, Williams PCM. Beyond early- and late-onset neonatal sepsis definitions: what are the current causes of neonatal sepsis globally? A systematic review and meta-analysis of the evidence. Pediatr Infect Dis J. 2024;43(12):1182–90. https://doi.org/10.1097/INF.0000000000004182
Chaurasia S, Sivanandan S, Agarwal R, Ellis S, Sharland M, Sankar MJ. Neonatal sepsis in South Asia: huge burden and spiralling antimicrobial resistance. BMJ. 2019;364:k5314. https://doi.org/10.1136/bmj.k5314
De Backer D, Dorman T. Surviving sepsis guidelines: a continuous move toward better care of patients with sepsis. JAMA. 2017;317(8):807–8. https://doi.org/10.1001/jama.2017.0204
Negm EM, Elgharabawy ES, Badran SG, Raafat AON, Soliman ST, Mahmoud HM, et al. Analysis of cumulative antibiogram reports in intensive care units at an Egyptian university hospital. J Infect Public Health. 2023;16(8):1220–9. https://doi.org/10.1016/j.jiph.2023.05.003
Procianoy RS, Silveira RC. The challenges of neonatal sepsis management. J Pediatr (Rio J). 2020;96(Suppl 1):80–6. https://doi.org/10.1016/j.jped.2019.11.006
Akter S, Chaudhury IJ, Jahan MA, Nasrin UT, Sah S, Mannan A. Pathogens and antibiogram of bloodstream isolates in neonatal sepsis: Findings from a tertiary care hospital, Bangladesh. Integr J Med Sci. 2022;9:1–6. https://doi.org/10.15342/ijms.2022.9113
Parajuli R, Pant ND, Bhandari R, Giri A, Rai S, Acharya GP, et al. Bacteriological profile of neonatal sepsis and antibiogram of the isolates. J Nepal Paediatr Soc. 2017;37(1):5–9. https://doi.org/10.3126/jnps.v37i1.16255
Kumar S, Parasher V, Sharma S. Bacteriological profile and antibiogram of blood culture isolates of septicemic patients from neonatal and pediatric intensive care units. Int J Med Health Res. 2018;4(9):1–4.
Jajoo M, Manchanda V, Chaurasia S, Sankar MJ, Gautam H, Agarwal R, et al. Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India. PLoS One. 2018;13(6):e0180705. https://doi.org/10.1371/journal.pone.0180705
Ahmed SH, Mokhtar EM, El-Kholy IM, El Essawy AK, El-Din AA, Shetaia YM. Fungal neonatal and infantile sepsis in Egypt: Risk factors and identification of fungal isolates. Afr J Clin Exp Microbiol. 2020;21(1):14–20. https://doi.org/10.4314/ajcem.v21i1.3
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 Pediatr. 2018;18:208. https://doi.org/10.1186/s12887-018-1182-9
Kabwe M, Tembo J, Chilukutu L, Chilufya M, Ngulube F, Lukwesa C, et al. Etiology, antibiotic resistance and risk factors for neonatal sepsis in a large referral center in Zambia. Pediatr Infect Dis J. 2016;35(7):e191–8. https://doi.org/10.1097/INF.0000000000001191
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Afnan Naeem
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purposes. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
.png)
