Distribution, antimicrobial resistance and predictors of mortality in neonatal sepsis.

Publisher: IOS Press Country of Publication: Netherlands NLM ID: 101468335 Publication Model: Print Cited Medium: Internet ISSN: 1878-4429 (Electronic) Linking ISSN: 18784429 NLM ISO Abbreviation: J Neonatal Perinatal Med Subsets: MEDLINE

Original Publication: Amsterdam : IOS Press, 2008-

Anti-Bacterial Agents/*therapeutic use ; Community-Acquired Infections/*mortality ; Drug Resistance, Multiple, Bacterial/*drug effects ; Neonatal Sepsis/*mortality; Community-Acquired Infections/drug therapy ; Community-Acquired Infections/microbiology ; Female ; Humans ; India ; Infant, Newborn ; Male ; Microbial Sensitivity Tests ; Neonatal Sepsis/drug therapy ; Neonatal Sepsis/microbiology ; Prevalence ; Retrospective Studies

Objective: The aim of this study is to investigate etiological agents, patterns of antimicrobial resistance and predictors of mortality in culture proven neonatal sepsis.
Method: This is a twenty-four month retrospective cohort study of infants with culture proven sepsis. Demographic data, type of isolates and its sensitivity pattern were recorded. Multidrug resistant gram-negative isolates were defined as resistance to any three of five antibiotic classes: extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones and piperacillin-tazobactam.
Result: A total of 183 case with culture positive sepsis were identified. Early onset sepsis occurred in 59% of cases. The majority of isolates (56.2%) were gram-positive but the most common individual isolates were klebsiella spp. (31.1%), Staphylococcus aureus (24.5%) and coagulase-negative staphylococci (CONS) (22.9%). The pathogen mix in early-onset did not differ from late-onset sepsis. High rates of multidrug resistance were observed in klebsiella spp. (49.1%), Escherichia coli (50%), citrobacter spp (50%), acinetobacter spp. (28.5%), pseudomonas spp. (100%) isolates. Methicillin resistance prevailed in 16.6% of coagulase-negative staphylococci, 24.4% of Staphylococcus aureus and 62.5% of enterococcus spp. Multivariate analysis revealed invasive ventilation and early onset sepsis to be independently associated with increased risk of mortality in contrast to breast milk feeding which is associated with decreased risk of mortality.
Conclusion: A high degree of antimicrobial resistance underscores the need to understand the pathogenesis of resistance, curtail the irrational prescription of antibiotics in neonates and the requirement for measures to prevent it in low-income and middle-income countries.

Keywords: Antimicrobial resistance; mortality; neonates

0 (Anti-Bacterial Agents)

Date Created: 20180712 Date Completed: 20181212 Latest Revision: 20181212

20221213

10.3233/NPM-1765

29991144