SPECTRUM AND ANTIBIOTIC SUSCEPTIBILITY OF GRAM NEGATIVE ORGANISMS ASSOCIATED WITH NEONATAL SEPSIS

Main Article Content

Saima Inam
Sadia Ikram
Muhammad Tahir Saeed
Sadaf Munir
Almas Raza
Asma Inam
Syed Zeeshan Haider Naqvi
Aroosh Shabbir

Keywords

Neonatal sepsis, Gram negative bacteria, Neonatal intensive care unit, Blood culture, Anti-bacterial agents

Abstract

This study involved the analysis of 492 blood samples to assess the prevalence of sepsis, specifically focusing on Gram-negative bacterial (GNB) neonatal sepsis. Out of the total cases diagnosed with culture-proven sepsis (96 patients), 54 (56.25%) were identified as GNB neonatal sepsis. Among the GNB neonatal sepsis cases, Pseudomonas aeruginosa was the predominant pathogen, isolated in 32 patients (59.26%), and followed by Klebsiella species in 12 patients (22.22%), E. coli in 6 patients (11.1%), and Acinetobacter species in 4 patients (7.41%).


Detailed antibiotic susceptibility profiles were determined for each identified pathogen. Notably, Carbapenem such as Imipenem (IPM) and Meropenem (MEM) exhibited robust efficacy, with over 80% susceptibility observed. The highest susceptibility was observed for Meropenem against Pseudomonas aeruginosa (87%), and the lowest susceptibility was noted for Ciprofloxacin against Klebsiella species (10%). However, Tazobactam-piperacillin (TZP) demonstrated varied effectiveness across pathogens, and only 31.25% of Pseudomonas aeruginosa isolates showed sensitivity to TZP. Commonly used antibacterial agents, including Ampicillin, Co-amoxiclav, and third-generation cephalosporin, displayed limited efficacy against isolates. In conclusion, Pseudomonas aeruginosa emerged as the most common Gram-negative organism causing neonatal sepsis. High resistance was observed in current empiric treatment choices like Amikacin (AK) and Tazobactam-piperacillin (TZP). Routinely used antibacterial agents, including Ampicillin, Co-amoxiclav, ceftriaxone, cefotaxime, and ciprofloxacin, were found to be ineffective against Gram-negative isolates, emphasizing the need for careful consideration in neonatal sepsis treatment.

Abstract 99 | pdf Downloads 63

References

1. Sands K, Carvalho MJ, Portal E, Thomson K, Dyer C, Akpulu C, et al. Characterization of antimicrobial-resistant Gram-negative bacteria that cause neonatal sepsis in seven low- and middle-income countries. Nature microbiology. 2021; 6(4):512-523. Doi: 10.1038/s41564-021-00870-7
2. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017; 390 (10104):1770-1780. Doi: 10.1016/s0140-6736 (17)31002-4
3. Scamardo MS, Dolce P, Esposito EP, Raimondi F, Triassi M, Zarrilli R. Trends, risk factors and outcomes of healthcare-associated infections in a neonatal intensive care unit in Italy during 2013-2017. Ital J Pediatr. 2020; 46(1):34. doi: 10.1186/s13052-020-0799-3
4. Wu IH, Tsai MH, Lai MY, Hsu LF, Chiang MC, Lien R, et al. Incidence, clinical features, and implications on outcomes of neonatal late-onset sepsis with concurrent infectious focus. BMC Infect Dis. 2017; 17(1):465. doi: 10.1186/s12879-017-2574-7
5. Folgori L, Tersigni C, Hsia Y, Kortsalioudaki C, Heath P, Sharland M, et al. The relationship between Gram-negative colonization and bloodstream infections in neonates: a systematic review and meta-analysis. Clin Microbiol Infect. 2018; 24(3):251-257.doi:10.1016/j.cmi.2017.08.008
6. Fleischmann C, Reichert F, Cassini A, Horner R, Harder T, Markwart R ,et al. Global incidence and mortality of neonatal sepsis: a systematic review and meta-analysis. Arch Dis Child. 2021 Aug; 106 (8): 745–752. doi: 10.1136/archdischild-2020-320217
7. Shaikh M, Hanif, M , Gul R, Hussain W, Hemandas H, Memon A. Spectrum and Antimicrobial Susceptibility Pattern of Micro-Organisms Associated With Neonatal Sepsis in a Hospital in Karachi, Pakistan. Cureus .Oct 2020; 12 (10): e10924. doi:10.7759/cureus.10924
8. Popescu CR, Cavanagh MMM, Tembo B, Chiume M, Lufesi N, Goldfarb DM, et al. Neonatal sepsis in low-income countries: epidemiology, diagnosis and prevention. Expert Rev Anti Infect Ther. 2020;18 (5):443-452. Doi: 10.1080/14787210.2020.1732818
9. Obeng-Nkrumah N, Labi AK, Addison NO, Labi JE, Awuah-Mensah G. Trends in paediatric and adult bloodstream infections at a Ghanaian referral hospital: a retrospective study. Ann Clin Microbiol Antimicrob. 2016;15(1):49.doi: 10.1186/s12941-016-0163-z
10. Bai X, Wei Q, Duan T, Yi Y, Peng H, Hu LJJoLM. Predominance of Gram-negative infections a cause of neonatal sepsis among low birth weight preterm infants. 2021; 45(1):7-12
11. Aku FY, Akweongo P, Nyarko K, Sackey S, Wurapa F, Afari EA, et al. Bacteriological profile and antibiotic susceptibility pattern of common isolates of neonatal sepsis, Ho Municipality, Ghana-2016. Maternal health, neonatology and perinatology. 2018; 4:2. Doi: 10.1186/s40748-017-0071-z
12. Hamer DH, Darmstadt GL, Carlin JB, Zaidi AK, Yeboah-Antwi K, Saha SK, et al. Etiology of bacteremia in young infants in six countries. Pediatr Infect Dis J. 2015; 34 (1):e1-8.10.1097/inf.0000000000000549
13. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet 2018; 392:1789–858. 10.1016/S0140-6736(18)32279-7 [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]
14. Yadav SK, Yadav S, Kanodia P, Bhatta N, Singh R, Khanal BJJoBKIoHS. Nosocomial Sepsis and its Risk Factors: A Cross-Sectional Study in a Neonatal Intensive Care Unit. 2019;2 (1):52-59
15. Yadav SK, Yadav S, Kanodia P, Bhatta N, Singh R, Khanal B. Profile and Risk Factors for Nosocomial Sepsis in a Neonatal Intensive Care Unit of BPKIHS. Int. J. Ther. Appl. 2018; 35: 54-59
16. G/eyesus T, Moges F, Eshetie S, Yeshitela B, and Abate E. Bacterial etiologic agents causing neonatal sepsis and associated risk factors in Gondar, Northwest Ethiopia. BMC Pediatrics. 2017; 17:137. DOI 10.1186/s12887-017-0892-y
17. Uwe N O , Ezenwa B , Fajolu I B, Oshun P , Chukwuma S T , Ezeaka V C. Antimicrobial susceptibility and neonatal sepsis in a tertiary care facility in Nigeria: a changing trend? JAC Antimicrob Resist. 2022 Sep 30; 4(5): dlac100. doi:10.1093/jacamr/dlac100. E Collection 2022 Oct
18. Nordberg V, Iversen A, Tidell A, Ininbergs K, Giske CG, Navér L. A decade of neonatal sepsis caused by gram-negative bacilli- a retrospective matched cohort study. Eur J Clin Microbiol Infect Dis. 2021;40 (9):1803-1813.10.1007/s10096-021-04211-8
19. Omenako K A, Enimil A, Marfo A F A, Timire C, Chinnakali P, Fenny A P,et al. Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021. Int. J. Environ. Res. Public Health. 2022; 19: 12968. https://doi.org/10.3390/ijerph191912968

Most read articles by the same author(s)