Antimicrobial resistance in neonatal septicaemia: A therapeutic challenge to Pediatricians of rural India

  • Dangre G
  • Tankhiwale N
  • Mudey A
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Abstract

Background: In spite of great advances in antimicrobial therapy, neonatal life support measures and the early detection of risk factors, septicaemia continues to be an immense challenge for health professionals and major cause of mortality and morbidity among neonates around the world. In India septicaemia occurs in 10.97% - 27% per 1000 live births and is leading cause of neonatal mortality accounting for one quarter to nearly half of all neonatal deaths. The neonatal intensive care units (NICUs) today face single common problem of tackling septicaemia. The prevalence of infections due to multidrug resistant (MDR) and Extended spectrum beta-lactamase (ESBL) producing gram negative bacteria has increased in recent years. Multidrug resistance (MDR) and Methicillin resistance among Staphylococcus aureus (MRSA) is another obstacle in the treatment. We have studied the isolates from neonatal septicaemia cases for MDR, ESBL and MRSA. Methods: This prospective cross-sectional study was conducted on 420 cases of clinically diagnosed neonatal septicaemia admitted in NICU in tertiary care rural hospital and teaching institute of central India. Blood culture was done in all cases by conventional three subculture method and antibiotic sensitivity was done by Kirby Bauer disc diffusion. All cases were studied for MDR, ESBL and MRSA as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Blood culture was positive in 49.05% cases. Klebsiella Pneumoniae was frequently isolated pathogen (63.11%), followed by Escherichia coli (12.62%) Staphylococcus aureus (10.68%), Enterobacter species (4.85%), Acinetobacter species (4.85%), Citrobacter freundii (3.88%). MDR was seen in 93.69% isolates. Gram negative isolates from enterobactericeae were 100% resistant to ampicillin. 71.74% of gram negative isolates were ESBL producers with highest ESBL production among Klebsiella pneumonia isolates (73.85%). All Staphylococcus aureus isolates were resistant to penicillin. Among Staphylococcus aureus isolates 45.45% were MRSA. Most sensitive antimicrobial against gram negative isolates was imipenem with 100% sensitivity, followed by amikacin (50%). Staphylococcus aureus isolates were 100% sensitive to vancomycin followed by amikacin (45.45%) and cotrimoxazole (45.45%). Conclusion: There is a need of continuous surveillance of bacteriological profile and antimicrobial resistance pattern of neonatal septicaemia in each and every NICU. Therapeutic strategies have to be carefully formulated to control infections in NICUs.

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Dangre, G., Tankhiwale, N., & Mudey, A. (2012). Antimicrobial resistance in neonatal septicaemia: A therapeutic challenge to Pediatricians of rural India. International Journal of Infectious Diseases, 16, e412. https://doi.org/10.1016/j.ijid.2012.05.564

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