Multidrug resistant microorganisms causing neonatal septicemia: In a tertiary care hospital Lahore, Pakistan

Abstract

Septicemia is an important cause of morbidity and mortality in neonates. Appropriate clinical diagnosis and empirical treatment is crucial as pathogens causing sepsis and their antibiotic susceptibility pattern varies in different settings. Therefore, this study was designed to determine the pattern of organisms causing neonatal sepsis and their antimicrobial resistance profile. One hundred and three blood culture specimens were collected aseptically. The specimens were processed in BACTEC 9120. Antimicrobial resistance profile was determined using Kirby-bauer disc diffusion method. Isolates showing resistance to any of the third generation cephalosporins were further confirmed for the production of ESBL by double disk diffusion method according to CLSI 2009 guidelines. Of 103 blood cultures, 71 (68.9%) were positive. Out of these positive cultures, 62 (87%) cases grew pure growth while 9 (12%) cases had polymicrobial infection. Out of these eighty isolates 30 (37.5%) and 50 (62.5%) were found in early and late onset septicemia, respectively. Thirty (42.2%) neonates died and K. pneumoniae was the main causative agent. The predominant isolates were K. pneumoniae (n=40) and CoNS (n=11). More than 90% of Gram-negative isolates showed resistance against beta -lactams, co-amoxiclav and amikacin. More than 50% of Gram-positive isolates were resistant to penicillin, macrolides, ciprofloxacin and co-trimoxazole. ESBLs producing K. pneumoniae (n=19), MRCoNS (n=6), MRSA (n=4) have also been found in this study. The study concludes that frequency of organisms was mainly found in late-onset neonatal septicemia. Multidrug resistant and ESBL producing organisms were main contributing factor towards high mortality.