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Category: Volume 06 Issue 02 February 2018
Hits: 1742

Title: Neonatal Intensive Care Unit in a Tertiary Care Hospital in North India

Authors: Natasha Sawhney, Sandeep Dogra, Bella Mahajan

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i2.02

Abstract

Neonatal infection is a foremost cause of admission in Neonatal intensive care unit (NICU), accounting annually about 1.6 miilion newborn deaths in developing countries and a big hurdle for achievement of the Millenium Development Goal for child survival. Neonatal meningitis is still a disease with high morbidity, although advances in perinatal care over the last few decades have been able to reduce its mortality rates to approximately 10%. Changing bacterial flora and emergence of resistant strains adds to the problem. Thus, neonatal meningitis requires accurate diagnosis and proper management for better outcome.

Methods: This prospective study was conducted among suspected neonatal meningitis cases admitted to the NICU at SMGS hospital from May 2016 to May 2017. After taking applied assent from the parents of the neonates, a total of 340 CSF samples were collected and processed by automated identification and susceptibility testing system as per validated laboratory protocols of Microbiology laboratory. Data of positive culture isolates was analysed by appropriate tools.

Results: Out of 340 clinically suspected meningitis cases in neonates, a total of 67 (19.7%) were positive. 42 neonates (62.7%) had Gram-negative isolates, 21 (31.3%) were Gram-positive pathogens and 4 (6%) had fungal infection. Among the Gram-negative isolates, common species isolated were Escherichia coli (38%), Acinetobacter sp. (23.8%) and Enetrobacter sp. (16.7%) followed by Klebsiella sp. (9.6%), Pseudomonas sp. (4.8%) along with the isolation of rare organisms like Stenotrophomonas sp., and Serratia sp. Antibiotic pattern suggested high degree of resistance to first line penicillins and gentamicin, moderate to amikacin and cefoperazone – sulbactum. Among the Gram-positive isolates, Enterococcus sp. and CONS were found in highest numbers, each contributing 38% of the total gram positive isolates, followed by Staphylococcus aureus (24%). Antibiotic pattern suggested 100% resistance to penicillins with all the isolates as Methicillin Resistant Staphylococcus aureus (MRSA). Moderate to high level resistance was seen in aminoglycosides (42.8%) and quinolones (52.3%) with 14.2 % of Vancomycin resistant enterococcus sp.

Conclusion: The present study highlights the presence of rare organisms causing meningitis and increasing trend of high to moderate level of antibiotic resistance calling for continuous monitoring by rapid detection and consecutive adjustment of empirical treatment regime. Further studies are required to study the trends and pattern of antibiotic resistance to develop hospital antibiotic policy.

Keywords: Meningitis, CSF culture, antibiotic resistance.

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Corresponding Author

Dr Natasha Sawhney

Demonstrator, Dept. of Microbiology,

Govt. Medical College, Jammu

9419127777, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.