Title: The Study of in Vitro Sensitivity and Resistance Pattern of Antibiotics in Neonatal Septicemia in Tertiary Care Hospital
Authors: Dr Shruti Dhale, Dr Subhash Valinjkar, Dr Sapna Anjutagi, Dr Vighnesh Narkhede
DOI: http://dx.doi.org/10.18535/jmscr/v4i8.07
Aims and objectives 1. To study in vitro sensitivity and resistance pattern of antibiotics in neonatal septicemia. 2. To find out the incidence of blood culture positive neonatal septicemia in tertiary care hospital Study Design: This was a Prospective observational cohort study which was conducted in a tertiary care center in a metropolitan city. Materials and methods: All symptomatic neonates upto 28 days old admitted in NICU of our institute with history and clinical symptoms suggestive of neonatal septicemia were enrolled in this study. The blood culture of all the suspected cases having clinical signs and symptoms of neonatal septicemia were analyzed and studied for culture sensitivity and resistance pattern. Incidence of blood culture positive neonatal septicemia amongst all neonates admitted in neonatal intensive care unit over the study period was aldo calculated. Results: Over the study period a total of 2035 neonates were admitted in our NICU. Out of these 2035 Neonates 197 neonates were diagnosed to be having sepsis depending upon clinical criteria. All these 197 cases were studied in this study. Blood samples were drawn from all these neoates and CBC,CRP and blood culture tests were done. On clinical examination the most common signs in these children were Retraction, Flaring, grunting (36.55%), oliguria (26.4%), lethargy (27.41%), vomiting (19.29%) and poor feeding (17.26%). High pitched cry, hyporeflexia, petechial, purpura and hypotonia were least common signs which were seen in 0.51 % cases. Irregular respiration and splenomegaly was not seen in any patient. Blood culture was positive in 53 cases. Out of these 53 blood culture positive cases 28 (52.8%) cases were having lateonset sepsisand 25 (47.2%) caseswere having early onset sepsis. An analysis of culture and sensitivity pattern of the blood culture positive cases revealed that overall most common organisms involved in cases of neonatal sepsis were methicillin-susceptible coagulase-negative staphylococci [MSCoNS] (22.64%) followed by enterobacter (16.98%), Methicillin-resistant staphylococcus aureus (13.2%) and klebsiella pneumonia (13.2%) . The most common gram positive organisms involved in neonatal sepsis were MSCoNS (22.64%) while the gram negative organisms most commonly involved were enterobacter (16.98%). 3(5.66%) had fungal septicemia caused by candida. Patients The least common organisms involved in neonatal sepsis were found to be due to E.tarda, C.Frundi and of polymicrobial etiology which was seen in 1.88% cases each. The study of sensitivity pattern of organisms revealed that 100% of MRSA were susceptible to ciprofloxacin, ofloxacin, amikacin and gentamicin. E-coli was sensitive to ciprofloxacin, meropenam and amikacin. Klebsiella isolated were found to be relatively resistant to ofloxacin and imipenem while acitenobacter were found to be susceptible to colistin in only 60% cases. Conclusion: Neonatal sepsis is one of the major cause of morbidity and mortality. Its incidence is increasing as more premature and low birth weight babies are resuscitated and are being managed in neonatal intensive care units. Prematurity, low birth weight babies and male gender are associated with increased risk of developing sepsis. In view of the changing spectrum of the causative agents of neonatal septicemia and their antibiotic sensitivity and resistance patterns from time to time and from one hospital to another, a positive blood culture and the antibiotic sensitivity and resistance pattern testing of the isolates are the best guide to the antimicrobial therapy and which would be beneficial for the best outcome of the disease. Early diagnosis and prompt antibiotic therapy is the key to management of neonatal sepsis. Keywords: neonatal sepsis, Early onset Sepsis, Late onset sepsis, Blood culture and sensitivity, Antibiotic theapy.
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