Clinical and Epidemiological Profile of Neonatal Sepsis in Referral Care NICU in South Kerala

Title: Clinical and Epidemiological Profile of Neonatal Sepsis in Referral Care NICU in South Kerala

Authors: Dr Sanuja Sarasam E, Dr Geetha S, Dr Sobha Kumar.S

DOI: https://dx.doi.org/10.18535/jmscr/v5i3.159

Abstract

Introduction: Neonatal sepsis continues to be a major cause for mortality and morbidity in neonates. It is 30 per 1000 live birth in India. The prevalence is more in preterm babies. As more preterm babies are now surviving.

Objective: To describe the clinical and bacteriologic spectrum of neonatal sepsis in referral neonatal intensive care unit.

Secondary objective: To compare risk factors and bacteriologic spectrum in early onset and late onset sepsis.

Setting: Tertiary care referral center in a teaching hospital in South Kerala.

Study period: January 2014 to December 2016.

Design: Retrospective cohort study.

Methods: All neonates admitted were assessed for bacterial sepsis.

Inclusion criteria included presence of one or more of the established clinical features, along with ≥2 of the laboratory criteria (total blood leukocyte count <5000/>15000, absolute neutrophil count (ANC) <500 cells/mm ³ or >1500/mm ³, immature to total neutrophil ratio >0.2, micro erythrocyte sedimentation rate (ESR) >15/1 h, C-reactive protein (CRP) >0.6 μg/ml, positive blood culture. Information assessed in a proforma. Cases were divided into early onset sepsis (EOS) (presenting in the first 72 h) and late onset sepsis (LOS) (presenting after 72 h).All cases were started on antibiotics and managed as per SAT hospital protocol and later upgraded or stopped based on culture and sensitivity. Cases were followed-up to discharge/death.

Results: There were 5202 admissions during study period. Of this 586 were of suspected sepsis.RDT was positive in 346 patients (59.04 %).Of these neonates 126 (36.4%) had culture positive sepsis. The incidence of culture positive sepsis was 126/546(21.5%). Of these 68(54%) was Early onset sepsis (EOS) and 58(46%) late onset sepsis (LOS). The total deaths were 353. Of these 9 deaths has culture positivity. The common organisms were Staphylococcus (35)27.8%, Klebsiella (25)19.8%, Acinetobacterium (24)19%, Pseudomonas (16)12.7% & E coli (8)6.3%, CONS (1) 1%.

Conclusion: The incidence of culture positive sepsis was 21.5%. Of these 54%was Early onset sepsis (EOS). The common organisms were Gram negative organisms in both EOS& LOS. Gram positive organism Staphylococcus aureus is also a major contributor in neonatal sepsis in our study. Acinetobacter sepsis is high (19%) in our study.

References

1. J. O. Klein, “Bacteriology of neonatal sepsis,” Pediatric Infectious Disease Journal, vol. 9, no. 10, pp. 777–778, 1990. View at Google Scholar · View at Scopus

2. Lawn JE, Wilczynska-Ketende K, Cousens SN. Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol 2006;35:706-18.

3. .Bizzarro M. J., Dembry L.-M., Baltimore R. S., Gallagher P. G. Changing patterns in neonatal Escherichia coli sepsis and ampi-cillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics. 2008; 121(4):689–696. doi: 10.1542/peds.2007-2171. [PubMed] [Cross Ref]

4. National Neonatology Forum NNPD Network. National Neonatal-Perinatal Database: Report for 2002-2003. New Delhi: National Neonatology Forum NNPD Network; 2005

5. Shrestha S., Adhikari N., Rai B. K., Shreepaili A. Antibiotic resistance pattern of bacterial isolates in neonatal care unit. Journal of the Nepal Medical Association. 2010;50(4):277–281. [PubMed]

6. Bangi VA, Devi S S. Neonatal sepsis: A risk approach. J NTR Univ Health Sci 2014;3:254-8

7. Kurien Anil Kuruvilla, Swati Pillai, Mary Jesudason* and Atanu Kumar Jana Bacterial Profile of Sepsis in a Neonatal Unit in South India: Indian Pediatrics 1998; 35:851-858

8. Mathur NB, Singh A, Sharma VK, Satyanarayana L. Evaluation of risk factors for fatal neonatal sepsis. Indian Pediatr 1996;33:817-22.

9. Sundaram V, Kumar P, Dutta S, Mukhopadhyay K, Ray P, Gautam V, et al. Blood culture confirmed bacterial sepsis in neonates in a North Indian tertiary care center: Changes over the last decade. Jpn J Infect Dis 2009;62:46-50.

10. Shamshul Ansari, Hari Prasad Nepal, Rajendra Gautam, Sony Shrestha, Puja Neopane, and Moti Lal Chapagain International Journal of Pediatrics Neonatal Septicemia in Nepal: Early-Onset versus Late-Onset Volume 2015 (2015), Article ID 379806
http://dx.doi.org/10.1155/2015/379806

11. M.-M. Karambin and M. Zarkesh, “Entrobacter, the most common pathogen of neonatal septicemia in Rasht, Iran,” Iranian Journal of Pediatrics, vol. 21, no. 1, pp. 83–87, 2011. View at Google Scholar · View at Scopus

12. H. A. Al-Shamahy, A. A. Sabrah, A. B. Al-Robasi, and S. M. Naser, “Types of bacteria associated with neonatal sepsis in Al-Thawra University Hospital, Sana’a, Yemen, and their antimicrobial profile,” Sultan Qaboos University Medical Journal, vol. 12, no. 1, pp. 48–54, 2012. View at Google Scholar · View at Scopus

13. Eman M. RabieShehab El-Din, 1 Moha-med M. Adel El-Sokkary, 2 , * Mohamed Reda Bassiouny, 3 and Ramadan Hassan. Epidemiology of Neonatal Sepsis and Implicated Pathogens: A Study from Egypt.Biomed Res Int. 2015; .

14. AH. Movahedian, R. Moniri, and Z. Mosayebi, “Bacterial culture of neonatal sepsis,” Iranian Journal of Public Health, vol. 35, no. 4, pp. 84–89, 2006. View at Google Scholar · View at Scopus

15. S. Gheibi, Z. Fakoor, M. Karamyyar et al., “Coagulase-negative Staphylococcus; the most common cause of neonatal septice-mia in Urmia, Iran,” Iranian Journal of Pediatrics, vol 18, no 3, pp 237–243, 2008. View at Google Scholar · View at Scopus

16. H. S. Naher and A. B. Khamael, “Neonatal sepsis; the bacterial causes and the risk factors,” International Research Journal of Medical Sciences, vol. 1, no. 6, pp. 19–22, 2013. View at Google Scholar

17. H. Movahedian, R. Moniri, and Z. Mosayebi, “Bacterial culture of neonatal sepsis,” Iranian Journal of Public Health, vol. 35, no. 4, pp. 84–89, 2006. View at Google Scholar · View at Scopus

18. S. Gheibi, Z. Fakoor, M. Karamyyar et al., “Coagulase-negative Staphylococcus; the most common cause of neonatal septicemia in Urmia, Iran,” Iranian Journal of Pediatrics, vol. 18, no. 3, pp. 237–243, 2008.View at Google Scholar · View at Scopus

19. C. H. Rasul, M. A. Hassan, and M. Habibullah, “Neonatal sepsis and use of antibiotic in tertiary care hospital,” Pakistan Journal of Medical Sciences, vol. 23, no. 1, pp. 78–81, 2007. View at Google Scholar ·View at Scopus

20. V. Sundaram, P. Kumar, S. Dutta et al., “Blood culture confirmed bacterial sepsis in neonates in a north Indian tertiary care center: changes over the last decade,” Japanese Journal of Infectious Diseases, vol. 62, no. 1, pp. 46–50, 2009. View at Google Scholar · View at Scopus

21. N. K. Jain, V. M. Jain, and S. Maheshwari, “Clinical profile of neonatal sepsis,” Kathmandu University Medical Journal, vol. 1, no. 2, pp. 117–120, 2003. View at Google Scholar · View at Scopus

22. M. Dagnew, G. Yismaw, M. Gizachew et al., “Bacterial profile and antimicrobial susceptibility pattern in septicemia suspected patients attending Gondar University Hospital, Northwest Ethiopia,” BMC Research Notes, vol. 6, no. 1, article 283, 2013. View at Publisher · View at Google Scholar · View at Scopus

23. T. V. Mhada, F. Fredrick, M. I. Matee, and A. Massawe, “Neonatal sepsis at Muhi-mbili National Hospital, Dar es Salaam, Tanzania; Aetiology, antimic-robial sensi-tivity pattern and clinical outcome,” BMC Public Health, vol. 12, article 904, 2012. View at Publisher · View at Google Scholar · View at Scopus

24. Ghotaslou R., Ghorashi Z., Nahaei M.-R. Klebsiella pneumoniae in neonatal sepsis: a 3-year-study in the pediatric hospital of Tabriz, Iran. Japanese Journal of Infect-ious Diseases. 2007;60(2-3):126–128. [PubMed]

25. Klein J. O., Remington J. S. Current concepts of infection of the fetus and newborn infant. In: Remington J., Klein J., editors. Infectious Diseases of the Fetus and Newborn. Philadelphia, Pa, USA: WB Saunders; 2000. pp. 1–24.

26. Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: A review of evidence from community-based studies. Pediatr Infect Dis J 2009;28:S3-9.

27. Patel S. J., Saiman L. Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact, and preven-tion including antibiotic steward-ship. Clinics in Perinatology. 2010;37(3): 547–563. doi: 10.1016/j.clp.2010.06.004. [PMC free article] [PubMed] [Cross Ref]

28. Karthikeyan G, Premkumar K. Neonatal sepsis: Staphylococcus aureus as the predominant pathogen. Indian J Pediatr 2001;68:715-7.

29. Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: Field trial in rural India. Lancet 1999;354:1955-61.

30. Gandhi S, Ranjan KP, Ranjan N, Sapre N, Masani M. Incidence of neonatal sepsis in tertiary care hospital: An overview. Int J Med Sci Public Health 2013;2:548-52.

Dr Sanuja Sarasam E

Asst. Professor Dept. of Pediatrics, Medical College Thiruvananthapuram, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mob 9847700321

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search

Abstract

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles