Bacterial profile of Early versus Late onset neonatal sepsis and its antimicrobial susceptibility: A 1-year retrospective study in a tertiary level teaching hospital of Nepal

Abstract

Introduction: Neonatal mortality accounts for 46% of all under-five deaths globally. The Neonatal Mortality Rate in Nepal (21/1,000 live births) still exceeds the global average. Infection remains one of the leading causes. South-Asian studies report different spectrum of pathogens in neonatal sepsis compared to Western literature, with concerns for emerging antimicrobial resistance. Local epidemiological data and periodic surveillance provides guidance to formulate antibiotic policy. This study was conducted to evaluate the organisms of neonatal sepsis and antimicrobial sensitivity pattern in a hospital setting.

Methods: A retrospective study was conducted in Neonatal Intensive Care Unit, Tribhuvan University Teaching Hospital from April, 2016 – April, 2017. All neonates treated as neonatal sepsis were screened. Only the cases with positive blood culture were enrolled.

Results: Out of 172 neonates with Probable sepsis, 36% cases were “Culture-proven sepsis”. Majority ere preterm (56.45%), Low Birth Weight (59.67%) and male (64.5%). Around 30% were outborn babies which probably contributed to high (75.8%) cases of Late-onset Neonatal Sepsis (LoNS). Besides Coagulase-Negative-Staphylococcus, antimicrobial-susceptible, Gram-negative organisms dominates Early-onset Neonatal Sepsis (EoNS). There were 53.19% Multidrug resistant (MDR) organisms in LoNS– Klebsiella followed by Pseudomonas, accounting for 64.7% deaths. Excluding Methicillin Resistant Staphylococcus aureus (MRSA), all LoNS associated MDR isolates were susceptible to Colistin. Majority (90%) Non-MDR isolates in LoNS were susceptible to Amikacin and Piperacillin-Tazobactum or Meropenem combination. All MRSA isolates were susceptible to Vancomycin or Teicoplanin.

Conclusion: Late onset neonatal sepsis remains the major burden. MDR isolates increase the challenge of newborn care with limited antimicrobial options and high mortality.