Antimicrobial resistance in neonates with suspected sepsis

Yadav, Sunil Kumar; Agrawal, Sumit; Singh, Sudhir; Giri, Arun; Singh, Gurbax; Ghimire, Rakesh; Stewart, Alex G.; Show, K L; Moses, Francis

doi:10.5588/pha.21.0038

Cited by 3 publications

(5 citation statements)

References 22 publications

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“…In our study, clinical sepsis was confirmed in 25% of cases with isolation of organisms in blood culture which is similar to other studies [ 10 - 12 ]. As the majority of referral centers do not have facilities for blood cultures, the start of empirical treatment before taking a blood culture in more than 50% of cases may be the reason for sterile culture in most of the cases.…”

Section: Discussionsupporting

confidence: 92%

Bacteriological Profile and Outcome of Culture-Positive Neonatal Sepsis in a Special Newborn Care Unit Setting, Odisha

Mohakud¹,

Mishra²,

Nayak³

et al. 2022

Cureus

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Introduction: Nearly one-third of neonatal mortality in India is due to neonatal sepsis and death occurs in 30% of culture-positive neonates. Pathogens such as Klebsiella pneumoniae and Escherichia coli are the most common bacteria responsible for neonatal sepsis in India and South Asia. Materials and Methods: It was an observational study, conducted in special newborn care units (SNCUs) of Capital Hospital in Bhubaneswar, Odisha from May 2017 to October 2019. All neonates (<28 days of life) with blood culture-positive sepsis were included in this study. Blood cultures were sent in all the babies with features of clinical sepsis. The demographic profile of neonates, clinical presentations, isolated organisms, and their sensitive patterns was recorded for analysis. Results: Blood culture was sent in 445 suspected neonates with clinical sepsis out of which 115 blood culture positive organisms were isolated. Among the isolated organisms, 42 (35.6%) cases were Staphylococcus aureus followed by Coagulase negative Staphylococcus (CONS) (20.8%), E. coli (19.1%), K. pneumoniae (10.4%), Acinetobacter baumannii (2.7%), Enterobacter spp.(4.3%), Enterococcus spp. (4.3%), and Pseudomonas aeruginosa (2.7%). S. aureus was the predominant organism found in both early and late-onset sepsis. All Gram-negative bacilli (GNB) are resistant to ampicillin whereas cephalosporin resistance was found in 68% of cases. Mortality due to sepsis was 8%. Conclusion: S. aureus followed by CONS was found to be the most common cause of sepsis in SNCU. A high degree of resistance of organisms to penicillins and cephalosporins calls for a re-evaluation of antibiotic policy and protocols for empirical treatment in neonatal sepsis.

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Section: Discussionsupporting

confidence: 92%

Bacteriological Profile and Outcome of Culture-Positive Neonatal Sepsis in a Special Newborn Care Unit Setting, Odisha

Mohakud¹,

Mishra²,

Nayak³

et al. 2022

Cureus

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“…Our finding is similar to a study performed in Nepal where the median TAT was approximately six days [ 25 ], and where, in around two-thirds of the neonates, the antibiotic was changed based on the culture report. In our study due to a large number of neonates being discharged within three days (we speculate that this was due to an improvement in the clinical condition of the neonate), the culture report was not received before discharge for every second neonate.…”

Section: Discussionsupporting

confidence: 90%

“…In the present study, clinical sepsis was confirmed (29%) more frequently than in previous reports from Ghana (17% and 22%) [ 5 , 16 ], Saudi Arabia (16%) [ 26 ], but was similar to Nepal (29%) [ 25 ] and lower than in Myanmar (42%) [ 27 ]. Additionally, our proportion of reported culture-confirmed neonates was higher than reported from high-income countries [ 28 ].…”

Section: Discussionsupporting

confidence: 60%

Sepsis among Neonates in a Ghanaian Tertiary Military Hospital: Culture Results and Turnaround Times

Tetteh

Fatchu

Ackah

et al. 2022

IJERPH

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In this study, we described the bacterial profile, antibiotic resistance pattern, and laboratory result turnaround time (TAT) in neonates with suspected sepsis from a tertiary-level, military hospital in Accra, Ghana (2017–2020). This was a cross-sectional study using secondary data from electronic medical records. Of 471 neonates clinically diagnosed with suspected sepsis in whom blood samples were collected, the median TAT from culture request to report was three days for neonates who were culture-positive and five days for neonates who were culture-negative. There were 241 (51%) neonates discharged before the receipt of culture reports, and of them, 37 (15%) were culture-positive. Of 471 neonates, twenty-nine percent ( n = 139) were bacteriologically confirmed, of whom 61% ( n = 85) had late-onset sepsis. Gram-positive bacterial infection (89%, n = 124) was the most common cause of culture-positive neonatal sepsis. The most frequent Gram-positive pathogen was coagulase-negative Staphylococcus (55%, n = 68) followed by Staphylococcus aureus (36%, n = 45), of which one in two were multidrug resistant. The reasons for large numbers being discharged before the receipt of culture reports need to be further explored. There is a need for improved infection prevention and control, along with ongoing local antimicrobial resistance surveillance and antibiotic stewardship to guide future empirical treatment.

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“…Furthermore, the predominance of Gram-positive bacterial isolates identified is consistent with the observation by Sands et al (2022) that they represent the most frequently reported cause of bacterial neonatal sepsis in low-and lower-middle-income countries [17,18]. Similarly, in a previous study in Ghana, CoNS were the most frequently isolated pathogens in early and late-onset infections [11].…”

Section: Discussionsupporting

confidence: 88%

“…SIRS is defined objectively if any two of the four criteria listed here are present: (a) body temperature over 38 or under 36 degrees Celsius; (b) heart rate less than 100 beats/minute; (c) respiratory rate greater than 60 cycles per minute or partial pressure of carbon dioxide less than 32 mmHg; and (d) leucocyte count greater than 12,000/microliters or less than 4000/microliters or there are over 10% immature forms or bands [15,16]. Neonatal sepsis is classified by time of occurrence of infection as early onset sepsis (EOS) in the first 72 h of life and thereafter as late onset sepsis (LOS) [17]. Those who meet the criteria for sepsis are offered empirical treatment in accordance with the STGs for 5-7 days with ampicillin plus gentamicin or ampicillin plus cefotaxime (neonatal sepsis other than cord sepsis), cloxacillin plus gentamicin (neonatal cord sepsis) and ampicillin plus gentamicin plus metronidazole (neonatal bowel related sepsis) [16].…”

Section: Management Of Sepsis In the Study Settingmentioning

confidence: 99%

Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021

Omenako

Enimil

Marfo

et al. 2022

IJERPH

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Neonatal sepsis is a life-threatening emergency, and empirical antimicrobial prescription is common. In this cross-sectional study of neonates admitted with suspected sepsis in a teaching hospital in Ghana from January–December 2021, we described antimicrobial prescription patterns, compliance with national standard treatment guidelines (STG), blood culture testing, antimicrobial resistance patterns and treatment outcomes. Of the 549 neonates admitted with suspected sepsis, 283 (52%) were males. Overall, 529 (96%) received empirical antimicrobials. Most neonates (n = 407, 76.9%) were treated empirically with cefuroxime + gentamicin, while cefotaxime was started as a modified treatment in the majority of neonates (46/68, 67.6%). Only one prescription complied with national STGs. Samples of 257 (47%) neonates underwent blood culture testing, of which 70 (27%) were positive. Isolates were predominantly Gram-positive bacteria, with coagulase-negative Staphylococcus and Staphylococcus aureus accounting for 79% of the isolates. Isolates showed high resistance to most penicillins, while resistance to aminoglycosides and quinolones was relatively low. The majority of neonates (n = 497, 90.5%) were discharged after successfully completing treatment, while 50 (9%) neonates died during treatment. Strengthening of antimicrobial stewardship programmes, periodic review of STGs and increased uptake of culture and sensitivity testing are needed to improve management of sepsis.

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Antimicrobial resistance in neonates with suspected sepsis

Cited by 3 publications

References 22 publications

Bacteriological Profile and Outcome of Culture-Positive Neonatal Sepsis in a Special Newborn Care Unit Setting, Odisha

Bacteriological Profile and Outcome of Culture-Positive Neonatal Sepsis in a Special Newborn Care Unit Setting, Odisha

Sepsis among Neonates in a Ghanaian Tertiary Military Hospital: Culture Results and Turnaround Times

Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021

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