Clinical and bacteriological profile of culture-negative and culture-proven neonatal sepsis in Palembang, Indonesia

Abstract

Introduction: Culture-negative and multidrug-resistant neonatal sepsis frequently occur in developing countries and complicate neonatal sepsis management. These conditions contribute to a high neonatal mortality rate and accelerate the misuse of antibiotics. However, the extent of culture-negative and multidrug-resistant neonatal sepsis in developing countries remains poorly characterized. This study aims to describe culture-negative and culture-proven neonatal sepsis epidemiology and the antimicrobial resistance patterns in Palembang, Indonesia.
 Methodology: A retrospective review of the medical records of all neonatal admissions between January 2016 and December 2018 was conducted at a tertiary-level referral hospital in Indonesia. The maternal and neonatal characteristics and microbiological results of the identified sepsis cases were obtained and analyzed.
 Results: Three hundred and fifty-six neonatal sepsis cases were admitted from 2016 to 2018, accounting for 14.1% of neonatal hospital admissions. The percentages of early-onset and late-onset sepsis were comparable (49.7% vs. 50.3%), with an 18.1% case fatality rate. The proportion of culture-negative sepsis was 44%. The mortality rates between culture-proven and culture-negative sepsis cases did not differ statistically (p = 0.11). Coagulase-negative staphylococci (30.9%), Klebsiella pneumoniae (18.1%), and Acinetobacter spp. (10.7%) were the most frequently isolated pathogens. Overall, 62.6% of all isolated organisms were multidrug-resistant bacteria, with a high prevalence of extended-spectrum cephalosporin-resistant and carbapenem-resistant strains.
 Conclusions: Culture-negative sepsis accounts for a significant proportion of neonatal sepsis cases. Early- and late-onset and culture-negative and culture-proven neonatal sepsis contribute to a comparable proportion of neonatal sepsis morbidity and mortality. There is an alarmingly high prevalence of resistance to extended-spectrum cephalosporin and carbapenem in neonatal sepsis cases.

Factors Associated With Culture-proven Neonatal Sepsis and Resistance to First-line Antibiotics in Indonesia

“…12 Several tertiary healthcare facilities in Indonesia also consistently reported a positive blood culture rate of no more than 50% in neonatal sepsis cases. [9][10][11]13 The major causative pathogen of neonatal sepsis across January 2020-August 2022 in Dr. Soetomo General Hospital was K. pneumoniae with 37 cases, followed by CoNS with 36 cases, A. baumannii with 18 cases and E. cloacae with 11 cases. Although the bacteriologic distribution remained consistent across the majority of species from 2019, there is a considerably higher amount of A. baumannii isolates being identified in this study compared with the previous report (18 cases vs. 1 case).…”

“…are responsible for the majority of bacteriologically confirmed neonatal sepsis cases. [9][10][11][12][13] In neonates with clinical suspicion of sepsis, empirical antibiotic therapy is often initiated by clinicians before culture results become available. As per the 2013 WHO recommendations, intravenous or intramuscular administration of ampicillin (or penicillin) and gentamicin is the recommended initial treatment approach.…”

The changing bacteriological profile of neonatal sepsis in a tertiary care hospital – Emergence of Citrobacter septicemia

“…10 The high consumption of antibiotics in culture-negative sepsis cases potentially relates to an increased risk of colonization by antibiotic-resistant bacteria in neonates. 11 In addition, culture-negative sepsis cases treated with antibiotics are ignored in epidemiological studies. Therefore, more studies are needed to obtain a better understanding of culturenegative sepsis, as it also contributes to significant morbidity and mortality.…”