Abstrato

Study on resistance pattern of neonatal bacterial sepsis to establish antibiotic stewardship for tertiary care NICU in central India.

Deepak Kumar Patel*, Mamta Dhaneria, Ashish J Pathak

Background: Neonatal sepsis is significant cause of morbidity and mortality among neonates worldwide. World Health Organization (WHO) has estimated that 1.6 million deaths occur globally every year due to neonatal infections and 40% of all neonatal deaths occur in developing countries. In India, the incidence of blood culture proven sepsis was reported as 8.5 per 1,000 live births, as per the national neonatal perinatal database. It was found that sepsis is one of the commonest causes of neonatal mortality contributing to 19% of all neonatal deaths so we planned a study to know about resistant pattern of neonatal bacterial sepsis and promote rational use of antibiotics for establish antibiotic stewardship at tertiary care hospital NICU.

Materials and methods: The retrospective observational study was conducted at RD Gardi medical college and CR Gardi hospital, Ujjain on neonates admitted in NICU with clinical suspicion of sepsis. The time duration of the study was from January 2019 to January 2020. Data was collected using a mobile phone based application; this application was specifically designed to collection of data for the study. And data were entered on Microsoft excel sheet and analyzed by a software STATA 10.

Results: Sepsis was common more common in boys, preterm babies, and very low birth weight babies. Among the clinical features of admitted neonates only respiratory distress had significant correlation with culture positive sepsis. Increase risk was associated with mechanical ventilation in neonates. Gram negative organism constitutes 87% of all isolates and gram positive 13%. The most frequently isolated organism in blood was Burkholderia cepacia (33%). Among gram positive organism’s Staph aureus was most frequently isolated. Gram negative organisms were most resistant to Ampicillin and Cephalosporin group of antibiotics and were most sensitive to colistin, tigecycline and meropenem. Gram positive organisms were least resistant to vancomycin, teicoplanin and linezolid.

Burkholderia cepacia was the most common causes of neonatal sepsis in our study. A significant proportion of the isolates were multidrug resistant strains which pose a great threat to neonatal survival. Implementation of effective preventive strategy to combat the emergence of antibiotic resistance needed. We recommended a combination of piperacillin-tazobactum and amikacin as a first line therapy and the combination of meropenem and vancomycin as the second line imperical therapy in our NICU.