Common Pathogens Associated with Neonatal Sepsis and Their Antibiotic Resistance Pattern in Sohag University Hospital

Yousef, Laila; Mohammed, Ahmed N.; Sayed, Sherif Abdel Aziz; Mohammad, Marwa

doi:10.21608/smj.2018.36160

Common Pathogens Associated with Neonatal Sepsis and Their Antibiotic Resistance Pattern in Sohag University Hospital

Document Type : Original Article

Authors

¹ Department of Clinical and Chemical pathology, Faculty of Medicine, Sohag University

² Department of Clinical Pathology,Faculty of Medicine, Sohag University.

10.21608/smj.2018.36160

Abstract

Introduction: Neonatal sepsis is defined as a clinical syndrome in an infant 28 days of life or younger, manifested by systemic signs of infection and isolation of a bacterial pathogen from the bloodstream[EmanShehab El-Din et al, 2015]. Positive blood culture and sensitivity of the isolate is the best guide to antimicrobial therapy and once started should be modified according to the culture sensitivity reports[Aggarwalet al, 2001].
Aim of the work: To determine clinical and microbiological pattern of neonatal sepsis in Sohag university hospital with special focus on causative pathogens and their response to used antimicrobials.
Patient and methods: Our study conducted over a period of 18 months between October 2015 and April 2017 at Sohag university hospital and included 75 neonates with suspected sepsis and positive blood culture using Egyptian neonatal network (EGNN) guidelines, subjected to full clinical examination, septic screen(CBC, ESR and CRP) and blood culture and sensitivity tests.
Results: All studied neonates presented with late onset sepsis with higher incidence in infants born via CS especially with low and very low birth weight.The incidence of neonatal sepsis was predominantly due gram negative bacteria mainly Klepseillapneumonae followed by staphylococcus haemolyticusandstaphylococcus epidermidis. Klebseilla isolates showed high sensitivity for aminoglycosides and quinolones antibiotics with resistance to penicillin's group, Staphylococcus isolates showed resistance to penicillin's and aminoglycosides while sensitive to quinolones and nitrofurantions. E.coli and Pseudomonas species showed moderate sensitivity to 3^rd generation cephalosporins, aminoglycosides, quinolones and nitrofurantoins with resistance to classic penicillin's.
Conclusion: In our study gram negative bacteria mainly Klepseillapneumonae was the most causative agent of neonatal sepsis. Most isolated organisms showed resistance to classic penicillins.Klepseillapneumonaeshowed high sensitivity for aminoglycosides and quinolones, Staphylococcus isolates showed high sensitivity to quinolones and nitrofurantions while E.coli and Pseudomonas species showed moderate sensitivity to 3^rd generation cephalosporins, aminoglycosides, quinolones and nitrofurantoins.

Keywords

References

1. Eman M. RabieShehab El-Din, Mohamed M. Adel El-Sokkary, Mohamed Reda Bassiouny, and Ramadan Hassan, “Epidemiology of Neonatal Sepsis and Implicated Pathogens: A Study from Egypt,” BioMed Research International, vol. 2015, Article ID 509484, 11 pages, 2015.

2. Aggarwal, Rajiv & Sarkar, Nupur&Deorari, Ashok & K. Paul, Vinod, “Sepsis in the newborn,” The Indian Journal of Pediatrics. 68. 1143-1147. 10.1007/BF02722932. vol. 68, pp. 1143–1147,2001.

3. J. H.Wu, C. Y. Chen, P. N. Tsao, W. S. Hsieh, and H. C. Chou“Neonatal sepsis: a 6-year analysis in a neonatal care unit inTaiwan,” Pediatrics and Neonatology, vol. 50, no. 3, pp. 88–95,2009.

4. UNICEF, WHO, the World Bank, and the United Nations, Levels and Trends in Child Mortality, UNICEF, New York, NY, USA, 2011.

5. R. E. Black, S. Cousens, H. L. Johnson et al., “Global, regional, and national causes of child mortality in 2008: a systematic analysis,” The Lancet, vol. 375, no. 9730, pp. 1969–1987, 2010.

6. B. J. Stoll, N. Hansen, A. A. Fanaroff et al., “Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants,” The New England Journal of Medicine, vol. 347, no. 4,pp. 240–247, 2002.

7. M. S. Edwards and C. J. Baker, “Sepsis in the newborn,” in Krugman’s Infectious Diseases of Children, A. A. Gershon, P. J.Hotez, andS. L. Katz,Eds., p. 545,Mosby, Philadelphia,Pa,USA,2004.

8. S. J. Patel and L. Saiman, “Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact, and prevention including antibiotic stewardship,” Clinics inPerinatology, vol. 37, no. 3, pp. 547–563, 2010

9. D. S. JumahandM. K. Hassan, “Predictor of mortality outcome in neonatal sepsis, “Medical Journal of Basrah University, vol. 25,pp. 11–18, 2007.

10 S. Shrestha,N.Adhikari, B. K. Rai, and. Shreepaili, “Antibiotic resistance pattern of bacterial isolates in neonatal care unit,” Journal of theNepalMedicalAssociation, vol. 50, no. 4, pp. 277– 281, 2010.

11. Collee, J.G., Miles, R.S., and Watt, B. (1996): Tests for the identification of bacteria. In Mackie and Macartney practical medical microbiology. Churchilllivingstone, New York. pp: 413–424.

12. Holt, J.G., Krieg, N.R., Sneath, P.H.A., Staley, J.T., and Williams, S.T. (1994): Bergey's Manual of Determinative Bacteriology, 9th edition. Williams and Wilkins, Baltimore.

13. Bauer, A.W., Kirby, W.M., Sherris, J.C., and Turck, M. (1966): Antibiotic susceptibility testing by a standardized single disk method. Am J ClinPathol; 45: 493-496.

14. Utomo, M.T. (2010): Risk Factors of Neonatal Sepsis: A Preliminary Study in Dr. Soetomo Hospital. Indonesian Journal of Tropical and Infectious Disease; 1: 23-26.

15. El Badawy, A., El Sebaie, D., Khairat, S., and Fouad, S. (2005): A Study of Microbiological Pattern of Neonatal Sepsis. Alex J Pediatr; 19: 357-367.

16.Fahmey, S.S. (2013): Early-onset sepsis in a neonatal intensive care unit in BeniSuef, Egypt: bacterial isolates and antibiotic resistance pattern. Korean JPediatr; 56: 332-337.

17.Kapoor, L., Randhawa, V.S., and Deb, M. (2005): Microbiological profile of neonatal septicemia in a pediatric care hospital in Delhi. J Commun Dis; 37: 227-232.

18. Kohli-Kochhar, R., Omuse, G., and Revathi, G. (2011): A ten-year review of neonatal bloodstream infections in a tertiary private hospital in Kenya. J InfectDevCtries; 5: 799-803.

19.Leal, Y.A. ., Alvarez-Nemegyei, J., Velazquez, J.R., Rosado-Quiab, U., Diego-Rodriguez, N., Paz-Baeza, E., and Davila-Velazquez, J. (2012): Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up. BMC Pregnancy Childbirth; 12: 48.

20..Li, Z. ., Xiao, Z., Zhong, Q., Zhang, Y., and Xu, F. (2013): 116 cases of neonatal early-onset or late-onset sepsis: A single center retrospective analysis onpathogenic bacteria species distribution and antimicrobial susceptibility. IntJClinExp Med; 6: 693-699.

21. Macharashvili, N., Kourbatova, E., Butsashvili, M., Tsertsvadze, T., McNutt, L.A., and Leonard, M.K. (2009): Etiology of neonatal blood streaminfections in Tbilisi, Republic of Georgia. Int J Infect Dis; 13: 499-505.

22. Chiabi, A., Djoupomb, M., Mah, E., Nguefack, S., Mbuagbaw, L., Zafack, J., Ghoyap, M., Nkoa, T., and Tchokoteu, P.F. (2011): The clinical and bacteriological spectrum of neonatal sepsis in a tertiary hospital in yaounde, cameroon. Iran J Pediatr; 21: 441-448.