Change in spectrum of microbial aetiology in relation to gestational age and birth weight and emergence of esbl in tertiary neonatal intensive care units

Abstract

Septicemia continues to be a major cause of neonatal mortality and morbidity worldwide. Aim: To study the incidence, microbial profile and emergence of extended spectrum beta lactamases mediated resistance (ESBL) in neonatal septicemia in relation to gestational age and birth weight. This is a prospective study of 1647 babies suspected of neonatal septicemia based on symptomatology and clinical diagnosis. Evaluated data included: age, sex, birth weight, type of isolated pathogen, and antibiotic sensitivity. Gram negative bacteria were the predominant organisms to be isolated. Klebsiella spp 232 (26.5%) was the predominant organism followed by E. coli 92(10.5%), and Acinetobacter 54(6.2%). Among Gram-positive bacteria, Staphylococcus aureus 176 (20.1%) was the predominant followed by coagulase negative Staphylococci 118(13.6%). Preterm babies were highly significantly more susceptible to infection than term babies (61.9% vs 40.4%; P<0.001). Klebsiella sps is the predominant organism (36.7% & 23.8%) isolated among both preterm male and female babies followed by Staphylococcus aureus (14.4% & 14.7%). Among term babies Staphylococcus aureus (32.6%) was the predominant among the male babies followed by E.coli (23.5%) and Staphylococcus aureus (33.3%) was the predominant among female babies followed by CoNS (26.9%). Among the low birth weight babies, Klebsiella sps was isolated in 41.9% and in normal weight babies, Staphylococcus aureus (42.9%) was the predominant among the male babies and Klebsiella sps (32.3%) was the predominant among female babies Multidrug resistant organisms were found to be most pathogenic. 32.8% of gram negative bacilli were ESL producer Klebsiella pneumoniae was the predominant ESL producer 47(43.9%) followed by E.coli 15 (14.0), and Pseudomonas aeruginosa 11(10.3%). AmpC production was seen in 18 (6.2%) of the isolates