Neonatal sepsis is a leading cause of neonatal mortality in the world. It is also one of the common morbidities in neonatal units in India.Majority of neonatal sepsis occurs in developing countries.The objective of the current study was to detect the common causative microorganisms of neonatal sepsis and their antimicrobial resistance patterns in a rural secondary care hospital in Tamil Nadu, India.
Neonates (0–28 days) admitted to this newborn care unit from October 2013 to September 2015, with a diagnosis of probable sepsis were studied. All the enrolled babies had blood cultures taken and were followed up till final outcome, which was discharge or death, irrespective of culture result. Univariate analysis was performed for factors associated with culture positivity, generating odds ratios, and confidence intervals.
Among the 107 babies with a diagnosis of probable sepsis, 28 (26.2%) had shown bacteria in culture. The majority (94.4%) were of early-onset sepsis. The predominant organisms were Staphylococcus aureus (10/28) and Klebsiella (6/28). 100% of Gram-negative bacilli and 90% of Staphylococcus were resistant to Ampicillin.
Gentamicin resistance among Gram-negative bacilli and Staphylococcus was 52.9% and 20%, respectively, while third-generation cephalosporin resistance was 31.2% and 20%, respectively. Among the neonates diagnosed as probable sepsis, idiopathic prematurity (P = 0.007) was found to have a statistically significant association with culture-positive sepsis.
The culture positivity rate among the neonates with probable sepsis in the current study was 26%. An alarmingly high degree of antibiotic resistance observed calls for robust infection control practices and an urgent evaluation and development of individual and national antibiotic policies for neonatal sepsis.
Easy availability and widespread use of broad-spectrum antibiotics in the presumptive treatment of infections prevail in India. Blood culture facilities are not often available in most of the settings in rural areas. In such scenarios, clinicians have to depend on empirical antibiotic regimens.
The high prevalence of resistance to Ampicillin makes it out of use in neonatal sepsis even in rural hospitals. The increasing resistance of Gram-negative organisms to extended-spectrum cephalosporins and carbapenems makes the choice of antibiotics difficult. Due consideration needs to be given to antistaphylococcal antibiotics in view of its high prevalence in both early-onset and late-onset neonatal sepsis.
Factor shown to be significantly associated with culture-positive sepsis was prematurity. None of the studied maternal factors had shown any significant association with culture-positive sepsis. Prematurity should be given more weight in scoring systems assessing sepsis risk.