Study of bacteriological profile and its antibiogram in the newborn care unit of a rural tertiary care centre in India

INTRODUCTION

Sepsis is a dysregulated host response to infection leading to life-threatening organ dysfunction.^[1] The infection of the bloodstream in newborn babies younger than 28 days is referred to as neonatal sepsis. In developing and underdeveloped nations, it continues to be a significant factor in neonatal morbidity and mortality.^[2] Blood cultures are an essential diagnostic tool for certain illnesses and antibiotic susceptibility patterns support therapeutic rationalisation. Prevalent bacterial agents and their antibiotic responsiveness usually vary with the geographical place and time.^[3] Hence, regular monitoring of the prevalence of bacterial pathogens and their trend in antibiotic resistance patterns is essential to maintain the appropriate antibiotic policy and thereby better patient management. Therefore, the goal of the present study is to know the prevalent bacteria and their antibiotic resistance that lead to neonatal sepsis in our unit which is a low-resourced hospital in a rural area.

MATERIAL AND METHODS

This was a retrospective study conducted in the special newborn care unit (SNCU) of Sri Narasimharaja District Hospital, Kolar, during the period from April 2021 to March 2023.

RESULTS

This study was conducted in an SNCU of a tertiary care low-resource setting hospital in a rural area. We collected 387 blood samples taken from inborn and outborn neonates admitted in our newborn care unit and those fit into our inclusion criteria, irrespective of gestational age and sex, with clinically suspected sepsis for blood culture and sensitivity and out of them, culture positivity was 10.8% with 42 samples tested positive for bacterial isolates. Out of which 57.14% are Gram-negative isolates and 42.85% of Gram-positive isolates. The most common organism identified was Klebsiella species in 17 among 42 samples which contribute to 40.4% followed by Staphylococcus species in 15 samples contributing 35.7% and all other prevalent organisms are <5% in the current sample [Table 1].

DISCUSSION

Neonatal sepsis is the second leading cause of infant mortality and India has the greatest frequency of the condition worldwide.^[4] The prevalence of microorganisms varies depending on the environment, their ability to develop and how frequently they infect people. The common pathogens isolated from the blood of infants with septicaemic disease, their bacteriological proficiency and antimicrobial susceptibility pattern will give us a better idea of how it can be managed effectively to prevent mortality.

This is a retrospective and cross-sectional study analysis of all neonatal sepsis patients with positive bacterial blood cultures in tertiary care hospitals. This study is the first of its kind to be conducted in the SNCU of the district hospital in Kolar to establish an appropriate antibiotic policy.

It is important to determine the prevalence of the bacteria causing newborn sepsis and its antibiotic susceptibility for effective management. In our study, 57.14% of positive blood cultures were Gram-negative isolates which was similar to the study conducted by Londhe et al.^[5] and 42.85% of Gram-positive isolates were found in our study in contrast to other similar studies conducted by Gupta et al.,^[6] Sarangi et al.^[7] and Parajuli et al.^[8] Out of 42 samples, 17 were found to be Klebsiella species which contributes about 40.4% making it the most common species isolated among Gram-negative organisms in several studies such as in Gupta et al.,^[6] Londhe et al.,^[5] Muley et al.,^[9] Pokhrel et al.,^[10] Akter et al.,^[11] Oyekale et al.^[12] and Kumar et al.,^[13] followed by Staphylococcus species in 15 samples contributing 35.7%which was similar to the study done by Londhe et al.,^[5] Akter et al.,^[11] Oyekale et al.^[12] and Acheampong et al.^[14] making it the predominant bacteria among Gram-positive isolates and all other prevalent organisms were <5% in the current sample.

The differences in culture positivity rates between studies may be caused by physical circulation, the style of study (retrospective vs. prospective) and whether the patient was on antibiotics before the blood sample being obtained for blood culture.^[13] Based on the blood culture results, there is a low prevalence of sepsis positivity among the samples collected may be due to the inability of the laboratory setup to detect very small amounts of bacteria in the culture provided, the time taken between the collection of the sample and analysis of the sample and the medium used for their transport and growth.^[14]

In our study, the antibiogram of Gram-negative organisms specifically that of Klebsiella was observed to be sensitive to Imipenem (77%), similar finding was seen in the study by Gupta et al.^[6] and Akter et al.^[11] followed by Gentamicin (75%) and Cotrimoxazole (75%) where sensitive to the bacteria. Klebsiella was found to be highly resistant to Ampicillin (100%), Cefotaxime (100%), Tigecycline (100%) and Cefuroxime (100%) [Table 2]. Similar resistance pattern has be observed in many studies such as in Akter et al.,^[11] Oyekale et al.^[12] and Acheampong et al.^[14]

This shift in antimicrobial sensitivity patterns may be caused by the fact that microbes frequently develop resistance to antibiotics while retaining sensitivity to medicines that are administered infrequently. Antimicrobial sensitivity may also vary between studies and over time. This might result from the promiscuous use of antibiotics for both prophylaxis and the treatment of sick newborns, which has led to the emergence of resistant strains.^[11]

Antibiogram of Staphylococcus in our study showed 100% of sensitivity to Vancomycin (100%) which was in concordance with the findings of previous studies, Gupta et al.,^[6] Sarangi et al.,^[7] Parajuli et al.^[8] and Acheampong et al.^[14] followed by Tigecycline (100%) similar to study by Sarangi et al.,^[7] Teicoplanin (100%). They also show complete resistance to Oxacillin (100%) and Ceftriaxone (100%) [Table 3].

To avoid multidrug resistance, these medications can be used as empirical therapy, although they should be implemented with caution. Neonatal septicaemia’s evolving microbial ecology is linked to considerable mortality as well as morbidity and long-term morbidity. Therefore, to guide the selection of empirical antibiotic therapy while awaiting the results of blood culture, regular periodical tracking of the neonatal sepsis-causing organisms and their patterns of antibiotic susceptibility is required.^[6] Our observation demonstrates that the issue of antibiotic resistance is a serious challenge for treating severe bacterial infections in newborns and poses a significant danger of antibiotic resistance. The use of antibiotics should be done wisely and with caution is a highly essential practice.^[6,11]

CONCLUSION

In our study, the frequency of blood culture-positive sepsis was found to be 10.8% in which Klebsiella (40.4%) followed by Staphylococcus (35.7%) are the most common bacterial pathogens identified in the rural newborn care centre in India. The routine empirical antibiotics in our unit cefotaxime and ampicillin are 100% resistant and need appropriate changes in the antibiotic policy by making piperacillin or cefoperazone and gentamicin as first line empirical antibiotics.