Study of causative agent & their susceptibility pattern in sepsis in young infants below 3 months of age
Keywords:
Sepsis, Antibiotic Sensitivity, Blood stream infections
Abstract
Introduction: Pathogens causing blood stream infections and their antibiotic susceptibility patterns constantly change over time & it is essential to monitor the epidemiology of infections to design appropriate antibiotic policy.
Methodology: Blood culture reports of Children below 3 months of age admitted to our hospital over a period of 4 years were analysed to find the causative agents of sepsis & their antibiotic susceptibilities. All data were collected in validated preformatted proforma sheet & analysed using appropriate statistical methods.
Results: Among 1401 blood cultures, culture positive growth was observed in 226 cases (16.1 %). In our study, Klebsiella pneumoniae was the commonest isolated in 23.4 % of blood cultures. Acinetobacter baumanii was the next commonest organism isolated in 13.7 % followed by MRSA growth in 11.9 %, MSSA in 4.8 %, E.coli in 8.8 %, Enterococcus faecalis in 7.5 %, B.cepacia in 6.6 %, P. aeruginosa in 5.3% & Enterobacter in 4.4 % of blood cultures. About 49% of K. pneumoniae were susceptible to Carbapenam & 60% of E.coli were susceptible to Amikacin & Tobramycin. All Enterobacter were sensitive to Imipenam, Meropenam, Ertapenam & Amikacin & 77% of A.baumanii were sensitive to Carbapenam. Yeasts were isolated in 8.4 %, the commonest being Candida tropicalis.
Conclusion: It is essential to closely monitor the bacterial flora and their antibiotic sensitivity pattern to evolve rational antibiotic policy which is suitable for each unit. Guidelines on the reduction of emergence of drug resistance must be provided and instituted within the units.
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References
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19. Abdullah Al-Taiar, Majeda S Hammoud, Liu Cuiqing, Jimmy K F Lee,Kin-Man Lui, Narongsak Nakwan, David Isaacs. Neonatal infections in China, Malaysia, Hong Kongand Thaiand. Arch Dis Child Fetal Neonatal Ed 2013;98:F249–F255, doi:10.1136/archdischild-2012-301767.
20. Tiskumara R, Fakharee SH, Liu CQ . Neonatal infections in Asia. Arch Dis Child Fetal Neonatal Ed 2009;94(2): F144–8. doi: 10.1136/adc.2008.139865. Epub 2008 Sep 19. [PubMed]
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22. Margot Anderson, Khonesavanh Luangxay, Kongkham Sisouk, Latdavan Vorlasan, Bandith Soumphonphakdy, Vanmaly Sengmouang, Vilada Chansamouth, Koukeo Phommasone, Russell Van Dyke, Euming Chong, David A. B. Dance, Rattanaphone Phetsouvanh,Paul N. Newton. Epidemiology of Bacteremia in Young Hospitalized Infants in Vientiane, Laos, 2000–2011; Journal Of Tropical Pediatrics, VOL. 60, NO. 1, 2014; doi:10.1093/tropej/fmt064
23. Osrin D, Vergnano S, Costello A. Serious bacterial infections in newborn infants in developing countries. Curr Opin Infect Dis 2004;17:217–24. DOI: 10.1097/01.qco.0000129618.15907.b3
24. Phetsouvanh R, Phongmany S, Soukaloun D. Causes of community-acquired bacteremia and patterns of antimicrobial resistance in Vientiane, Laos. Am J Trop Med Hyg 2006;75:978–85.
25. Tinuade A Ogunlesi, Olusoga B Ogunfowora, Olubunmi Osinupebi and Durotoye M Olanrewaju,Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Changing trends in newborn sepsis in Sagamu, Nigeria: Bacterial aetiology, risk factors and antibiotic susceptibility . Journal of Paediatrics and Child Health 47 (2011) 5–11. DOI: 10.1111/j.1440-1754.2010.01882.x
26. Olusanya O, Olanrewaju DM, Ogunfowora OB, Laditan AAO. Neonatal septicaemia at the Ogun State University Teaching Hospital, Sagamu. Niger. Med. Pract. 1991; 22: 39–42.
27. R Yousefimashouf, R Esmaeili, MY Alikhani, A Moshtaghi. Frequency Of Antibiotic Resistance Patterns In Bacteria Isolated From Children; Arch Dis Child 2014; 99 A309, doi . 10.1136/archdischild-2014-307384.910
28. Zaki Mel S. Extended spectrum beta-lactamases among Gram-negative bacteria from an Egyptian pediatric hospital: a two-year experience. J Infect Dev Ctries 2007; 1(3):269–74. [PubMed]
29. Ariffin N, Hasan H, Ramli N, et al. Comparison of antimicrobial resistance in neonatal and adult intensive care units in a tertiary teaching hospital. Am J Infect Control 2012; 40:572–5. [PubMed]
30. Al Jarousha AM, El Jadba AH, Al Afifi AS, El Qouqa IA. Nosocomial multidrug-resistant Acinetobacter baumannii in the neonatal intensive care unit in Gaza City, Palestine. Int J Infect Dis 2009; 13:623–8.
31. Meng X, Dong M, Wang D, et al. Antimicrobial susceptibility patterns of clinical isolates of gram-negative bacteria obtained from intensive care units in a tertiary hospital in Beijing, China. J Chemother 2011;23:207–10.
32. Tsering DC, Chanchal L, Pal R, Kar S. Bacteriological profile of septicemia and the risk factors in neonates and infants in Sikkim. J Glob Infect Dis 2011; 3:42–5. DOI: 10.4103/0974-777X.77295 [PubMed]
33. Zakariya BP, Bhat V, Harish BN, et al. Neonatal sepsis in a tertiary care hospital in South India: bacteriological profile and antibiotic sensitivity pattern. Indian J Pediatr 2011; 78:413–7. [PubMed]
34. Akindele JA, Rotilu IO. Outbreak of neonatal Klebsiella septicaemia: a review of antimicrobial sensitivities. Afr. J. Med. Med. Sci. 1997; Mar-Jun;26(1-2):51-3. [PubMed]
35. Hill PC, Onyeama CO, Ikumapayi UN, et al. Bacteraemia in patients admitted to an urban hospital in West Africa. BMC Infect Dis 2007; 7:2. doi:10.1186/1471-2334-7-2.
36. Nantanda R, Hildenwall H, Peterson S, et al. Bacterial aetiology and outcome in children with severe pneumonia in Uganda. Ann Trop Paediatr. 2008; 28(4) :253–60. DOI: 10.1179/146532808X375404.
37. Nwadioha SI, Kashibu E, Alao OO, Aliyu I. Bacterial isolates in blood cultures of children with suspected septicaemia in Kano: a two-year study. Niger Postgrad Med J 2011; 18:130–3. [PubMed]
38. Onipede AO, Onayade AA, Elusiyan JB, et al. Invasive bacteria isolates from children with severe infections in a Nigerian hospital. J Infect Dev Ctries 2009; 3:429–36. [PubMed]
39. Rahman S, Hameed A, Roghani MT, Ullah Z. Multidrug resistant neonatal sepsis in Peshwar, Pakistan. Arch. Dis. Child. Fetal Neonatal Ed. 2002 Jul; 87(1): F52–4. [PubMed]
40. Adejuyigbe EA, Adeodu OO, Ako-Nai KA, Taiwo O, Owa JA. Septicaemia in high risk neonates at a teaching hospital in Ile-Ife, Nigeria. East. Afr. Med. J. 2001 Oct; 78 (10): 540–3. [PubMed]
41. Kapoor L, Randhawa VS, Deb M. Microbiological profile of neonatal septicaemia in a pediatric care hospital in Delhi. J. Commun. Dis. 2005 Sep; 37(3): 227–32. [PubMed]
42. Aurangzeb B, Hammed A. Neonatal sepsis in hospital-born babies: bacterial isolates and antibiotic susceptibility patterns. J. Coll. Physicians Surg. Pak. 2003; 13: 629–32. [PubMed]
43. Shahsanam G, Fakoor Z, Karamyyar M, Khashabi J, Ilkhanizadeh B, Asghari Sana F, et al. Coagulase negative staphylococcus; the most common cause of Neonatal septicaemia in Urmia, Iran. Iranian journal of Pediatrics. 2008; 18 (3) : 237-243.
44. Stefania Vergnano, Esse Menson, Nigel Kennea, Nick Embleton, Alison Bedford Russell, Timothy Watts, Michael J Robinson, Andrew Collinson, Paul T Heath; Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed 2011;96:F9–F14.doi:10.1136/adc.2009.178798 F9
2. May M, Daley AJ, Donath S. Early onset neonatal meningitis in Australia and New Zealand, 1992-2002. Arch Dis Child Fetal Neonatal Ed 2005; 90:F324–7. [PubMed]
3. Isaacs D. A ten year, multicentre study of coagulase negative staphylococcal infections in Australasian neonatal units. Arch Dis Child Fetal Neonatal Ed, 2003; 88:F89–93. doi:10.1136/fn.88.2.F89 . Arch Dis Child Fetal Neonatal Ed. 2003 Mar;88(2):F89-93.
4. Zaidi AK, Huskins WC, Thaver D. Hospital-acquired neonatal infections in developing countries. Lancet 2005; Mar 26-Apr 1;365(9465):1175-88.
5. Corless CE, Guiver M, Borrow R. Simultaneous detection of Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR. J Clin Microbiol 2001; 39:1553–8.
6. Crosson FJ, Moxon ER. Factors influencing kanamycin resistance in gram-negative enteric neonatal sepsis. Pediatrics 1978; 61:478. doi: 10.1542/peds.61.3.478.
7. Sharma D, Kumar C, Pandita A, Pratap OT, Dasi T, Murki S. Bacteriological profile and clinical predictors of ESBL neonatal sepsis; J Matern Fetal Neonatal Med. 2015 Feb 10:1-4.
8. Hamer DH, Darmstadt GL, Carlin JB, Zaidi AK, Yeboah-Antwi K, Saha SK, Ray P, Narang A, Mazzi E, Kumar P,Kapil A, Jeena PM, Deorari A, Chowdury AK, Bartos A, Bhutta ZA, Adu-Sarkodie Y, Adhikari M, Addo-Yobo E,Weber MW. Etiology of bacteremia in young infants in six countries; Young Infants Clinical Signs Study Group. Pediatr Infect Dis J. 2015 Jan; 34(1):e1-8.
9. Chandel DS, Johnson JA, Chaudhry R, Sharma N, Shinkre N, Parida S, Misra PR, Panigrahi. Extended-spectrum beta-lactamase-producing Gram-negative bacteria causing neonatal sepsis in India in rural and urban settings; P. J Med Microbiol. 2011 Apr; 60(P 4):500-7. doi: 10.1099/jmm.0.027375-0. Epub 2010 Dec 23.
10. Washington C. Winn, Stephen D. Allen , Stephen Allen, William M Janda , Elmer W. Koneman, Paul C. Schreckenberger, Gary W. Procop, Gail L. Woods. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. Wolters Kluwer;6th Revised edition, Nov 2005.
11. Jennifer M. Andrews for the BSAC Working Party on Susceptibility testing. BSAC standardized disc susceptibility testing method. Journal of Antimicrobial Chemotherapy (2001) 48, Suppl. S1, 43-57. doi: 10.1093/jac/48.suppl_1.43
12. Goel G, Das D, Mukherjee S, Bose S, Das K, Mahato R, Bhattacharya S. A method for early detection of antibiotic resistance in positive blood cultures: experience from an oncology centre in eastern India; Indian J Med Microbiol. 2015 Feb; 33 Suppl:53-8. doi: 10.4103/0255- 0857.150883.
13. Kirsty Le Doare, Julia Bielicki, Paul T. Heath, Mike Sharland. Systematic Review of Antibiotic Resistance Rates Among Gram-Negative Bacteria in Children With Sepsis in Resource-Limited Countries; Journal of the Pediatric Infectious Diseases Society, Vol. 4, No. 1, pp. 11–20, 2015. DOI:10.1093/jpids/piu014. [PubMed]
14. Ahmed Ahmed El-Nawawy,a Mohamed Mohamed Abd El-Fattah,a Hala Abd El-Raouf Metwally,b Shahira Salah El Din Barakat, Ihab Abdel Rehim Hassana. One Year Study of Bacterial and Fungal Nosocomial Infections among Patients in Pediatric IntensiveCare Unit (PICU) in Alexandria; Journal of Tropical Pediatrics Vol. 52, No. 3, doi:10.1093/tropej/fmi091. [PubMed]
15. Anwer SK, Mustafa S, Pariyani S, Ashraf S, Taufiq KM. Neonatal sepsis: an etiological study. J Pak Med Assoc 2000; 50(3): 91-94. [PubMed]
16. Y. Bell, M. Barton, M. Thame, A. Nicholson, H. Trotman. Neonatal sepsis in Jamaican neonates; Annals of Tropical Paediatrics (2005) 25(4), 293–296, DOI: 10.1179/146532805X72449. [PubMed]
17. Airede AI. Neonatal septicaemia in an African city of high altitude. J Trop Pediatr 1992; 38(4): 189–91. [PubMed]
18. DV Patel, AS Nimbalkar, AR Sethi, AR Kungwani, SM Nimbalkar. Microbial Profile By Bactec In A Level Three Neonatal Intensive Care Unit In Rural Western India; Arch Dis Child 2012;97(Suppl 2):A1–A539. doi:10.1136/archdischild-2012-302724.1168.
19. Abdullah Al-Taiar, Majeda S Hammoud, Liu Cuiqing, Jimmy K F Lee,Kin-Man Lui, Narongsak Nakwan, David Isaacs. Neonatal infections in China, Malaysia, Hong Kongand Thaiand. Arch Dis Child Fetal Neonatal Ed 2013;98:F249–F255, doi:10.1136/archdischild-2012-301767.
20. Tiskumara R, Fakharee SH, Liu CQ . Neonatal infections in Asia. Arch Dis Child Fetal Neonatal Ed 2009;94(2): F144–8. doi: 10.1136/adc.2008.139865. Epub 2008 Sep 19. [PubMed]
21. Jain A, Mondal R. Prevalence & antimicrobial resistance pattern of extended spectrum beta-lactamase producing Klebsiella spp isolated from cases of neonatal septicaemia. Indian J Med Res 2007;125:89–94.
22. Margot Anderson, Khonesavanh Luangxay, Kongkham Sisouk, Latdavan Vorlasan, Bandith Soumphonphakdy, Vanmaly Sengmouang, Vilada Chansamouth, Koukeo Phommasone, Russell Van Dyke, Euming Chong, David A. B. Dance, Rattanaphone Phetsouvanh,Paul N. Newton. Epidemiology of Bacteremia in Young Hospitalized Infants in Vientiane, Laos, 2000–2011; Journal Of Tropical Pediatrics, VOL. 60, NO. 1, 2014; doi:10.1093/tropej/fmt064
23. Osrin D, Vergnano S, Costello A. Serious bacterial infections in newborn infants in developing countries. Curr Opin Infect Dis 2004;17:217–24. DOI: 10.1097/01.qco.0000129618.15907.b3
24. Phetsouvanh R, Phongmany S, Soukaloun D. Causes of community-acquired bacteremia and patterns of antimicrobial resistance in Vientiane, Laos. Am J Trop Med Hyg 2006;75:978–85.
25. Tinuade A Ogunlesi, Olusoga B Ogunfowora, Olubunmi Osinupebi and Durotoye M Olanrewaju,Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Changing trends in newborn sepsis in Sagamu, Nigeria: Bacterial aetiology, risk factors and antibiotic susceptibility . Journal of Paediatrics and Child Health 47 (2011) 5–11. DOI: 10.1111/j.1440-1754.2010.01882.x
26. Olusanya O, Olanrewaju DM, Ogunfowora OB, Laditan AAO. Neonatal septicaemia at the Ogun State University Teaching Hospital, Sagamu. Niger. Med. Pract. 1991; 22: 39–42.
27. R Yousefimashouf, R Esmaeili, MY Alikhani, A Moshtaghi. Frequency Of Antibiotic Resistance Patterns In Bacteria Isolated From Children; Arch Dis Child 2014; 99 A309, doi . 10.1136/archdischild-2014-307384.910
28. Zaki Mel S. Extended spectrum beta-lactamases among Gram-negative bacteria from an Egyptian pediatric hospital: a two-year experience. J Infect Dev Ctries 2007; 1(3):269–74. [PubMed]
29. Ariffin N, Hasan H, Ramli N, et al. Comparison of antimicrobial resistance in neonatal and adult intensive care units in a tertiary teaching hospital. Am J Infect Control 2012; 40:572–5. [PubMed]
30. Al Jarousha AM, El Jadba AH, Al Afifi AS, El Qouqa IA. Nosocomial multidrug-resistant Acinetobacter baumannii in the neonatal intensive care unit in Gaza City, Palestine. Int J Infect Dis 2009; 13:623–8.
31. Meng X, Dong M, Wang D, et al. Antimicrobial susceptibility patterns of clinical isolates of gram-negative bacteria obtained from intensive care units in a tertiary hospital in Beijing, China. J Chemother 2011;23:207–10.
32. Tsering DC, Chanchal L, Pal R, Kar S. Bacteriological profile of septicemia and the risk factors in neonates and infants in Sikkim. J Glob Infect Dis 2011; 3:42–5. DOI: 10.4103/0974-777X.77295 [PubMed]
33. Zakariya BP, Bhat V, Harish BN, et al. Neonatal sepsis in a tertiary care hospital in South India: bacteriological profile and antibiotic sensitivity pattern. Indian J Pediatr 2011; 78:413–7. [PubMed]
34. Akindele JA, Rotilu IO. Outbreak of neonatal Klebsiella septicaemia: a review of antimicrobial sensitivities. Afr. J. Med. Med. Sci. 1997; Mar-Jun;26(1-2):51-3. [PubMed]
35. Hill PC, Onyeama CO, Ikumapayi UN, et al. Bacteraemia in patients admitted to an urban hospital in West Africa. BMC Infect Dis 2007; 7:2. doi:10.1186/1471-2334-7-2.
36. Nantanda R, Hildenwall H, Peterson S, et al. Bacterial aetiology and outcome in children with severe pneumonia in Uganda. Ann Trop Paediatr. 2008; 28(4) :253–60. DOI: 10.1179/146532808X375404.
37. Nwadioha SI, Kashibu E, Alao OO, Aliyu I. Bacterial isolates in blood cultures of children with suspected septicaemia in Kano: a two-year study. Niger Postgrad Med J 2011; 18:130–3. [PubMed]
38. Onipede AO, Onayade AA, Elusiyan JB, et al. Invasive bacteria isolates from children with severe infections in a Nigerian hospital. J Infect Dev Ctries 2009; 3:429–36. [PubMed]
39. Rahman S, Hameed A, Roghani MT, Ullah Z. Multidrug resistant neonatal sepsis in Peshwar, Pakistan. Arch. Dis. Child. Fetal Neonatal Ed. 2002 Jul; 87(1): F52–4. [PubMed]
40. Adejuyigbe EA, Adeodu OO, Ako-Nai KA, Taiwo O, Owa JA. Septicaemia in high risk neonates at a teaching hospital in Ile-Ife, Nigeria. East. Afr. Med. J. 2001 Oct; 78 (10): 540–3. [PubMed]
41. Kapoor L, Randhawa VS, Deb M. Microbiological profile of neonatal septicaemia in a pediatric care hospital in Delhi. J. Commun. Dis. 2005 Sep; 37(3): 227–32. [PubMed]
42. Aurangzeb B, Hammed A. Neonatal sepsis in hospital-born babies: bacterial isolates and antibiotic susceptibility patterns. J. Coll. Physicians Surg. Pak. 2003; 13: 629–32. [PubMed]
43. Shahsanam G, Fakoor Z, Karamyyar M, Khashabi J, Ilkhanizadeh B, Asghari Sana F, et al. Coagulase negative staphylococcus; the most common cause of Neonatal septicaemia in Urmia, Iran. Iranian journal of Pediatrics. 2008; 18 (3) : 237-243.
44. Stefania Vergnano, Esse Menson, Nigel Kennea, Nick Embleton, Alison Bedford Russell, Timothy Watts, Michael J Robinson, Andrew Collinson, Paul T Heath; Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed 2011;96:F9–F14.doi:10.1136/adc.2009.178798 F9
CITATION
DOI: 10.17511/ijmrr.2015.i3.061
Published: 2015-04-30
How to Cite
1.
Chandran R, Parakh H, N. Iyer R, Rao JR. Study of causative agent & their susceptibility pattern in sepsis in young infants below 3 months of age. Int J Med Res Rev [Internet]. 2015Apr.30 [cited 2024Nov.23];3(3):321-8. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/233
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