Bacteriological and Mycological Profile of Neonatal Septicemia in a Tertiary Care Hospital.

INTRODUCTION : Sepsis is a complex syndrome caused by an uncontrolled Inflammatory response (SIR), of infectious origin, characterized by Multiple manifestations which can result in dysfunction or failure of one or more organs and even death. Neonatal sepsis is a clinical syndrome characterized by systemic Signs of infection in the first month of life. Globally, WHO estimates 5 million neonatal deaths a year. 98% of these occur in developing countries. The commonest etiology is sepsis which constitutes more than one third of the causes. Neonatal septicemia is an important cause of morbidity and mortality among neonates in India, with an estimated incidence of approximately 4% in intramural live births. The spectrum of pathogens analyzed from hospital based data Collected by National Neonatal Perinatal Database network from different centres in our country includes Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeroginosa, Enterobacter spp and Acinetobacter. Other Pathogens contributing to neonatal sepsis includes Staphylococcus Aureus, Streptococcus viridians and Candida species.Systemic infections due to pathogenic fungi are also assuming Increasing importance in the neonatal intensive care units. The NICU Babies become colonized very early. About 10% of these babies get Colonized in the first week of life and about 64% babies get colonized by 4 weeks of hospital stay24. Among pathogenic fungi responsible for NICU Outbreaks, C.albicans, C.parapsilosis and C.tropicalis are notorious. AIMS AND OBJECTIVES : 1. To identify the bacterial and fungal agents causing sepsis in the newborn. 2. To study the antimicrobial susceptibility pattern of the isolates with a view to formulate an empiric antibiotic regimen. 3. To detect emerging pattern of resistance in these organisms by standard methods. 4. To know the prevalence of Extended spectrum beta lactamases production in gram negative bacteria. MATERIALS AND METHODS : 150 Newborn babies (<1month old) with clinical suspicion of sepsis were included in the prospective study. A detailed prenatal and postnatal history with special emphasis on any predisposing factors for infection and thorough clinical assessment were carried out. Inclusion criteria: Neonates with characteristics indicating probable sepsis: 1) Temperature > 99 degree F or 95 degree F. 2) Change in behavior - Abnormal cry or does not cry. - Not accepting feed. - Drowsy or unconscious. – Seizures, 3) Septic focus on umbilicus or skin, 4) Diarrhoea, 5) Rapid respiratory rate >60/mt. 6) Hospitalised or brought for consultation for other clinical illness and developing signs and symptoms of sepsis after hospitalization. Exclusion criteria: 1) No signs and symptoms indicating probable sepsis. 2) Prior antibiotic administration. The skin over the Venipuncture site is cleaned with 70% alcohol and 2% tincture of iodine. About 0.5-1ml of blood was collected and directly inoculated into the Brain heart infusion broth and Robertson cooked meat broth with liquid paraffin overlay under aseptic precautions and incubated at 37 degree centigrade for 24hours. CONCLUSION : A prospective study was undertaken over a period of one year in 150 neonates to determine the bacterial and fungal isolates of neonatal sepsis. Lethargy (48.7%) and Respiratory distress(42.15%) were the predominant presenting clinical findings. Preterm and low birth weight babies carried the highest risk of infection. The spectrum of bacterial isolates among the neonatal sepsis were Gram positive cocci 37.1% and Gram negative bacilli 56.5% . Fungi contributed to the remaining 6.4%. The commonest organisms isolated were Klebsiella pneumonia (38.7) and Staphylococcus aureus (24.2%). The incidence of ESBL producing Klebsiella pneumoniae and Escherichia coli were 37.5% and 20% respectively. All strains were sensitive to Imipenam. 80% of Gram negative bacilli were sensitive to Amikacin, and Ciprofloxacin. Among the Staphylococcus aureus, 66.7% were methycillin sensitive and 33.3% were methycillin resistant. Candida was found in 6.4% of culture proven septicemia. The commonest being Candida albicans (75%).Candida tropicalis contributed to the remaining 25%. All candida isolates were sensitive to Amphotericin B. The overall mortality rate was 10.7%. Presence of methycillin resistant Staphylococcus aureus and Extended spectrum β lactamase producing gram negative bacilli in the neonatal ward is of grave significance. Continued surveillance of neonatal septicemia is mandatory due to the changing pattern of causative organisms and their antimicrobial susceptibility pattern