Pokhrel Bhishma, Koirala Tapendra, Shah Ganesh, Joshi Suchita, Baral Pinky
Department of Pediatrics, Patan Academy of Health Sciences, Lagankhel, PO Box 26500, Lalitpur, Nepal.
School of Medicine, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal.
BMC Pediatr. 2018 Jun 27;18(1):208. doi: 10.1186/s12887-018-1176-x.
Neonatal sepsis, one of the leading causes of mortality in neonatal intensive care units (NICU) of developing countries like Nepal, is often not extensively studied. In order to decrease the morbidity and mortality associated with neonatal sepsis, neonatologists should have a keen knowledge of the existing bacteriological flora and their antibiotic susceptibility pattern. In this study, we aim to determine the bacteriological profile and antibiotic susceptibility pattern of culture positive neonatal sepsis in the NICU of a tertiary teaching hospital in Nepal.
This was a retrospective cross-sectional study of all blood culture positive sepsis cases among neonates admitted to the neonatal intensive care unit of Patan Hospital, Nepal between April 15, 2014 and April 15, 2017. All neonates with a clinical suspicion of sepsis with a positive blood culture were identified. Patient demographics, clinical details, maternal risk factors, and laboratory data including bacteriological profiles and antimicrobial susceptibilities were recorded and analyzed.
Of the 336 neonates admitted in the NICU, 69 (20.5%) had culture-positive sepsis. The majority were early-onset sepsis (n = 54, 78.3%) and were among the preterm babies (n = 47, 68.1%). Most bacterial isolates were gram-negative, predominantly the Klebsiella species (n = 23, 33.3%). Klebsiella showed high resistance to commonly used antibiotics such as; Cefotaxime (90.5%), Gentamicin (75%), Ciprofloxacin (76.2%), Ofloxacin (72.2%) and Chloramphenicol (65%). However, they showed good susceptibility to Carbapenems (100%), Colistin (88.8%) and Tigecycline (81.8%). Among cultures with gram-positive species, Coagulase-negative Staphylococci (CONS) (n = 14, 20.3%) predominated. CONS showed high resistance to Oxacillin (80%), Cefotaxime (66.7%) and Meropenem (80%) but good susceptibility (100%) to Vancomycin and Linezolid. Prevalence of multidrug-resistant strain was 73.9%.
Klebsiella species and CONS were the most common causes of neonatal sepsis in our study. A significant proportion of the isolates were multidrug resistant strains, which pose a great threat to neonatal survival, and thereby, warrant modification of existing empirical therapy. Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed. We recommend a combination of Piperacillin-Tazobactam and Ofloxacin as the first line therapy and combination of Vancomycin and Meropenem as the second line empirical therapy in our NICU.
在尼泊尔等发展中国家的新生儿重症监护病房（NICU），新生儿败血症是主要死因之一，但往往未得到广泛研究。为降低与新生儿败血症相关的发病率和死亡率，新生儿科医生应深入了解现有的细菌菌群及其抗生素敏感性模式。在本研究中，我们旨在确定尼泊尔一家三级教学医院NICU中培养阳性的新生儿败血症的细菌学特征和抗生素敏感性模式。
这是一项回顾性横断面研究，研究对象为2014年4月15日至2017年4月15日期间入住尼泊尔帕坦医院新生儿重症监护病房的所有血培养阳性败血症病例。确定所有临床怀疑败血症且血培养阳性的新生儿。记录并分析患者的人口统计学、临床细节、母亲风险因素以及包括细菌学特征和抗菌药物敏感性在内的实验室数据。
在入住NICU的336例新生儿中，69例（20.5%）血培养阳性败血症。大多数为早发型败血症（n = 54，78.3%），且多为早产儿（n = 47，68.1%）。大多数细菌分离株为革兰氏阴性菌，主要是克雷伯菌属（n = 23，33.3%）。克雷伯菌对常用抗生素如头孢噻肟（90.5%）、庆大霉素（75%）、环丙沙星（76.2%）、氧氟沙星（72.2%）和氯霉素（65%）表现出高度耐药性。然而，它们对碳青霉烯类（100%）、黏菌素（88.8%）和替加环素（81.8%）表现出良好的敏感性。在革兰氏阳性菌培养物中，凝固酶阴性葡萄球菌（CONS）（n = 14，20.3%）占主导。CONS对苯唑西林（80%）、头孢噻肟（66.7%）和美罗培南（80%）表现出高度耐药性，但对万古霉素和利奈唑胺表现出良好的敏感性（100%）。多重耐药菌株的患病率为73.9%。
在我们的研究中，克雷伯菌属和CONS是新生儿败血症最常见的病因。相当一部分分离株是多重耐药菌株，这对新生儿生存构成巨大威胁因此，有必要修改现有的经验性治疗方案。迫切需要实施有效的预防策略来对抗抗生素耐药性的出现。我们建议在我们NICU中，哌拉西林-他唑巴坦和氧氟沙星联合作为一线治疗，万古霉素和美罗培南联合作为二线经验性治疗。
