Detection of ESBL and Carbapenemase-Producing Gram-Negative Bacteria in Neonatal Sepsis and their Correlation with Semi-Quantitative CRP

Background: Neonatal sepsis continues to be a major contributor to morbidity and mortality globally, especially when induced by multidrug-resistant Gram-negative bacteria. This study sought to identify Extended-Spectrum Beta-Lactamase (ESBL) and carbapenemase-producing Gram-negative bacteria isolated from neonates with sepsis and to connect these findings with semi-quantitative C-Reactive Protein (CRP) levels, and correlated with the presence of resistant organisms. Aim and Objectives: This study seeks to isolate Gram-negative bacteria from neonates with clinically suspected sepsis admitted to the Neonatal Intensive Care Unit (NICU), identify the presence of ESBL and carbapenemase production among these isolates, and evaluate their correlation with semi-quantitative CRP levels. Materials and Methods: A cross-sectional descriptive study was performed over three months. Blood samples were collected for culture and CRP testing. Isolates were identified using standard microbiological methods. ESBL production was confirmed by the combined disk diffusion method, and carbapenemase production by the E-test and Carbapenem Inactivation Method. CRP levels were measured using a latex agglutination assay. Results: Out of 75 Gram-negative isolates from neonatal sepsis cases, Klebsiella pneumoniae was predominant (50.7%), followed by Acinetobacter baumannii (24%) and Escherichia coli (13.3%). ESBL production was observed in 18 isolates (24%), predominantly in K. pneumoniae (39.5%). Carbapenemase production was noted in 8 isolates (10.7), predominantly in A. baumannii (11.1). No significant statistical correlation was found between CRP levels and resistance (p > 0.05). However, elevated CRP levels (>24 mg/L) were more commonly associated with resistant isolates, suggesting potential as an early indicator. Conclusion: This study highlights the increasing burden of antibiotic resistance in neonatal sepsis, emphasising the need for routine detection of ESBL and carbapenemase producers. Semi-quantitative CRP can be a valuable, rapid, and cost-effective tool to aid in early diagnosis and guide empirical treatment strategies.