Know Your Bugs Better for Handling Neonatal Septicemia: Indian Study with Special Reference to Blood Culture Positivity and Antimicrobial Susceptibility of These Bugs

Background: Neonatal sepsis is a significant cause of neonatal mortality in developed as well as developing countries. The etiologic agents and risk factors are diverse resulting in variable rates in any geographical area. Timely blood culture reports can reduce mortality and morbidity. Aim and Objectives: Detection of microbial agents causing neonatal septicemia and to know their antimicrobial susceptibility pattern. Material and Methods: Blood culture samples were collected from around 456 neonates suspected of neonatal septicaemia over a period of one year and incubated in BacT/Alert. Positive flagged bottles were subcultured on Blood agar and MacConkey agar. Culture positive isolates were identified by routine microbiological procedures and antimicrobial susceptibility testing was performed on Vitek 2 compact. Results: Amongst the 456 blood samples taken from suspected cases, 95(20.8%) were culture positive. The major risk factors were difficult delivery, premature and prolonged rupture of membranes and the commonest symptoms were lethargy and poor feeding. About 58(61.1%) were early onset and presented symptoms before 24 hours, whereas 37(38.9%) were late onset septicaemia. Amongst the isolates Klebsiella pneumoniae 22(23.1%) was the predominant bacterial pathogen followed by Escherichia Coli 16(16.8%), Staphylococcus Aureus 14(14.7%) and CoNS 14(14.7%). Pseudomonas spp and Enterococcus species were 8(8.4%) each, Acinetobacter spp. were 5(5.2%)and Streptococcus spp. were 3(3.1%).The isolates were multi drug resistant and mostly resistant to first line drugs like cephalosporins and penicillin group. The case fatality rate was 12.6 % among culture positives. Conclusion: Neonatal sepsis rates vary enormously across countries. Stringent infection control measures, early diagnosis and prompt management is the key to better patient outcome.