Distribution, antimicrobial resistance and predictors of mortality in neonatal sepsis.
OBJECTIVE
The aim of this study is to investigate etiological agents, patterns of antimicrobial resistance and predictors of mortality in culture proven neonatal sepsis.


METHOD
This is a twenty-four month retrospective cohort study of infants with culture proven sepsis. Demographic data, type of isolates and its sensitivity pattern were recorded. Multidrug resistant gram-negative isolates were defined as resistance to any three of five antibiotic classes: extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones and piperacillin-tazobactam.


RESULT
A total of 183 case with culture positive sepsis were identified. Early onset sepsis occurred in 59% of cases. The majority of isolates (56.2%) were gram-positive but the most common individual isolates were klebsiella spp. (31.1%), Staphylococcus aureus (24.5%) and coagulase-negative staphylococci (CONS) (22.9%). The pathogen mix in early-onset did not differ from late-onset sepsis. High rates of multidrug resistance were observed in klebsiella spp. (49.1%), Escherichia coli (50%), citrobacter spp (50%), acinetobacter spp. (28.5%), pseudomonas spp. (100%) isolates. Methicillin resistance prevailed in 16.6% of coagulase-negative staphylococci, 24.4% of Staphylococcus aureus and 62.5% of enterococcus spp. Multivariate analysis revealed invasive ventilation and early onset sepsis to be independently associated with increased risk of mortality in contrast to breast milk feeding which is associated with decreased risk of mortality.


CONCLUSION
A high degree of antimicrobial resistance underscores the need to understand the pathogenesis of resistance, curtail the irrational prescription of antibiotics in neonates and the requirement for measures to prevent it in low-income and middle-income countries.
['Bandyopadhyay|T|T|', 'Kumar|A|A|', 'Saili|A|A|', 'Randhawa|V S|VS|']
D000900:Anti-Bacterial Agents D017714:Community-Acquired Infections D024901:Drug Resistance, Multiple, Bacterial D005260:Female D006801:Humans D007194:India D007231:Infant, Newborn D008297:Male D008826:Microbial Sensitivity Tests D000071074:Neonatal Sepsis D015995:Prevalence D012189:Retrospective Studies
Antimicrobial resistance mortality neonates