The etiology of neonatal sepsis and patterns of antibiotic resistance

To study the patterns of causative bacteria and antibiotic resistance in neonatal sepsis.

Descriptive study.

Department of Neonatology, The Children s Hospital and the Institute of Child Health, Lahore from July 2000 to December 2000.

Two hundred and twenty-eight neonates (age 0-28 days) with clinical sepsis and positive blood cultures were selected. Blood cultures were taken before antibiotics (intravenous cefotaxime and amikacin) administration. The clinical and birth records were thoroughly analyzed. Blood culture reports (n=233) were analyzed for bacterial isolates and pattern of resistance to cefotaxime, ceftazidime, amikacin and ciprofloxacin were compared as percentage of reports showing resistance to the above antibiotics.

Among 228 cases included in the study, the male to female ratio was 2.1 to 1. The gestational age was less than 36 weeks in 68 (30%) cases and low birth weight babies were 143 (62.6%). History of birth asphyxia was present in 103 (45%) cases. There were 142 (62.3%) cases of early onset (< 7 days) sepsis and 86 (37.7%) cases of late onset (>7 days). Out of 233 positive blood cultures Escherichia coli was found to be commonest (47.8%, n=111, p <0.05) both in early onset (47.8%, n=68, p <0.05) and late onset sepsis (47.3%, n=43, p<0.05). Staphylococcus aureus was the most common among gram positive organism. Resistance to cefotaxime, ceftazidime and amikacin was 34% to 80% and to ciprofloxacin 13% to 72%. A total of 64 cases (28%) died. Mortality was four times higher in early onset sepsis (n=53 vs 11, 47% vs 12%).

Gram negative bacteria are the commonest cause of neonatal sepsis. The resistance to the commonly used antibiotics is alarmingly high. Mortality is four times higher in early onset sespis.