Skin colonization by pathogenic bacteria as a risk factor for neonatal sepsis

Neonatal sepsis continues to be a leading cause of mortality among the NICU admitted neonates. The most common causative organisms have been proven to be hospital-acquired organisms.

This study was planned with aim of understanding the pathological colonization of neonatal skin and associated risk factors as well as finding a possible correlation between blood culture isolates and neonatal skin colonizers and their antimicrobial resistance patterns.

This prospective cohort study was conducted at a tertiary care centre in Northern India from January 2021 to June 2022. The study participants were 50 pre-term neonates and 50 term neonates, who were born in our hospital and subsequently admitted to the NICU. Skin swabs, taken from 5 body sites within 24 h of birth and at discharge, were cultured for isolation of pathological bacteria. Neonates were followed-up during their hospital stay for observing any occurrence of blood culture positive sepsis.

Out of 100 neonates, 31 pre-term and 28 term neonates were colonized within 24 h of birth while almost all were colonized by discharge. Posterior auricular fossa was the most colonized site. Coagulase Negative Staphylococcus (n = 195) and Escherichia coli (n = 51) were the most common isolates. Risk factors found to be significantly associated with colonization were low birth weight (<2500g), premature rupture of membranes (PROM), invasive mechanical ventilation and positive urine and vaginal cultures of mothers. Neonates with culture positive sepsis also had colonization with MDROs.

Neonatal skin colonization and their antimicrobial resistance rates increased over the course of hospital stay, having a possible contribution towards culture positive sepsis.