Objective: To investigate the spectrum of organisms causing neonatal sepsis in Peshawar, Pakistan and to assess their sensitivity to various groups of drugs.
Methods: Blood taken from newborn babies admitted to the special care baby unit at the Khyber Teaching Hospital with a clinical diagnosis of neonatal sepsis was cultured. The data obtained from October 1997 to December 2000 were analysed and the results tabulated.
Results: A total of 1598 blood cultures were taken; 1003 were positive (positivity rate 62.8%). Escherichia coli was the most common organism found (36.6%), followed by Staphylococcus aureus (29.5%), Pseudomonas (22.4%), Klebsiella (7.6%), and Proteus (3.8%). No group B streptococcus was grown. Listeria monocytogenes was found in one cerebrospinal fluid culture. E coli and Pseudomonas showed a high degree of resistance to commonly used antibiotics (ampicillin, augmentin, and gentamicin), a moderate degree of resistance to cephalosporin (cefotaxime, ceftzidime, and ceftrioxone), and low resistance to drugs not used for newborn babies (ofloxacin, ciprofloxacin, and enoxabid). S aureus showed a low resistance to all three groups of antibiotics.
Conclusion: Neonatal sepsis remains one of the leading causes of neonatal admission, morbidity, and mortality in developing countries. Gram negative organisms are the major cause of neonatal sepsis in Peshawar. Such organisms have developed multidrug resistance, and management of patients infected with them is becoming a problem in developing countries.
Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries.1,2 It is also a major cause of mortality in both developed and developing countries.2–5 The spectrum of organisms that cause neonatal sepsis changes over time and varies from region to region. It can even vary from hospital to hospital in the same city. This is due to the changing pattern of antibiotic use and changes in lifestyle. Gram negative organisms were the most common cause of neonatal sepsis in Europe and America in the 1960s. It changed to group B streptococcus during the 1970s and coagulase negative Staphylococcus during the late 1980s and 1990s. In most of the developing countries, Gram negative organisms remain the major cause of neonatal sepsis, particularly early onset neonatal sepsis.1,4–10 These organisms have developed increasing multidrug resistance over the last two decades,8,9,11 due to the indiscriminate and inappropriate use of antibiotics, over the counter sale of antibiotics, lack of legislation to control their use, poor sanitation, and ineffective infection control in the maternity services.12 The rapid emergence of multidrug resistant neonatal sepsis in developing countries is a new potential threat to the survival of newborn babies, who are often already in a poor condition.
MATERIALS AND METHODS
This was a prospective study carried out in the special care baby unit of the Khyber Teaching Hospital, Peshawar, which is a 1100 bed teaching hospital acting as a tertiary care centre for the rest of the province. More than 70% of admissions to the unit are outborn. The annual number of admissions is about 1700 per year. Sepsis accounts for almost 40% of the admissions. Babies with a clinical diagnosis of neonatal sepsis were enrolled in this study. Babies who had received antibiotics before admission or had surgical problems, chromosomal and congenital anomalies, or dysmorphism were excluded.
Blood was taken by a standard method and cultured in the microbiology laboratories of Pakistan Medical Research Council, Khyber Medical College, Peshawar. Sensitivity to various antibiotics was tested by a standard disc diffusion technique.
Blood culture results obtained from October 1997 to December 2000 were analysed. Of a total of 1598 blood cultures, 1003 were positive (positivity rate of 62.8%): 367 (36.6%) were positive for Escherichia coli, 296 (29.5%) for Staphylococcus aureus, 225 (22.4%) for Pseudomonas, 77 (7.6%) for Klebsiella, and 38 (3.8%) for Proteus. No group B streptococcus was grown from any culture, and Listeria monocytogenes was grown from one cerebrospinal fluid culture.
The pattern of sensitivity of these organisms was analysed for three groups of antibiotics:
1. penicillins and aminoglycosides, which are used as first line antibiotics;
2. cephalosporins, which are used as a second line antibiotics;
3. quinolones, which are not recommended for use in children less than 4 years of age, but may be indicated if the child has blood culture positive severe sepsis and the organism is not sensitive to any other antibiotic.
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