Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : February | Volume : 16 | Issue : 2 | Page : SC13 - SC17 Full Version

Bacteriological Profile of Sepsis among Low Birth Weight Neonates: A Hospital-based Cross-sectional Study from Northern India


Published: February 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51935.15984
Neeraj Singh, Rupa R Singh, Baljeet Maini, Bablu Kumar Gaur

1. Junior Resident, Department of Paediatrics, TMMC and RC, Moradabad, Uttar Pradesh, India. 2. Professor, Department of Paediatrics, TMMC and RC, Moradabad, Uttar Pradesh, India. 3. Professor, Department of Paediatrics, TMMC and RC, Moradabad, Uttar Pradesh, India. 4. Associate Professor, Department of Paediatrics, TMMC and RC, Moradabad, Uttar Pradesh, India.

Correspondence Address :
Dr. Bablu Kumar Gaur,
A-110, Parshawnath Pratibha Aptt, Delhi Road, Moradabad, Uttar Pradesh, India.
E-mail: drbkgaur@gmail.com

Abstract

Introduction: Septicaemia in neonates is characterised by the generalised bacteriological infection which is characterised with a blood culture positivity after 28 days of birth along with clinical presentation of systemic infection. It is one of the common causes of death among Low Birth Weight (LBW) neonates. Incidence of sepsis varies based on different variables, such as hospitals, obstetric and nursing procedures, gender, period of gestation, weight of the baby at birth, place of delivery status, mother’s health and nutrition and perinatal care.

Aim: To know the bacteriological profile and antibiotic susceptibility patterns of organisms causing sepsis in LBW neonates.

Materials and Methods: This cross-sectional hospital-based observational study was conducted in tertiary care hospital, Moradabad, Western Uttar Pradesh, India. LBW newborns (Birth weight <2.5 kg) hospitalised in the Neonatal Intensive Care Unit (NICU) over a period of one year from June 2019 to May 2020 with a diagnosis of clinical sepsis were enrolled. Relevant investigations and treatment were started as per our NICU protocol. Data was entered sequentially in Microsoft Excel spreadsheet and analysed in Statistical Package for the Social Sciences (SPSS) (version 20.0) using Chi-square test.

Results: During the study period, total 145 LBW neonates were admitted in NICU. Out of whom, 83 neonates were admitted with clinical sepsis. A 87.9% of LBW neonates were preterm. Blood culture reports were positive in 30 (36.2%) LBW neonates. In culture proven sepsis, 20 (67%) neonates had early onset neonatal sepsis and 10 (33%) had late onset neonatal sepsis. In culture proven early onset neonatal sepsis, 13 (65%) LBW neonates had gram negative sepsis and 7 (35%) had gram positive sepsis. The most frequently isolated organisms were Acinetobacter baumannii (23.3%) and Klebsiella pneumoniae-(16.7%). These organism were resistance to cefotaxime, ampicillin, amikacin and ciprofloxacin.

Conclusion: Acinetobacter sepsis in LBW neonates is surging rapidly and is associated with high degree of Antimicrobial Resistance (AMR). Therefore, knowledge and awareness of multidrug resistant organism causing sepsis in LBW neonates and their latest antimicrobial sensitivity pattern is essential to choose most appropriate antibiotics.

Keywords

Antibiotic sensitivity, Blood culture, Microorganism, Neonatal sepsis

Sepsis remains as one of the common causes of mortality in LBW newborns (1). The birth weight of the neonates is one of the determining factors for development of sepsis. LBW neonates are two times more likely to develop sepsis than Normal Birth Weight (NBW) newborns. This results from either prematurity, prolonged hospital stay and increased invasive procedures such as endotracheal incubation, indwelling catheters and multiple pricks (2). Although advances in medical field have improved the survival of LBW neonates but they remain at a high risk for sepsis (3). LBW is defined as a birth weight of less than 2500 g (upto and including 2499 g) irrespective of gestational age as per World Health Organisation (WHO) (4). Depending on the onset of symptoms, neonatal sepsis is of two types; onset before 72 hours of life (Early Onset Neonatal Sepsis (EONS)) or after 72 hours (Late Onset Neonatal Sepsis (LONS)) (5). The established risk factors associated with neonatal sepsis are LBW, preterm birth/prematurity, Prolonged Rupture Of Membranes (PROM), foul smelling amniotic fluid, multiple per vaginal examination, maternal septicaemia and bottle feeding (6). Microorganisms causing sepsis and their antibiotic susceptibility patterns may change over time and differ among countries (7). As per National Neonatal Perinatal Database (NNPD), Klebsiella pneumoniae was reported as the most common pathogen followed by Staphylococcus aureus and Pseudomonas species in India, whereas group B streptococci is the commonest cause of neonatal sepsis in developed countries (8),(9).

In India, most of studies had discussed the culture positivity rate, microbiological profile and antibiotics susceptibility patterns of microorganism causing sepsis in all suspected newborns (10),(11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21). But, only one study have discussed all the parameters (culture positivity rate, microbiological profile and antibiotics susceptibility patterns) in high risk group such as LBW and preterm neonate (22). This study was done with an aim to know the clinical presentation, culture positivity, pathogens causing EONS and LONS and their antibiotic susceptibility patterns in LBW neonates.

Material and Methods

The present study was a cross-sectional observational study which was carried out in LBW neonates admitted to NICU. The study was conducted over a period of one year (June 2019 to May 2020) after obtaining approval from Institutional Ethical Research Committee (TMMC and RC/IEC/18-19/013).

Inclusion criteria: All the eligible LBW (birth weight <2.5 kg) neonates suspected of having clinical sepsis and admitted in NICU were included. Diagnosis of clinical sepsis was based on presence of atleast one of the following clinical features of sepsis; Refusal to feed, grunting, chest retraction, lethargy, respiratory rate >60/min, apnea, temperature instability such as hyperthermia/fever or hypothermia, vomiting, abdominal distension, abnormal gastric residual, convulsion, hypotonia, irritability, pus draining umbilicus, multiple (>10) pustules and bleeding diathesis (6).

Exclusion criteria: Asymptomatic LBW neonates, neonates born with gross congenital anomalies, at risk neonates and babies of all non consenting parents were excluded from the study.

Sample size: Minimum sample size was calculated using the formula n=Z2α/2 P (100-P)/E2P (Prevalence rate)=42% (13). As per sample size calculation, a figure of 83 was arrived at to be the minimum sample size. Enrollment of neonates was done after obtaining written informed consent from parents.

Study Procedure

A detailed history including gestational age, birth weight, age on admission, mode of delivery, place of delivery, sex and day of onset of symptoms were noted in predesigned proforma. After admission in NICU, relevant investigations including blood sugar, sepsis screen (Total Leucocyte Count (TLC), Absolute Neutrophil Count (ANC), C-Reactive Protein (CRP) I/T Ratio, Micro Erythrocyte Sedimentation Rate (ESR)), X-ray chest and blood/Cerebrospinal Fluid (CSF) culture were send. Antibiotics therapy and supportive treatment were started as per our NICU protocol. With aseptic precautions about 2 mL of venous blood was drawn by a venous puncture and aseptically inoculated into blood culture bottles. BACTEC system was used for blood culture and bacterial growth. The isolated organisms were identified and tested for antimicrobial susceptibility patterns using Kirby-Bauer disc diffusion susceptibility method and Clinical and Laboratory Standards Institute (CLSI) guidelines (23). Antibiotic sensitivity patterns were interpreted and reported by the microbiologist.

Statistical Analysis

Research data were entered sequentially in Microsoft Excel spreadsheet and analysed in SPSS software version 20. Group comparisons were done by applying Chi-square test. Frequency and percentage were calculated. The p-value <0.05 was taken as significant.

Results

During the study period, total 145 LBW neonates were admitted in the NICU. Out of whom, 83 LBW neonates were admitted with clinical sepsis. Of these 83 neonates, 64 were inborn and 19 were outborn and 57 (68.6%) newborn were male and 26 (31.4%) newborn were female. A 60 (72.3%) newborns were presented in early neonatal period (<7 days) and 23 (27.7%) newborns presented in late neonatal period (8-28 days). Caesarean delivery was done in 25 (30.2%) neonates and normal delivery in 58 (69.8%) LBW newborns. There were 2 (2.4%) neonates who had birth weight less than 1000 gm Extremely Low Birth Weight (ELBW), 7 (8.4%) had birth weight between 1000-1499 gm Very Low Birth Weight (VLBW) and rest 74 (89.2%) had birth weight between 1500-2499 gm. Home delivery was reported among 9% and hospital delivery among 91% subjects. Preterm delivery was found among 73 (87%) and term delivery among 10 (13%) subjects (Table/Fig 1).

The mean age and mean weight of neonates were 3.63±5.65 days and 1975±410 gm, respectively. Blood culture positivity was seen in 30 (36.2%) neonates only. In culture proven sepsis, 20 (67%) neonates had EONS and 10 (33%) had LONS. In culture proven EONS, 13 (65%) LBW neonates had gram negative sepsis and 7 (35%) had gram positive sepsis. Similarly in LONS, 6 (60%) LBW neonates had gram negative sepsis and 4 (40%) had gram positive sepsis. In culture negative clinical sepsis, 34 (64.1%) neonates had sepsis screen positive (≥2 sepsis screen parameter positive) sepsis while 19 (35.9%) had sepsis screen negative sepsis (Table/Fig 2).

Out of 83 newborns, breathing difficulty (67.4%) and hypothermia (57.8%) were the most common clinical presentation of early onset sepsis while refusal to feed (62.6%) and lethargy (57.8%) were the most common clinical presentation of late onset sepsis. Detailed clinical presentation of EONS and LONS is shown in (Table/Fig 3).

Among culture positive cases, the most frequently isolated organisms in LBW neonates were Acinetobacter baumannii 7 (23.3%), Klebsiella pneumoniae 5 (16.7%), Staphylococcus aureus 4 (13.3%), E. Coli 3 (10%), Pseudomonas 3 (10%), I#IMRSAI?I 2 (10%) I#ICONS I?I2 (6.6%) as shown in (Table/Fig 4). It was seen that Acinetobacter baumannii was sensitive to colistin (100%), meropenem (85%) and piperacillin-tazobactam (57%) while Klebsiella pneumoniae was sensitive to meropenem (100%) and piperacillin-tazobactam (80%). Details of the bacterial isolates and their antibiotics sensitivity patterns is shown in (Table/Fig 5).

Discussion

The LBW neonates are risk of several morbidities, of which sepsis is the most common and devastating morbidity leading to high mortality. LBW babies are at the highest risk of infection because of prolonged hospitalisation, impaired immunity, central venous line catherisation and invasive ventilation. This study provides the most updated data about this high risk group. According to previous studies done in India, the blood culture positivity rate in NICU vary from centre to centre and time to time. It has ranged from 7.8% (24) to 64.87% (25) in all newborns admitted with suspected sepsis. In this study, blood culture positivity rate among the LBW neonates with clinical sepsis was 36.2%. Almost similar culture positivity rate in LBW neonates were reported by Rawat A and Shukla OS (40%) and Hoque M et al., (29.8%) (22),(26). However, positivity rate in this study was high as compared to the results reported by Simiyu DE (13.9%) and Lee SM et al., (21.1%) (27),(28).

In this study it was found that EONS (67%) was more common than LONS (33%) in LBW neonates, which was similar to a study done in Kenya where the frequency of EONS and LONS was 56.7% and 25.4%, respectively (27). On contrary, LONS was more common in studies done by Lim WH et al., (29). In this study, gram negative bacilli were predominant organism as compared with gram positive cocci. Acinetobacter baummanii (23.3%) and Klebsiella pneumoniae (16.7%) was the most common isolates identify in both EONS and LONS in LBW neonates. Similar microbiological profile of sepsis in preterm LBW neonates was reported by Hoque M et al., where Acinetobacter (41.2%) and Klebsiella pneumoniae (23.5%) were the most common organisms in both types of sepsis (26). Another study done in Kenya reported by Simiyu DE found Klebsiella and Citrobacter as the most common organism causing sepsis in LBW neonates (27). In a study done in Taiwan by Lim WH et al., in VLBW neonates where E. coli (40%) was the most common organisms in EONS and coagulase negative staphylococci (54.7%) was the most common bacteria in LONS (29). Another study done in Gujarat, India reported by Rawat A and Shukla OS found that common bacteria for EONS were Klebsiella, Pseudomonas and Methicillin Resistant Staphylococcus aureus (MRSA) (22). In this study, the frequency of Acinetobacter was 23.3% which was higher to the studies which were conducted by Nazir A (13.7%), Arora U and Jaitwani J (12.3%), and Mondal GP et al., (15.2%) (30),(31),(32).

Antibiotic susceptibility pattern was studied for all isolates causing sepsis in LBW neonates. The analysis of drug resistance pattern showed that, Acinetobacter baumannii resistant to ampicillin (100%) and lowest to colistin (0%), meropenem (15%) and piperacillin-tazobactam (43%) Staphylococcus aureus was sensitive to cefoxitin (67%) and cloxacillin (67%). Most of organisms were resistance to commonly used antibiotics such as ampicillin, amoxiclav, amikacin, and cefotaxime. In this study, colistin (100%) and meropenem (100%) were found to be most sensitive antibiotics for gram negative sepsis while for gram positive sepsis, linezolid (100%) and vancomycin (100%) were found to be most sensitive antibiotics. Almost similar antibiotics resistance patterns have been reported by Delhi Neonatal Infection Study (DeNIS) where most of isolated pathogens showed a high degree of AMR, not only to commonly used antibiotics but also to so-called reserve antibiotics such as extended-spectrum cephalosporins and carbapenems (33). Recently, similar antibiotic resistance patterns in LBW neonates were reported by Nazir A where Acinetobacter baummanii had resistance to reserve antibiotics such as carbapenems (30). A comparison of studies on microbiological profile and antibiotic sensitivity patterns of organism causing sepsis in LBW newborns is discussed in (Table/Fig 6) (22),(26),(27),(28),(29),(30),(33),(34).

The AMR is today, a global problem and it is surging rapidly in India. There are certain risk factors for emergence of AMR such as irrational use of broad spectrum antibiotics, poor infection control practice, lack of antibiotics stewardship policy, lack of nurse patient ratio and overcrowding (35). Hence, in any NICU, it is very essential to have annual review to define the current bacteriological profile and their sensitivity pattern of organisms causing sepsis in high risk group such as LBW neonates. This situation is alarming because these are the reserve antibiotics. If we do not follow rational antibiotics policy and continue using these antibiotics as empirical treatment, multidrug resistance organisms will naturally develop. For prevention of neonatal infection, strict infection control practices should be followed and for appropriate effective management, rational antibiotics policy of NICU should be place in all NICUs.

Limitation(s)

The limitations of this study were small sample size and study has enrolled LBW neonates which were only admitted to our hospital. There is also a need for more epidemiological and clinical studies to track changes in microorganisms that cause sepsis in high risk group.

Conclusion

Gram negative bacilli were the most common organism causing sepsis in LBW neonates. Most of these organisms were resistant to commonly used antibiotic such as cefotaxime, amikacin, ampicillin and ciprofloxacin. In order to minimise the AMR in neonatal sepsis, successful prophylactic steps, timely and accurate diagnosis, and subsequent administration of antibiotics therapy are crucial. The terrifyingly high level of AMR, calls for an urgent review and implementation of antimicrobial guidelines and rules for neonatal sepsis.

References

1.
Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: A systematic review. The Lancet Respiratory Medicine. 2018;6(3):223-30. Doi: 10.1016/S2213-2600(18)30063-8. [crossref]
2.
Belachew A, Tewabe T. Neonatal sepsis and its association with birth weight and gestational age among admitted neonates in Ethiopia: Systematic review and meta-analysis. BMC Pediatr. 2020;20(55):02-07. Doi: 10.1186/s12887-020-1949-x. [crossref] [PubMed]
3.
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Changes in pathogens causing early onset sepsis in very-low-birth-weight infants. N Engl J Med. 2002;347:240-47. Doi: 10.1056/NEJMoa012657. [crossref] [PubMed]
4.
WHO, UNICEF. Low birthweight: Country, regional and global estimates. Geneva, UNICEF and WHO, 2004. Available at: https://apps.who.int/iris/handle/10665/43184. Assessed on 15 July 2016.
5.
Stoll BJ, Hansen NI, Sanchez PJ. Early onset neonatal sepsis: The burden of group B streptococcal and E. coli disease continues. Pediatrics. 2011;127:817-26. Doi: 10.1542/peds.2010-2217. [crossref] [PubMed]
6.
Paul VK. Ghai Essential Paediatrics. 9th edition. New Delhi. CBS publishers; 2019:161-63.
7.
Zaidi A, Thaver D, Ali S, Khan T. Pathogens associated with sepsis in newborns and young infants in developing countries. Pediatr Infect Dis J. 2009;28:S10-18. Doi: 10.1097 /INF.0b013e3181958769. [crossref] [PubMed]
8.
Deorari A, Agrawal R, Paul VK, Agrawal R, Upadhayay A, Chawla D GG. National Neonatal- Perinatal Database. NNPD Nodal Center AIIMS Delhi. New Delhi; 2005. Available at: https://www.newbornwhocc.org /pdf/nnpd_report_2002-03.PDF. Accessed 10 August 2019.
9.
Labi AK, Obeng-Nkrumah N, Bjerrum S, Enweronu-Laryea C, Newman MJ. Neonatal bloodstream infections in a Ghanaian tertiary hospital: Are the current antibiotic recommendations adequate? BMC Infect Dis. 2016;16:598. Doi.org/10.1186/s12879-016-1913-4. [crossref] [PubMed]
10.
Thakur S, Thakur K, Sood A, Chaudhary S. Bacteriological profile and antibiotic sensitivity pattern of neonatal septicaemia in a rural tertiary care hospital in North India. Indian J Med Microbiol. 2016;34(1):67-71. [crossref] [PubMed]
11.
Jyothi P, Basavaraj MC, Basavaraj PV. Bacteriological profile of neonatal septicaemia and antibiotic susceptibility pattern of the isolates. J Nat Sci Biol Med. 2013;4(2):306-09. Doi: 10.4103/0976-9668.116981. [crossref] [PubMed]
12.
Nayak S, Rai R, Kumar VK, Sanjeev H, Pai A, Ganesh HR. Distribution of microorganisms in neonatal sepsis and antimicrobial susceptibility patterns in a tertiary care hospital. Arch Med Health Sci. 2014;2:136-39. [crossref]
13.
Srinivasa S, Arunkumar D. Bacterial isolates and their antibiotic susceptibility patterns in neonatal sepsis. Curr Pediatr Res. 2014;18(12):83-86.
14.
Mehar V, Yadav D, Somani P, Bhatambare G, Mulye S, Singh K. Neonatal sepsis in a tertiary care center in central India: Microbiological profile, antimicrobial sensitivity pattern and outcome. J Neonat Perinat Med. 2013;6(2):165-72. [crossref] [PubMed]
15.
Goyal M, Jain R, Mittal J, Vijay Y, Mehru N. A clinico-bacteriological profile, antimicrobial susceptibility and outcome of neonatal sepsis in tertiary care hospital, Jaipur. Indian J Basic Applied Med Res. 2018;7(2):256-69.
16.
Sethi AB, Srigade V, Dharmateja G. Neonatal sepsis: Risk factors, clinical and bacteriological profile, and antibiotic sensitivity. Indian J Child Health. 2018;5(6):432-37. [crossref]
17.
Pavan Kumar DV, Mohan J, Rakesh PS, Prasad J, Joseph L. Bacteriological profile of neonatal sepsis in a secondary care hospital in rural Tamil Nadu, Southern India. J Family Med Prim Care. 2017;6:735-38. [crossref] [PubMed]
18.
Muley VA, Ghadage DP, Bhore AV. Bacteriological profile of neonatal septicaemia in a tertiary care hospital from western India. J Glob Infect Dis. 2015;7(2):75-77. Doi: 10.4103/0974-777X.154444. [crossref] [PubMed]
19.
Zakariya BP, Bhat V, Harish BN, Arun Babu T, Joseph NM. Neonatal sepsis in a tertiary care hospital in South India: Bacteriological profile and antibiotic sensitivity pattern. Indian J Pediatr. 2011;78:413 17. [crossref] [PubMed]
20.
Kumhar GD, Ramachandran VG, Gupta P. Bacteriological analysis of blood culture isolates from neonates in a tertiary care hospital in India. J Health Popul Nutr. 2002;20:343 47.
21.
Bhat YR, Lewis LE, Vandana KE. Bacterial isolates of early onset neonatal sepsis and their antibiotic susceptibility pattern between 1998 and 2004: An audit from a center in India. Ital J Pediatr. 2011;37:32. [crossref] [PubMed]
22.
Rawat A, Shukla OS. Haemato-bacteriological profile and antibiogram of suspected cases of early onset sepsis in very low birth weight neonates. Sri Lanka Journal of Child Health. 2019;48(1):59-64. [crossref]
23.
Clinical and Laboratory Standards Institute. 20th informational supplement. Wayne, PA: Clinical and Laboratory Standards Institute; 2014. Performance standards for antimicrobial susceptibility testing.
24.
Galhotra S, Gupta V, Bains HS, Chhina D. Clinico-bacteriological profile of neonatal septicaemia in a tertiary care hospital. J Mahatma Gandhi Inst Med Sci. 2015;20:148-52. [crossref]
25.
Ghosh S, Basu G. A hospital based study on clinico microbiological profile of neonatal septicaemia. Asian Journal of Medical Sciences. 2018;9(2):25-30. Doi: 10.3126/AJMS.V9I2.19120. [crossref]
26.
Hoque M, Ahmed A, Halder S, Khan M, Chowdhury M. Morbidities of preterm VLBW neonates and the bacteriological profile of sepsis cases. Pulse. 2010;4(1):05-09. Doi: 10.3329/pulse.v4i1.6955. [crossref]
27.
Simiyu DE. Neonatal septicaemia in low birth weight infants at Kenyatta National Hospital, Nairobi. East Afr Med J. 2005;82(3):148-52. Doi: 10.4314/eamj.v82i3.9272. [crossref] [PubMed]
28.
Lee SM, Chang M, Kim KS. Blood culture proven early onset sepsis and late onset sepsis in very-low-birth-weight infants in Korea. J Korean Med Sci. 2015;30(1):67-S74. Doi: 10.3346/jkms.2015.30.S1.S67. [crossref] [PubMed]
29.
Lim WH, Lien R, Huang YC, Chiang MC, Fu RH, Chu SM, et al. Prevalence and pathogen distribution of neonatal sepsis among very-low-birth-weight infants. Pediatr Neonatol. 2012;53(4):228-34. Doi: 10.1016/j.pedneo.2012.06.003. [crossref] [PubMed]
30.
Nazir A. Multidrug-resistant Acinetobacter septicaemia in neonates: A study from a teaching hospital of Northern India. J Lab Physicians. 2019;11:23-28. Doi: 10.4103/JLP.JLP_129_18. [crossref] [PubMed]
31.
Arora U, Jaitwani J. Acinetobacter spp. An emerging pathogen in neonatal septicaemia in Amritsar. Indian J Med Microbiol. 2006;24:81. 25. Doi: 10.4103/0255-0857.19911. [crossref] [PubMed]
32.
Mondal GP, Raghavan M, Bhat BV, Srinivasan S. Neonatal septicaemia among inborn and outborn babies in a referral hospital. Indian J Pediatr. 1991;58:529-33. Doi: 10.1007/BF02750936. [crossref] [PubMed]
33.
Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: A cohort study. Lancet Glob Health. 2016;4:e752 60. Doi: 10.1016/S2214-109X(16)30148-6. [crossref]
34.
Jatsho J, Nishizawa Y, Pelzom D, Sharma R. Clinical and bacteriological profile of neonatal sepsis: A prospective hospital-based study. Int J Pediatr. 2020;2020:1835945. Doi: 10.1155/2020/1835945. [crossref] [PubMed]
35.
Chaurasia S, Sivanandan S, Agarwal R, Ellis S, Sharland M, Sankar MJ. Neonatal sepsis in South Asia: Huge burden and spiralling antimicrobial resistance. BMJ. 2019;364:k5314. Doi: 10.1136/bmj.k5314. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/51935.15984

Date of Submission: Aug 15, 2021
Date of Peer Review: Nov 03, 2021
Date of Acceptance: Dec 17, 2021
Date of Publishing: Feb 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 18, 2021
• Manual Googling: Nov 05, 2021
• iThenticate Software: Dec 16, 2021 (9%)

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