A prospective study of nosocomial sepsis was performed in the NICU of Surgiscope Pvt. Hospital to determine the organisms causing nosocomial infection in neonates and their resistance patterns; also studied were risk factors, clinical presentation, hematologic parameters, and outcomes over a 12-month period. A total of 363 neonates were admitted to the ICU. A total of 250 blood samples were sent for culture and sensitivity testing in suspicious cases of nosocomial infection. All patients were on antibiotics. Of these, 36.8% (92 of 250) had a positive result on culture. Isolated bacteria were mostly gram-negative bacilli (80.43%) with a marked predominance of Klebsiella (n = 32 [43.2%]) followed by Escherichia coli (n = 18 [24.32%]), Pseudomonas (n = 16 [21.62%]), and acinetobacter (n = 5 [6.75%]). Resistance to gentamicin was 100% for all organisms. Resistance to amikacin was 100% for E coli, Pseudomonas, and acinetobacter and 40% for Klebsiella. Resistance of these gram-negative rods ranged from 70% to 100% and 50% to 100% for ceftriaxone and ceftazidime, respectively. Among the culture-positive cases, prematurity (67.39%) and low birth weight (60.86%) were the main risk factors. Refusal to feed (78%) and lethargy (68%) were the 2 main clinical presentations of nosocomial sepsis. It was also observed that in the culture-positive group, 68.5% (63 of 92) had low hemoglobin levels (<14 gm /dL), 18.5% (17 of 92) had leukopenia (total leukocyte count <5000 mm3), and 63% (58 of 92) of patients had thrombocytopenia (platelet count <100 000 mm3), 75% (69 of 92) had an elevated immature to total neutrophil ratio. C-reactive protein was positive in 84.78% (78 of 92) of cases, and 30.43% (28 of 92) of culture-positive neonates died. Mortality was high in preterm low birth weight infants (37% [23 of 62]). Emergence of multidrug-resistant organisms in the ICU is a serious problem causing high mortality and should be prevented with strict implementation of strategies to control nosocomial infection, active surveillance of infection rates, and adherence to well-planned antibiotic protocols.
- Copyright © 2015 by the American Academy of Pediatrics