Frequency of Bacteria Causing Neonatal Sepsis in Neonatal Intensive Care Unit
Objective: To determine the frequency of bacteria causing neonatal sepsis in Neonatal Intensive Unit (NICU). Study Design: Cross sectional descriptive study. Settings: Neonatal Intensive Care Unit, Department of Pediatrics Liaquat University of Medical and Health Sciences Hyderabad.
Period: Six months from 8th July 2018 to 7th January 2019.
Material and Methods: A total of 141 neonates with neonatal sepsis admitted in neonatal ICU were included in this study. The relevant clinical history and specific physical examination was performed by principal researcher. The blood cultures were obtained at the time of admission. The bacteriological profile was explored in pre-designed proforma.
Results: The average age of the neonates were 18.33 ± 6.93 days. There were 73 (51.77%) male and 68 (48.23%) female. Streptococcus pneumonia was the most common pathogens responsible for neonatal sepsis found in 33.3%, Escherichia coli (E. coli) was observed in 11.3%, Klebsiella 14.9%, Staphylococcus aureus (S. aureus ) was 9.2%. Conclusion: We conclude that according to local patterns of bacterial pathogens Streptococcus pneumonia was the commonest pathogens followed by, E. coli, Klebsiella and S. aureus respectively.
Bacteria, Neonatal Intensive Care Unit, Neonatal Sepsis, Streptococcus pneumonia
Early onset neonatal sepsis occurs within 0-3 days of life while late onset sepsis occurs after 4th day of life. The common clinical features identified in babies with sepsis are fever (59%), respiratory distress (60%), seizures (14%), lethargy (68%), apnoea (18%), poor feeding (70%), vomiting (39%), irritability (47%), abdominal distension (41%) and abnormal bleeding (15%). In a study from Pakistan 11.5% neonatal deaths in a tertiary care hospital were due to infections and sepsis [1-3].
Different studies from different parts of the world have shown variable bacteriological pathologies. In studies from different parts of the subcontinent, gram negative rods have been noted as the more common organisms, while some other studies have shown gram positive cocci like Staphylococcus aureus to be the most common pathogen in 80% of the case . While in another study bacteriological profile Escherichia coli (E. coli) (15.6%), Klebsiella (37.5%) and Staphylococcus aureus, S. aureus (25%) and Streptococcus pneumonia (40.5%) were the common pathogens responsible for neonatal sepsis . Therefore knowledge of local common organisms causing neonatal sepsis is essential in to choose appropriate antimicrobial treatment. In addition, geographical variability is seen in patterns of micro-organisms which often changes with time.
This study was planned to document the bacteria’s causing neonatal sepsis as it can help in management of neonatal sepsis according to local patterns of bacterial pathogens. Further the complication of antibiotic decreases, organism common in our population will be identified. Moreover the results of present study will evaluate the existence of any difference and deviation for proportion of pathogens reported by international studies.
The objective of this study is to determine the frequency of bacteria causing neonatal sepsis in Neonatal Intensive Unit (NICU), LUMHS Hyderabad.
Materials And MethodsNeonatal sepsis
Positive blood culture (≥ 10 CFU/ml) plus any of the following:
Fever (>101 F): elevated rectal temperature greater than 38ºC. Respiratory distress: the respiratory rate >60 breaths/min. Seizures: abnormal moments (convulsions).
Apnoea: Cessation of breathing more than 20 second was considered as apnoea.
Poor feeding: <8 feedings per day.
Vomiting: History of eject matter from the stomach through the mouth for ≥ 2 times.
Irritability: The state of being irritable on stimuli. Abdominal distension: The tense abdomen, bowl sound absents, green aspirate from mouth.
Abnormal bleeding: persistent bleeding per rectal bleed, oral, per vaginum and hematemesis was taken as abnormal bleeding. A Cross sectional descriptive study was done by Non probability consecutive sampling technique at NICU, Department of Pediatrics Liaquat University of Medical and Health Sciences Hyderabad during total 6 months period from 8th July 2018 to 7th January 2019. Total 136 children with neonatal sepsis was taken, taking the least proportion as for Escherichia coli (E. coli) (15.6%); 6 with 06% margin of error.
All full term or preterm babies of age ≤ 28 days, either gender with suspected neonatal sepsis admitted in NICU at Liaquat University Hospital Hyderabad were included in study. Neonates having Culture negative (no growth) or who were already on antibiotics were excluded from the study
All the neonates with fulfillment of the inclusion criteria were enrolled and entered in the study after approval from Research Evaluation Unit of College of Physician and Surgeon Pakistan. (Date of approval 7th July 2018 and reference number cpsp/reu/ped-2015-164-3217). The babies with clinical suspicion of neonatal sepsis were considered for this study after obtaining consent from the parents or next to kin. The neonatal sepsis was labelled according to the criteria mentioned in operational definition. The relevant clinical history and specific physical examination was performed by principal researcher. The blood cultures were obtained by taking 1 ml blood samples aseptically collected in sterile blood culture bottles by principal researcher using aseptic technique before the commencement of antibiotics and was immediately transported to the hospital laboratory for analysis. The specimen was examine by the pathologist have ≥ 5 years’ experience. The data was collected on pre-designed proforma. All the financial burden of the study was paid by researcher herself.
The data was analysed using Statistical package for social sciences SPSS version 20. Frequency and percentage was calculated for gender, presenting complains (fever, respiratory distress, seizures, apnoea, poor feeding, vomiting, irritability, abdominal distension and abnormal bleeding), mode of delivery (spontaneous vaginal, assisted vaginal and caesarean section), bacteriological profile [(Escherichia coli (E. coli), Klebsiella, staphylococcus aureus (S. aureus) and streptococcus pneumonia)] and residence (urban or rural), neonatal anemia and hyperbilirubinemia.
The mean and standard deviation was calculated for age, gestational age at delivery and age at the onset of symptoms. The post stratification chi-square test was used post-stratification at 95% CI on categorical variables and the p-value of ≤ 0.05 was taken as statistically significantx.
A total of 141 neonate with neonatal sepsis admitted in neonatal ICU were included in this study. The average age of the neonate was 18.33 ± 6.93 day’s similarly average gestation age at birth and age at onset of symptoms (Table 1). There were 73 (51.77%) male and 68 (48.23%) female as shown in Table 1. The common clinical features identified in babies with sepsis are fever (97.2%), respiratory distress (58.2%), as tabulated in Table 1. Frequency of bacteriological profile of neonatal sepsis is presented in Table 2. Streptococcus pneumonia was the common pathogens responsible for neonatal sepsis found in 33.3%, Escherichia coli (E. coli) was observed in 11.3%, Klebsiella 14.9%, Staphylococcus aureus-S. aureus was 9.2%. Regarding mode of delivery, rate of caesarean section was 65.25%, SVD 22.7% and instrument delivery was 12.05% as shown Table 2.
Rate of E. coli, Klebsiella, S. Aureus and streptococcus pneumonia was not statistically significant among different age groups of neonate. Similarly it was also not significant between groups (Table 2). Stratification analysis was performed according to presenting symptoms as shown in table I. Rate of E. coli, Klebsiella, S. Aureus and streptococcus pneumonia was not statistically significant with fever while Rate of E. coli, Klebsiella and S. Aureus was statistically high with those cases who had respiratory distress. It was not statistically significant with symptom seizure and apnoea. Stratification analysis was also performed with respect to gestational age at delivery, mode of delivery, age at onset of symptoms, residence neonatal anemia and hyperbilirubinemia as shown in Table 1.
Table 1: Descriptive characteristics and presenting complaints of the patients (n=141).
|Profile||Streptococcus pneumonia||E. coli||Klebsiella||S. Aureus|
|<10 (n=29)||10 (34.5%)||2 (6.9%)||1 (3.4%)||4 (13.8%)|
|11-20 (n=50)||17 (34%)||7 (14%)||8 (16%)||3 (6%)|
|21-25 (n=43)||12 (27.9%)||6 (14%)||8 (18.6%)||5 (11.6%)|
|26-28 (n=19)||8 (42.1%)||1 (5.3%)||4 (21.1%)||1 (5.3%)|
|P value=0.740||P value=0.591||P value=0.253||P value=0.573|
|Male (n=73)||21 (28.8%)||9 (12.3%)||11 (15.1%)||9 (12.3%)|
|Female (n=68)||26 (38.2%)||7 (10.3%)||10 (14.7%)||4 (5.9%)|
|P value=0.233||P value=0.703||P value=0.952||P value=0.186|
|Yes (n=137)||45 (32.8%)||16 (11.7%)||20 (14.6%)||12 (8.8%)|
|No (n=04)||2 (50%)||0 (0%)||1 (25%)||1 (25%)|
|P value=0.473||P value=0.468||P value=0.565||P value=0.268|
|Yes (n=82)||38 (46.3%)||14 (17.1%)||16 (19.5%)||10 (12.2%)|
|No (n=59)||9 (15.3%)||2 (3.4%)||5 (8.5%)||3 (5.1%)|
|P value=0.811||P value=0.0005||P value=0.003||P value=0.268|
|P value=0.810||P value=0.985||P value=0.40||P value=0.868|
|Yes (n=39)||8 (20.5%)||7 (17.9%)||6 (15.4%)||3 (7.7%)|
|No (n=102)||39 (38.2%)||9 (8.8%)||15 (14.7%)||10 (9.8%)|
|P value=0.054||P value=0.126||P value=0.919||P value=0.698|
|Yes (n=56)||20 (35.7%)||5 (8.9%)||3 (5.4%)||9 (16.1%)|
|No ( n=85)||27 (31.8%)||11 (12.9%)||18 (21.2%)||4 (4.7%)|
|P value=0.626||P value=0.462||P value=0.010||P value=0.022|
|Yes (n=49)||17 (34.7%)||6 (12.2%)||10 (20.4%)||6 (12.2%)|
|No (n=92)||30 (32.6%)||10 (10.9%)||11 (12%)||7 (7.6%)|
|P value=0.803||P value=0.806||P value=0.180||P value=0.365|
|Yes (n=65)||22 (33.8%)||6 (9.2%)||10 (15.4%)||6 (9.2%)|
|No (n=76)||25 (32.9%)||10 (13.2%)||11 (14.5%)||7 (9.2%)|
|P value=0.905||P value=0.464||P value=0.880||P value=0.997|
|Yes (n=86)||29 (33.7%)||6 (7%)||16 (18.6%)||5 (5.8%)|
|No (n=55)||18 (32.7%)||10 (18.2%)||5 (9.1%)||8 (14.5%)|
|P value=0.903||P value=0.056||P value=0.122||P value=0.133|
|Yes (n=45)||15 (33.3%)||5 (11.1%)||9 (20%)||3 (6.7%)|
|No (n=96)||32 (33.3%)||11 (11.5%)||12 (12.5%)||10 (10.4%)|
|P value=0.999||P value=0.952||P value=0.244||P value=0.473|
Table 2: Characteristics of participants (n=141).
|Profile||streptococcus pneumonia||E. coli||Klebsiella||S. Aureus|
|Gestational Age At Delivery|
|≤ 36 Weeks (n=88)||31 (35.2%)||8 (9.1%)||9 (10.2%)||11(12.5%)|
|37 to 40 Weeks (n=53)||16 (30.2%)||8 (15.1%)||12 (22.6%)||2 (3.8%)|
|P value=0.539||P value=0.276||P value=0.045||P value=0.083|
|Mode Of Delivery|
|SVD (n=32)||20 (62.5%)||1 (11.1%)||0 (0%)||26 (28.3%)|
|Forceps (n=9)||10 (31.3%)||5 (55.6%)||0 (0%)||1 (1.1%)|
|Vacuum (n=8)||0 (0%)||1 (11.1%)||5 (62.5%)||15 (16.3%)|
|C/S (n=92)||2 (6.3%)||0 (0%)||0 (0%)||11 (12%)|
|P value=0.005||P value=0.0005||P value=0.0005||P value=0.409|
|Age at symptoms onset|
|≤ 10 days (n=79)||27 (34.2%)||9 (11.4%)||9 (11.4%)||7 (8.9%)|
|>10 days (n=62)||20 (32.3%)||7 (11.3%)||12 (19.4%)||6 (9.7%)|
|P value=0.810||P value=0.985||P value=0.187||P value=0.868|
|Urban (n=60)||14 (23.3%)||9 (15%)||18 (30%)||6 (10%)|
|Rural (n=81)||33 (40.7%)||7 (8.6%)||3 (3.7%)||7 (8.6%)|
|P value=0.030||P value=0.239||P value=0.0005||P value=0.792|
Neonatal septicemia has been defined as bacteremia producing a clinical syndrome caused by circulating microorganism/toxic products, within first month of life. To determine the frequency of bacteriological profile of neonatal sepsis in patients a total of 141 neonate of either gander with neonatal sepsis admitted at neonatal ICU were included in this study. In our study the average age of the neonate was 18.33 ± 6.93 days. The prevalence of neonatal sepsis in females (48.23%) was not significantly different from that in males (51.77%).
Regarding frequency of bacteriological profile of neonatal sepsis in our study, Streptococcus pneumonia was the common pathogens responsible for neonatal sepsis found in 33.3%, Escherichia coli (E. coli) was observed in 11.3%, Klebsiella 14.9%, Staphylococcus aureus (S. aureus) was 9.2%. In a study from Nepal most common bacterial isolates was Klebsiella species (n=23, 33.3%) [6,7]. In a study from Ghana gram positive organisms were more common 18 (69%) than gram negative organisms (31%). Staphylococcus epidermidis was the most common 14 (53.8%) organism identified . In a local study from Islamabad blood Culture was positive in 7.2% samples. Gram negative organisms (E. coli) were predominant (6.67%) and only 1 were gram positive . A Ethiopian study showed that Gram positive bacteria were commonly isolated 81 (67.5%). The S. aureus was 49 (40.8%) followed by coagulase negative Staphylococci 26 (21.6%) . In an Iranian study most common cause of early and late onset sepsis was Coagulase-Negative Staphylococci . Above mentioned international, regional and local studies revealed different organism than our study emphasizing the different pathogens causing the neonatal sepsis in different locations.
In our study out of 141 neonates, 42.5% were residing in urban area while 57.4% were from rural area. C-Section does not increase the risk of neonatal sepsis. About 83.5% neonates were born with normal vaginal delivery while 16.5% via caesarean section, neonates born via NVD is 2.29 times more risk of developing NNS as compared to caesarean section (p<0.05). A study from Rawalpindi had incidence of suspected neonatal sepsis of 29.5%. Majority of the babies (70.3%) were preterm 11. In a study from United Arab Emirates prevalence of neonatal sepsis was 80 (2.9%) had a blood culture-proven sepsis with a Gram-negative pathogen. Vaginal delivery was present in 38 (47%) and Cesarean section in 42 (53%) .
In our study, the most common clinical feature in babies with sepsis were fever (97.2%), followed by respiratory distress (58.2%), seizures (44%), apnoea (27.7%), poor feeding (39.7%), vomiting (34.8%), irritability (46.1%), abdominal distension (61%) and abnormal bleeding (31.9%). In an international the most common clinical feature at presentation in neonatal sepsis was respiratory distress . In another study neonatal jaundice (70.19%) was most common in early onset neonatal sepsis while feeding intolerance (49.44%) was most common complaint in late onset sepsis .
We conclude that according to local patterns of bacterial pathogens Streptococcus pneumonia was the commonest pathogens followed by, E. coli, Klebsiella and S. aureus respectively. The epidemiology of neonatal sepsis, causative risk factors may be used to develop guidelines for management of neonatal sepsis.
- Rana U, Purani C, Petal P, et al. Clinico-bacteriological profile of neonatal sepsis in a tertiary care hospital. ARC J Pediatrics 2016; 2:1-8. [Crossref][Google Scholar]
- Sathyamurthi B, Leela KV, Narayanababu R, et al. Clinical and bacteriological profile of neonatal sepsis in a tertiary care hospital. Int J Sci Study 2016; 4:57-60. [Crossref] [Google Scholar] [Indexed]
- Malik FR, Amer K, Ullah M, et al. Why our neonates are dying? Pattern and outcome of admissions to neonatal units of tertiary care hospitals in Peshawar from January, 2009 to December, 2011. JPMA 2016; 66:40-44. [Google Scholar][Indexed]
- Chapagain RH, Acharya R, Shrestha N, et al. Bacteriological Profile of Neonatal Sepsis in Neonatal Intermediate Care Unit of Central Paediatric Referral Hospital in Nepal. J Nepal Health Res Coun 2015; 13:205-208.
- Soto-Noguerón A, Carnalla-Barajas MN, Solórzano-Santos F, et al. Streptococcus pneumoniae as cause of infection in infants less than 60 days of age: serotypes and antimicrobial susceptibility. Int J Infect Dise2016; 42:69-73. [Crossref]
- Muley VA, Ghadage DP, Bhore AV. Bacteriological profile of neonatal septicemia in a tertiary care hospital from Western India. J Glob Infect Diseas 2015; 7:75.
- Pokhrel B, Koirala T, Shah G, et al. Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal. BMC pediatric 2018; 18:1-8.
- Aku FY, Akweongo P, Nyarko K, et al. Bacteriological profile and antibiotic susceptibility pattern of common isolates of neonatal sepsis, Ho Municipality, Ghana-2016. Maternal health, neonatal perinatal 2018; 4:1-8.
- Srinivasa S, Arunkumar D. Bacterial isolates and their Antibiotic susceptibility patterns in Neonatal sepsis. Cur Ped Res 2014; 18:83-86. [Google Scholar]
- Moges F, Eshetie S, Yeshitela B, et al. Bacterial etiologic agents causing neonatal sepsis and associated risk factors in Gondar, Northwest Ethiopia. BMC paediatrics 2017; 17:1-10.
- Ahmed M, Yasrab M, Khushdil A, et al. Neonatal sepsis in a tertiary care hospital: bacteriological profile and its antibicrobial sensitivity. PAFMJ 2018; 68:1654-1658.
- AlAbdullatif M, Narchi H, Khan N, et al. Microbiology of Neonatal Gram-Negative Sepsis in A Level III Neonatal Intensive Care Unit (NICU). A Single Center Experience. Glob J of PedNeonatol Car 1:2. [Google Scholar]
- Dedeke I, Arowosegbe A, Shittu O, et al. Neonatal sepsis in a Nigerian tertiary hospital: clinical features, clinical outcome, aetiology and antibiotic susceptibility pattern. South Afric J Infect Diseas 2017; 32:127-131. [Google Scholar]
- Li X, Ding X, Shi P, et al. Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital, 2013 to 2017. Medicine 2019; 98: e14686. [Crossref][Google Scholar][Indexed]
Citation: Bushra Ilyas, Salma Shaikh, Muhammad Nadeem Chohan, Mushtaque Ali shah, Mohammad Touseef, Frequency of Bacteria Causing Neonatal Sepsis in Neonatal Intensive Care Unit , J Res Med Dent Sci, 2022, 10(5): 146-150.
Received: 21-Feb-2022, Manuscript No. 47175; , Pre QC No. 47175; Editor assigned: 23-Feb-2022, Pre QC No. 47175; Reviewed: 09-Mar-2022, QC No. 47175; Revised: 22-Apr-2022, Manuscript No. 47175; Published: 06-May-2022