Early onset of neonatal sepsis: Analysis of the risk factors and the bacterial isolates by using the BacT alert system

Objective: To evaluate the risk factors and the bacterial isolates of early onset of neonatal sepsis and to study their resistance patterns. Methods: Neonates who were suspected of early onset sepsis (EOS) based on the presence of risk factors, and/or clinical features that were consistent with bacterial infections, with the positivity of two or more sepsis screen parameters during the first 72 hours of life were studied prospectively. The demographic data, risk factors, clinical features, haematological screening parameters and CRP were studied. Bacterial isolates from a single blood culture and their resistance patterns were analyzed by using the BacT alert system. Results: A total of 52 neonates with early onset sepsis were studied. The male: female ratio was 1.36: 1. The mean (SD) birth weight and gestation were 2169 ± 878 g and 35.9± 3.6 weeks respectively, 19 were inborn. The estimated incidence of EOS among the inborn neonates was 11 per 1000 live births. One or more risk factors were present in 34.6% of the cases. A significantly higher incidence of EOS among the premature (OR, 15.8) and low birth weight (OR, 10.2) neonates was observed. Two or more sepsis screen parameters were positive in 67% cases. The blood culture yielded bacterial growth in 28.8% cases. The common organisms which were isolated were Klebsiella, followed by Pseudomonas and MRSA. A high resistance to the commonly used antibiotics like ampicillin and gentamicin was observed. The case fatality rate was 19.2%. Conclusions: The premature and low birth weight neonates were at an increased risk of developing EOS. Gram negative organisms, especially Klebsiella and Pseudomonas remained as common pathogens. A high resistance of the blood culture isolates to the commonly used antibiotics was observed.