Bacterological Profile of Neonatal Septicemia with special emphasis on Plasmid Mediated Amp C β Lactamase Producing Gram Negative Isolates.

Subitha, B (2010) Bacterological Profile of Neonatal Septicemia with special emphasis on Plasmid Mediated Amp C β Lactamase Producing Gram Negative Isolates. Masters thesis, Coimbatore Medical College, Coimbatore.


Download (453kB) | Preview


INTRODUCTION : Neonatal septicemia is a major cause of morbidity and mortality in the newborn1. Neonatal septicemia is classified into early onset septicaemia (EOS) and late onset septicemia (LOS) based on the age at onset. World Health Organization (WHO) estimates that there are about 5 million neonatal deaths occur globally per year. Ninety eight percent of them are occurring in developing countries. Neonatal Death rate varies in developing countries between 11-68/1000 live birth. The most common causes of death in neonatal period is infection (32%) followed by birth asphyxia (29%) and prematurity (24%). Neonatal infections currently cause 1.6 million deaths in developing countries. In India septicemia occur in 10.97-27/1000 live births and is the leading cause of neonatal mortality, accounting for one quarter to nearly half of all neonatal deaths. In Tamil Nadu as per the study Kuruvil et al the incidence of neonatal septicemia is 9.8 per 1000 live birth Vellore. AIMS AND OBJECTIVES : AIM: The aim of the present study is to identify the common Bacterial isolates of neonatal septicemia and their antibiotic susceptibility patterns with special reference to plasmid mediated AmpC β-lactamase producing Gram negative isolates and also compare the CRP level with culture positivity. OBJECTIVES : 1. To determine the bacteriological profile of neonatal septicemia. 2. To evaluate the antimicrobial susceptibility pattern of organisms isolated from neonatal septicemia. 3. To identify the prevalence of ESBL producers among the Gram negative isolates of neonatal septicemia. 4. To identify the prevalence of plasmid mediated AmpC β-lactamase producers among the Gram negative isolates of neonatal septicemia. 5. To compare the CRP level with culture positivity. MATERIALS AND METHODS : This prospective study was conducted on 273 Neonates with signs and symptoms of septicemia admitted in Neonatal Intensive Care Unit at Coimbatore medical college & Hospital, Coimbatore over the period of 14 months from May’2008 to June’2009. Approval was obtained from the ethical committee prior to conduct of this study. Informed consent was obtained from the parents of neonates. Inclusion criteria: Age<28 days, >30 weeks of gestation & Full term babies, Presence of three or more clinical symptoms and signs of septicemia like lethargy, poor feeding, irritability, fever, vomiting, abdominal distension, jaundice, respiratory distress, hypothermia, cyanosis and convulsions. Exclusion criteria: Extreme prematurity <30 wks of gestation, Gross congenital anomalies, Undergone surgery. The name, age, sex, address, date of admission, inpatient number and detailed clinical history of the patients were noted. A thorough head to foot general examination, systemic examination and Respiratory Distress Syndrome (RDS) scoring were carried out by the pediatricians. RESULTS : During the study period, 273 neonates with signs and symptoms of septicemia admitted at Neonatal Intensive Care Unit, Coimbatore Medical College & Hospital were investigated with Blood culture & sensitivity and CRP assay. The Resistant Bacterial isolates were analyzed for ESBL and plasmid mediated AmpC β-lactamase enzyme production by conventional Microbiological methods. The Male : Female Neonates ratio of this study was 1.1:1. Out of 273 neonates, 173 (63 %) were less than 7 days old (EOS) and 100(37%) were in between 7-28 days after birth. (LOS). CONCLUSION : The study of bacteriological profile of neonatal septicemia revealed early onset septicemia as more common than late onset septicemia. Klebsiella pneumoniae was the most common bacterial isolate followed by Staphylococcus aureus, CONS, Escherichia coli, Enterobacter spp, Pseudomonas aeuriginosa, Acinetobacter spp and Streptococci spp in causing neonatal septicemia. Single CRP level measured at the onset of infection lacked sufficient sensitivity to beuseful in identifying neonatal septicemia. Antimicrobial susceptibility revealed Imepenam as the most effective antibiotic followed by Cefoperazone + Sulbactum, Cefepime and Amikacin against Gram negative isolates. Among the Gram negative isolates of the neonatal septicemia 27% were ESBL producers and 22% were plasmid mediated AmpC β-lactamase producers. Failure to distinguish AmpC β-lactamase producers from ESBL producers will lead to inappropriate antimicrobial treatment and may result in increased mortality. The ability to detect and distinguish between AmpC and ESBL producing organisms has therapeutic importance as well as epidemiological significance.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Bacterological Profile ; Neonatal Septicemia ; Special Emphasis ; Plasmid Mediated ; Amp C β Lactamase ; Gram Negative Isolates.
Subjects: MEDICAL > Microbiology
Depositing User: Subramani R
Date Deposited: 14 Aug 2017 05:34
Last Modified: 14 Aug 2017 05:34

Actions (login required)

View Item View Item