Anum Nizamuddin Sheikh, Ali Sajjad, Shahina Hanif.
Neonatal Sepsis: An Evaluation of Bacteriological Spectrum, Antibiotic Susceptibilities and Prognostic Predictors at Civil Hospital, Karachi.
Pak Paed J Jan ;38(3):143-55.

Introduction: Neonatal sepsis is defined as a clinical syndrome of bacteremia with systemic signs and symptoms of infection in first four weeks of life. It is responsible for around 1.6 million deaths annually in developing countries. Since pattern of organisms, antibiotic sensitivities and predictors of mortality and morbidity vary across the globe; there is dire need of assessment of etiological, therapeutic and prognostic aspects of the disease. Methodology: Six month long, cross-sectional descriptive study was undertaken at neonatal intensive care unit of Paediatric ward – 3, Civil Hospital, Karachi, from July 2012 to December 2012 using convenient sampling technique. All neonates (from birth till 28 days) admitted with clinical signs and symptoms of presumed sepsis were included in the study, excluding neonates with congenital anomalies and history of blood transfusion. Result: Amongst 125 cases of presumed neonatal sepsis, male to female ratio of 1.7:1, blood culture positivity rate of 32% and overall mortality rate of 16% was observed. Cases of gram negative organisms (52.5%) and early onset sepsis (71%) were more frequent than gram positive (47.5%) and late onset (29%) respectively, with gram negative organisms being more frequent in early onset sepsis and normal vaginal delivery (NVD) cases in contrast to gram positive being more common in late onset sepsis and C-section delivery cases respectively. Most frequent organisms isolated in our study were Staph aureus, Pseudomonas aeroginosa and Klebsiella. Cases with male gender, gram negative bacteria (especially Pseudomonas aeroginosa and Klebsiella), early onset of sepsis, and multidrug resistance had much worse prognosis in terms of morbidity and mortality, significant enough to entitle them as potential predictor of mortality in our setting. Overall organisms showed low sensitivity to penicillin and aminoglycosides, moderate sensitivity to cephalosporins, and high sensitivity to carbapenems, fluoroquinolones, amikacin and vancomycin. Conclusion: A characteristic pattern of marginally higher gram negative organisms involved in neonatal sepsis can thus be concluded. Better sensitivities of organisms to cephalosporins, flouroquinolones, carbapenenems, vancomycin and amikacin guides to their use as empirical antibiotics in early treatment of neonatal sepsis in our setup. Predictors of poor outcome included male gender, culture proven cases, early onset sepsis and gram negative organisms especially Pseudomonas and Klebsiella.

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