Clinical and Microbiological Profile of Neonatal Sepsis at a Tertiary Care Hospital in Dehradun, India

摘要

Introduction: Neonatal sepsis is the most common cause of neonatal mortality. It is responsible for 30-40% of neonatal deaths in developing countries. Due to the non-specific nature of presentation, neonatal sepsis is very difficult to diagnose, despite its high incidence. Blood culture is still considered as the gold standard for the diagnosis of neonatal septicaemia. However, sensitivity and specificity of blood culture varies considerably due to many factors, and the final diagnosis of neonatal sepsis is based on a combination of clinical, microbiological and haematological parameters. Aim: To find sensitive clinical indicators for suspecting neonatal sepsis and to ascertain the microbiological profile of neonatal sepsis. Materials and Methods: This six months (01st May 2017- 31st October 2017) prospective observational study was conducted in the Department of Microbiology of Sri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India, on 45 neonates admitted in the Neonatal Intensive Care Unit (NICU). Half ml to 2 mL of blood was drawn following strict aseptic precautions, before the start of antibiotics. Microbial detection and identification were by fully automated BACT/ALERT 3D and VITEK 2 systems, respectively. The data was expressed in terms of frequency and percentage, and statistical results were analysed with help of Microsoft Excel. Results: In this study, culture yielded positive results in a relatively high proportion (60%) of suspected cases. Respiratory distress, reduced movements, and poor feeding were very frequently encountered in both suspected and confirmed cases of neonatal sepsis. Fever was seen only in around half of all neonates of suspected and confirmed neonatal sepsis. In this study, bacteria were 81.48% of the isolates, whereas fungi were 18.51%. Although, as a group, gram-negative bacteria formed the predominant group isolated in cases of neonatal sepsis, yeasts like Candida species were the predominant isolate (18.51%). In this study, isolation of gram-negative bacteria (74.07%) predominated over gram-positive bacteria (7.4%). Conclusion: Respiratory distress, reduced movements, and poor feeding were sensitive indicators for suspecting neonatal sepsis. Fever was a relatively uncommon finding in this study. Candida species and Acinetobacter baumanii were more frequently isolated. Automation can significantly help in reducing mortality in neonatal sepsis.