Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Ophthalmology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
ASH 2024 Annual Meeting 2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on adolescent vaping

LIVE: Wednesday 29th January, 18:00-19:30 CET

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?
ADVANCED SEARCH
Log in
Top
Antimicrobial Resistance & Infection Control
Published in:

Open Access 01-12-2017 | Research

Emerging antimicrobial resistance in early and late-onset neonatal sepsis

Authors: Lamiaa Mohsen, Nermin Ramy, Dalia Saied, Dina Akmal, Niveen Salama, Mona M. Abdel Haleim, Hany Aly

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2017

Login to get access

Abstract

Background

Compared to developed countries, the use of antimicrobials in Egypt is less regulated and is available over the counter without the need for prescriptions. The impact of such policy on antimicrobial resistance has not been studied. This study aimed to determine the prevalence of early and late onset sepsis, and the frequency of antimicrobial resistance in a major referral neonatal intensive care unit (NICU).

Methods

The study included all neonates admitted to the NICU over a 12-month period. Prospectively collected clinical and laboratory data were retrieved, including blood cultures and endotracheal aspirate cultures if performed.

Results

A total of 953 neonates were admitted, of them 314 neonates were diagnosed with sepsis; 123 with early onset sepsis (EOS) and 191 with late onset sepsis (LOS). A total of 388 blood cultures were obtained, with 166 positive results. Total endotracheal aspirate samples were 127; of them 79 were culture-positive. The most frequently isolated organisms in blood were Klebsiella pneumoniae (42%) and Coagulase negative staphylococcus (19%) whereas in endotracheal cultures were Klebsiella pneumoniae (41%) and Pseudomonas aeruginosa (19%). Gram negative organisms were most resistant to ampicillins (100%), cephalosporins (93%–100%) and piperacillin-tazobactam (99%) with less resistance to aminoglycosides (36%–52%). Gram positive isolates were least resistant to vancomycin (18%). Multidrug resistance was detected in 92 (38%) cultures, mainly among gram negative isolates (78/92).

Conclusions

Antibiotic resistance constitutes a challenge to the management of neonatal sepsis in Egypt. Resistance was predominant in both early and late onset sepsis. This study supports the need to implement policies that prohibits the non-prescription community use of antibiotics.
Literature
1.
Afroza S. Neonatal sepsis- a global problem: an overview. Mymensingh Med J. 2006;15(1):108–14.PubMed
2.
Goldstein B, Giroir B, Randolph A. International consensus conference on pediatric sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6(1):2–8.CrossRefPubMed
3.
Edwards MS, Baker CJ. Sepsis in the newborn. In: Gershon AA, Hotez PJ, Katz SL, editors. Krugman’s infectious diseases of children. Philadelphia: Mosby; 2004. p. 545.
4.
Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG. Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics. 2008;121(4):689–96.CrossRefPubMed
5.
Tallur SS, Kasturi AV, Nadgir SD, Krishna BV. Clinico-bacteriological study of neonatal septicemia in Hubli. Indian J Pediatr. 2000;67(3):169–74.CrossRefPubMed
6.
Karunasekera KA, Pathirana D. A preliminary study on neonatal septicaemia in a tertiary referral hospital paediatric unit. Ceylon Med J. 1999;44(2):81–6.PubMed
7.
Karthikeyan G, Premkumar K. Neonatal sepsis: Staphylococcus aureus as the predominant pathogen. Indian J Pediatr. 2001;68(8):715–7.CrossRefPubMed
8.
Malik AS, Pennie RA. Early onset neonatal septicaemia in a level II nursery. Med J Malaysia. 1994;49(1):17–23.PubMed
9.
Mahmood A, Karamat KA, Butt T. Neonatal sepsis: high antibiotic resistance of the bacterial pathogens in a neonatal intensive care unit in Karachi. J Pak Med Assoc. 2002;52(8):348–50.PubMed
10.
Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr. 1988;112(5):761–7.CrossRefPubMed
11.
Villari P, Sarnataro C, Lacuzio L. Molecular epidemiology of Staphylococcus epidermidis in a neonatal intensive care unit over a three year period. J Clin Microbiol. 2000;38(5):1740–6.PubMedPubMedCentral
12.
Miller M, Holmes HT, Krisher K. Susceptibility test methods: dilution and disc diffusion methods. In: Murray PR, Pfaller MA, Jorgensen JH, Yolken RH, editors. Manual of clinical microbiology, vol. 118. 8th ed; 2003. p. 1526–43.
13.
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty- fifth informational supplement (M100-S25). Wayne: Clinical and Laboratory Standards Institute; 2015.
14.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multi drug-resistant, extensively drug-resistant and pan drug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268–81.CrossRefPubMed
15.
Taheri PA, Eslamieh H, Salamati P. Is ceftizoxime an appropriate surrogate for amikacin in neonatal sepsis treatment? A randomized clinical trial. Acta Med Iran. 2011;49(8):499–503.PubMed
16.
Kalathia MB, Shingala PA, Parmar PN, Parikh YN, Kalathia IM. Study of umbilical cord blood culture in diagnosis of early-onset sepsis among newborns with high-risk factors. J Clin Neonatol. 2013;2(4):169–72.CrossRefPubMedPubMedCentral
17.
Viswanathan R, Singh AK, Basu S, Chatterjee S, Sardar S, Isaacs D. Multi-drug resistant gram negative bacilli causing early neonatal sepsis in India. Arch Dis Child Fetal Neonatal Ed. 2012;97(3):F182–7.CrossRefPubMed
18.
Awad HA, Mohamed MH, Badran NF, Mohsen M, Abd-Elrhman AS. Multidrug-resistant organisms in neonatal sepsis in two tertiary neonatal ICUs, Egypt. J Egypt Public Health Assoc. 2016;91(1):31–8.CrossRefPubMed
19.
Aamir MM, Abu El Wafa WM, Ali AE, Hamouda HM, Mourad FE. Prevalence of multidrug resistant bacteria causing late-onset neonatal sepsis. Int J Curr Microbiol App Sci. 2015;4(5):172–90.
20.
Chaurasia S, Sankar MJ, Agarwal R, Yadav CP, Arya S, Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration. Characterization and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study. Lancet Glob Health. 2016;4:e752–60.CrossRef
21.
Moore KL, Kainer MA, Badrawi N, Afifi S, Wasfy M, Bashir M, et al. Neonatal sepsis in Egypt associated with bacterial contamination of glucose-containing intravenous fluids. Pediatr Infect Dis J. 2005;24(7):590–4.CrossRefPubMed
22.
Shehab El-Din ER, El-Sokkary MA, Bassiouny MR, Hassan R. Epidemiology of neonatal sepsis and implicated pathogens: a study from Egypt. Biomed Res Int. 2015; doi:10.​1155/​2015/​509484.
23.
Mohammed D, El Seifi OS. Bacterial nosocomial infections in neonatal intensive care unit, Zagazig university hospital, Egypt. Egyptian Pediatric Association Gazette. 2014;62:72–9.CrossRef
24.
Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Pediatr Infect Dis J. 2009;28(1):3–9.CrossRef
25.
Mugalu J, Nakakeeto MK, Kiguli S, Kaddu-Mulindwa DH. Aetiology, risk factors and immediate outcome of bacteriologically confirmed neonatal septicaemia in Mulago hospital, Uganda. Afr Health Sci. 2006;6(2):120–6.PubMedPubMedCentral
26.
Singh SA, Dutta S, Narang A. Predictive clinical scores for diagnosis of late onset neonatal septicemia. J Trop Pediatr. 2003;49(4):235–9.CrossRefPubMed
27.
Motara F, Ballot DE, Perovic O. Epidemiology of neonatal sepsis at Johannesburg hospital. S Afr J Epidemiol Infect. 2005;20(3):90–3.
28.
Jain NK, Jain VM, Maheshwari S. Clinical profile of neonatal sepsis. Kathmandu Univ Med J. 2003;1(2):117–20.
29.
Movahedian AH, Moniri R, Mosayebi Z. Bacterial culture of neonatal sepsis. Iranian J Public Health. 2006;35(4):84–9.
30.
Ahmed AS, Chowdhury MA, Hoque M, Darmstadt GL. Clinical and bacteriological profile of neonatal septicemia in a tertiary level pediatric hospital in Bangladesh. Indian Pediatr. 2002;39(11):1034–9.PubMed
31.
32.
Blanco J, Muriel-Bombin A, Sagredo V, Taboada F, Gandia F, Tamayo L, et al. Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study. Crit Care. 2008;12(6):R158.CrossRefPubMedPubMedCentral
33.
Slagle TA, Bifano EM, Wolf JW, Gross SJ. Routine endotracheal cultures for the prediction of sepsis in ventilated babies. Arch Dis Child. 1989;64(1 Spec No):34–8.CrossRef
34.
El Badawy A, El Sebaie D, Khairat S, Fouad S. A study of microbiological pattern of neonatal sepsis. Alexandria J Pediatr. 2005;19(2):357–67.
35.
Fahmey SS. Early-onset sepsis in a neonatal intensive care unit in Beni Suef, Egypt: bacterial isolates and antibiotic resistance pattern. Korean J Pediatr. 2013;56(8):332–7.CrossRefPubMedPubMedCentral
36.
Abd el Haleim MM, Nawar NN, Abd el Rahman EM, Abo Hussein HH, Kamel NR. Epidemiologic and microbacteriologic study of neonatal septicaemia in Cairo University neonatal intensive care units. Res J Med Med Sci. 2009;4(1):67–77.
37.
El Feky EA. Abd el Rahman Z, Mansi YA. Retrospective analysis of neonatal bacteremia and antimicrobial resistance pattern in neonatal intensive care unit. Res J Med Med Sci. 2011;6(2):62–8.
38.
Shrestha S, Adhikari N, Rai BK, Shreepaili A. Antibiotic resistance pattern of bacterial isolates in neonatal care unit. J Nepal Med Assoc. 2010;50(180):277–81.
39.
Berezin EN. Solorzano F; Latin America working group on bacterial resistance. Gram negative infections in pediatric and neonatal intensive care units in Latin America. J Infect Dev Ctries. 2014;8(8):942–53.CrossRefPubMed
40.
Aftab R, Iqbal I. Bacteriological agents of neonatal sepsis in NICU at Nishtar Hospital Multan. J Coll Physicians Surg Pak. 2006;16(3):216–9.PubMed
41.
Rahman S, Hameed A, Roghani MT, Ullah Z. Multidrug resistant neonatal sepsis in Peshawar, Pakistan. Arch Dis Child Fetal Neonatal Ed. 2002;87(1):F52–4.CrossRefPubMedPubMedCentral
42.
Anwer SK, Mustafa S, Pariyani S, Ashraf S, Taufiq KM. Neonatal sepsis: an etiologic study. J Pak Med Assoc. 2000;50(3):91–4.PubMed
43.
Robillard PY, Nabeth P, Hulsey TC, Sergent MP, Perianin J, Janky E. Neonatal bacterial septicemia in a tropical area. Four-year experience in Guadeloupe (French West Indies). Acta Paediatr. 1993;82(8):687–9.CrossRefPubMed
44.
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002;110(2Pt1):285–91.CrossRefPubMed
45.
Nambiar S, Singh N. Change in epidemiology of health care associated infections in a neonatal intensive care unit. Pediatr Infect Dis J. 2002;21(9):839–42.CrossRefPubMed
46.
Mannan MA, Shahidullah M, Noor MK, Dey AC, Nasrin N, Marma U. Nosocomial infections in a newborn intensive care unit of a tertiary care health. Bangladesh J Child Health. 2008;32:92–6.
47.
Muhammad Z, Ahmed A, Hayat U, Wazir MS, Rafiyatullah, Waqas H. Neonatal sepsis: causative bacteria and their resistance to antibiotics. J Ayub Med Coll Abbottabad. 2010;22(4):33–6.PubMed
48.
Sivanandan S, Soraisham AS, Swarnam K. Choice and duration of antimicrobial therapy for neonatal sepsis and meningitis. Int J Pediatr. 2011; doi:10.​1155/​2011/​712150.
49.
Le Doare K, Bielicki J, Heath PT, Sharland M. Systematic review of antibiotic resistance rates among gram negative bacteria in children with sepsis in resource limited countries. J Ped Infect Dis. 2014;4(1):11–20.CrossRef
50.
Patel SJ, Saiman L. Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact, and prevention including antibiotic stewardship. Clin Perinatol. 2010;37(3):547–63.CrossRefPubMedPubMedCentral
51.
Polin RA, Denson S. Brady MT; Committee on Fetus and Newborn; Committee on Infectious Diseases. Strategies for prevention of health care associated infections in the NICU. Pediatrics. 2012;129(4):e1085–93.CrossRefPubMed
52.
Gray JW, Ubhi H, Milner P. Antimicrobial treatment of serious gram negative infections in newborns. Curr Infect Dis Rep. 2014;16(2):400.CrossRefPubMed
53.
54.
Falagas ME, Kasiakou SK. Colistin: the revival of Polymyxins for the management of multidrug resistant gram negative bacterial infections. Clin Infect Dis. 2005;40(9):1333–41.CrossRefPubMed
55.
Goswami NN, Trivedi HR, Goswami AP, Patel TK, Tripathi CB. Antibiotic sensitivity profile of bacterial pathogens in postoperative wound infections at a tertiary care hospital in Gujarat, India. J Pharmacol Pharmacother. 2011;2(3):158–64.CrossRefPubMedPubMedCentral
56.
Desjardins M, Delgaty KL, Ramotar K, Seetaram K, Toye B. Prevalence and mechanisms of erythromycin resistance in group a and group B streptococcus: implications for reporting susceptibility results. J Clin Microbiol. 2004;42(12):5620–3.CrossRefPubMedPubMedCentral
57.
Rice LB. Antimicrobial resistance in gram-positive bacteria. Am J Med. 2006;119(6 Suppl 1):S11–9.CrossRefPubMed
58.
Courvalin P. Vancomycin resistance in gram positive cocci. Clin Infect Dis. 2006;42(Suppl 1):S25–34.CrossRefPubMed
59.
Chua K, Howden BP. Treating gram-positive infections: vancomycin update and the whys, wherefores and evidence base for continuous infusion of anti-gram-positive antibiotics. Curr Opin Infect Dis. 2009;22(6):525–34.CrossRefPubMed
60.
Hooper DC. Fluoroquinolone resistance among Gram positive cocci. Lancet Infect Dis. 2002;2(9):530–8.CrossRefPubMed
Metadata
Title
Emerging antimicrobial resistance in early and late-onset neonatal sepsis
Authors
Lamiaa Mohsen
Nermin Ramy
Dalia Saied
Dina Akmal
Niveen Salama
Mona M. Abdel Haleim
Hany Aly
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2017
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-017-0225-9

Other articles of this Issue 1/2017

Inappropriate use of antibiotics among communities of Gondar town, Ethiopia: a threat to the development of antimicrobial resistance

  • Open Access
  • Research

Implementation of central line-associated bloodstream infection prevention bundles in a surgical intensive care unit using peer tutoring

  • Open Access
  • Research

Post-ERCP infection and its epidemiological and clinical characteristics in a large Chinese tertiary hospital: a 4-year surveillance study

  • Open Access
  • Research

Readiness for antimicrobial resistance (AMR) surveillance in Pakistan; a model for laboratory strengthening

  • Open Access
  • Research

Comparison of subsequent infection in methicillin-resistant Staphylococcus aureus nasal carriers between ST72 community-genotype and hospital genotypes: a retrospective cohort study

  • Open Access
  • Research

High prevalence of the mcr-1 gene in retail chicken meat in the Netherlands in 2015

  • Open Access
  • Letter to the Editor

Keynote webinar | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the broader systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on adolescent vaping

  • Live
  • Webinar | 29-01-2025 | 18:00 (CET)

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Watch it live: Wednesday 29th January, 18:00-19:30 CET
 

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Join the webinar

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more
Image Credits