Bacterial profile of early versus late onset neonatal sepsis in a North Indian tertiary care centre: Heading towards a change

Abstract

Traditional division of neonatal sepsis into early (EOS) and late onset sepsis (LOS) may be fallible. We analyzed the bacteriological profile of neonatal sepsis day wise to see if the organisms causing EOS and LOS are really different in the current era. This retrospective study was conducted in a tertiary care neonatal unit from 1995–2006. Neonates with proven sepsis were included. The exact age of the neonate when the blood culture was obtained was extracted. To identify the overlap between vertically and hospital acquired sepsis, a similar percentage contribution of a particular organism on a day wise analysis in the first 7 days of life was required. Day wise analysis was done by χ2 for trends. One thousand and four hundred and ninety-one neonates had blood culture proven sepsis (38.6 per 1000 live births). EOS was caused predominantly by Klebsiella pneumoniae and non-fermenting Gram-negative bacilli; whereas LOS was caused mainly by Staphylococcus aureus. All organisms were isolated on all the days of life. Thirty one percent developed culture proven sepsis in first 24 hours of life. Non-fermenting Gram-negative bacilli significantly contributed on day 1 while S. aureus sepsis was significantly higher from day 7 onward on trend analysis. The definition of EOS and LOS based on day of isolation alone may not be applicable. A prospective evaluation of the source of early bacterial infections is required.

Keywords

Bacterial sepsis - neonate - organisms - trends - EOS - LOS