Sepsis with extended-spectrum β-lactamase producing Gram-negative bacteria in neonates – risk factors, clinical profile and outcome

Abstract

This was a prospective study over one year conducted at the neonatal unit of a tertiary hospital in North India. Babies with positive blood/cerebrospinal fluid cultures for Gram-negative bacteria were taken as study cases. A screening and confirmatory test for extended-spectrum-β-lactamase (ESBL) detection with antibiotic sensitivity carried for each isolated organism. 50 out of 102 Gram-negative isolates were found to be ESBL producers. The most common species isolated were Klebsiella species (54), of which 37 (68%) were ESBL producers. Other isolates were Acinetobacter species (2 out producers), E.coli (12/35) and Pseudomonas species (0/5). Infection with ESBL-producing bacteria was more likely after prolonged rupture of membranes and previous neonatal treatment with antibiotics. Newborns with infections with ESBL-producing bacteria were more likely to manifest lethargy (P = 0.04), seizures (P = 0.024) and shock (P = 0.012) and had a higher mortality than the non-ESBL group. ESBL-producing bacteria were more likely to be resistant to other antibiotic classes, especially the aminoglycosides, which has important implications for the continuing suitability of routine first-line antibiotic regimens for neonatal sepsis.

Keywords

ESBL - early onset neonatal sepsis - late onset neonatal sepsis - antibiotic resistance