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Clinical Trial
. 2018 Jun 28;13(6):e0180705.
doi: 10.1371/journal.pone.0180705. eCollection 2018.

Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India

Mamta Jajoo  1 , Vikas Manchanda  2 , Suman Chaurasia  3 , M Jeeva Sankar  3 , Hitender Gautam  2 , Ramesh Agarwal  3 , Chander Prakash Yadav  4   5 , Kailash C Aggarwal  6 , Harish Chellani  6 , Siddharth Ramji  7 , Monorama Deb  8 , Rajni Gaind  8 , Surinder Kumar  9 , Sugandha Arya  6 , Vishnubhatla Sreenivas  4 , Arti Kapil  10 , Purva Mathur  11 , Reeta Rasaily  12 , Ashok K Deorari  3 , Vinod K Paul  3 ; Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration, New Delhi, India
Affiliations
Clinical Trial

Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India

Mamta Jajoo et al. PLoS One. .

Abstract

Background: There is a paucity of data on the epidemiology of sepsis in outborn neonates being referred to level-3 units in low- and middle-income countries (LMIC). The objective of the present study was to evaluate the prevalence of sepsis and outcomes of outborn neonates with sepsis, and to characterize the pathogen profile and antimicrobial resistance (AMR) patterns of common isolates in them.

Methods: In this prospective observational cohort study (2011-2015), a dedicated research team enrolled all neonates admitted to an outborn level-3 neonatal unit and followed them until discharge/death. Sepsis work-up including blood culture(s) was performed upon suspicion of sepsis. All the isolates were identified and tested for antimicrobial susceptibility. Gram-negative pathogens resistant to any three of the five antibiotic classes (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam) were labeled multi-drug resistant.

Results: Of the total of 2588 neonates enrolled, culture positive sepsis and total sepsis-i.e. culture positive and/or culture negative sepsis-was diagnosed in 13.1% (95% CI 11.8% to 14.5%) and 54.7% (95% CI 52.8% to 56.6%), respectively. The case fatality rates were 23.4% and 11.0% in culture-positive and total sepsis, respectively. Sepsis accounted for two-thirds of total neonatal deaths (153/235, 63.0%). Bacterial isolates caused about three-fourths (296/401; 73.8%) of the infections. The two common pathogens-Klebsiella pneumoniae (n = 50, 12.5%) and Acinetobacter baumannii (n = 46, 11.5%)-showed high degree of multi-drug resistance (78.0% and 91.3%, respectively) and carbapenem resistance (84.0% and 91.3%, respectively). About a quarter of infections were caused by Candida spp. (n = 91; 22.7%); almost three-fourths (73.7%) of these infections occurred in neonates born at or after 32 weeks' gestation and about two-thirds (62.1%) in those weighing 1500 g or more at birth.

Conclusions: In this large outborn cohort, we report high burden of sepsis, high prevalence of systemic fungal infections, and alarming rates of antimicrobial resistance among bacterial pathogens.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow.
See this image and copyright information in PMC

References

    1. Morbidity and mortality among outborn neonates at 10 tertiary care institutions in India during the year 2000. J Trop Pediatr 2004. June;50(3):170–4. doi: 10.1093/tropej/50.3.170 - DOI - PubMed
    1. Lui K, Abdel-Latif ME, Allgood CL, Bajuk B, Oei J, Berry A et al.; New South Wales and Australian Capital Territory Neonatal Intensive Care Unit Study Group. Improved outcomes of extremely premature outborn infants: effects of strategic changes in perinatal and retrieval services. Pediatrics 2006. November;118(5):2076–83. doi: 10.1542/peds.2006-1540 - DOI - PubMed
    1. Elwan A. Mortality Among Outborn Versus Inborn Neonates: A Retrospective Comparative Study. Med. J. Cairo Univ 2009. June; 77(4):209–217
    1. Beeram M, Solarin K, Young M, Abedin M. Morbidity and mortality of infants born before arrival at the hospital. Clin Pediatr (Phila) 1995. June;34(6):313–6. - PubMed
    1. Neonatal data collection group. Outcome of Inborn Compared with Outborn Very Low Birth Weight Infants Admitted to Level 3 Malaysian Nurseries. Med J Malaysia March 1995;50(1):42–51 - PubMed

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