Haemato-bacteriological profile and antibiogram of suspected cases of early onset sepsis in very low birth weight neonates

Introduction: The current Indian neonatal mortality rate is 28 per 1000 live births. Whilst the leading cause of mortality is prematurity and its complications, the second is neonatal sepsis.

Objectives: To describe spectrum of isolates in neonatal sepsis together with their antibiotic sensitivity pattern and significance of routine blood investigations for diagnosis of early onset septicaemia.

Method: A cross-sectional study was performed in 100 neonates with risk factors for septicaemia after obtaining informed consent. Routine blood investigations such as complete blood count and C-reactive protein (CRP) were done on the first day of life. Specificity, sensitivity, positive predictive value and negative predictive value of total leucocyte count, absolute neutrophil count and CRP were calculated. Blood culture was done using Bactec Peds Plus/F culture as a gold standard to diagnose septicaemia. The study was approved by the Institutional Ethics Committee.

Results: Out of 100 neonates with suspected sepsis, 40 were found to have culture proven sepsis. CRP had the highest sensitivity (45%) and negative predictive value (71%), leucopenia had the highest positive predictive value (72%) and neutropenia had the highest specificity (91.7%). The common bacteria for early onset sepsis (EOS) were Klebsiella, Pseudomonas and methicillin resistant Staphylococcus Aureus (MRSA) contributing 17% each to the bacteriological profile. All the gram negative bacteria in our study were sensitive to gentamicin and gram positive bacteria were sensitive to nitrofurantoin, tigecycline, tetracycline, vancomycin, teicoplanin, and linezolid.

Conclusions: This study showed that leucopenia, neutropenia and CRP are good indicators of sepsis, when used in combination. A negative CRP can exclude sepsis as it has the highest negative predictive value. This study also showed that gram negative bacilli (Klebsiella and Pseudomonas) were the common organisms associated with early onset neonatal sepsis.