Multidrug resistance in the neonatal unit and its therapeutic implications
Keywords:
multidrug resistance, neonatal sepsis
Abstract
Background Neonatal septicemia constitutes an important causeof morbidity and mortality among neonates in Indonesia. The ex-
cessive use of antibiotics may cause antibiotic resistant bacteria
and may cause neonatal fungal infection.
Objective To investigate the spectrum of organisms which cause
neonatal sepsis and assess their sensitivity to various groups of
drugs in the neonatal unit.
Methods A prospective study conducted on newborn babies de-
livered in Cipto Mangunkusumo Hospital, Jakarta from July 2004-
May 2005 who presented clinical signs of septicemia were sub-
jected for blood culture. Those sensitive to antibiotics for 7 days
yet showed no clinical improvement were also cultured for fungi.
Results A total of 499 blood cultures were taken, 320 were posi-
tive for bacteria (positivity rate was 65.3%). There were 192 samples
cultured for fungi, and the positivity rate was 64% (all for Candida
sp). Acinetobacter calcoaceticus was the most common bacteria
found (35.7%), followed by Enterobacter sp (7.0%), and Staphylo-
coccus sp (6.8%). Most bacteria showed high degrees of resis-
tance to commonly used antibiotics (ampicillin and gentamicin).
There were also high degrees of resistance to cephalosporins by
both Gram negative and Gram positive organisms. Only 61.7% of
A. calcoaceticus, and 45.7% of Enterobacter sp were sensitive to
ceftazidime. Gram negative organisms were also highly resistant
to amikacin, but Staphylococcus sp was only moderately resis-
tant. Resistance to carbapenem (meropenem and imipenem) var-
ied from moderate to low. Drugs which were not used for newborn
babies (quinolones/ciprofloxacin and chloramphenicol) varied from
moderate to high resistance.
Conclusion Neonatal sepsis remains one of the major causes of
mortality in our neonatal unit. Most organisms have developed
multidrug resistance, and management of patients infected with
these organisms and especially those with fungi infection are be-
coming a problem in developing countries
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V, Flannery B, Almeida Lins MC, Mello Sampaio JL, et
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siella pneumoniae in a neonatal intensive care unit, risk
factors for infection and colonization. J Hosp Infect
2003;53:198-206.
30. Jain A, Roy I, Gupta MK, Kumar M, Agarwal SK.
Prevalence of extended-spectrum betalactamase-pro-
ducing Gram-negative bacteria in septicaemic neonates
in a tertiary care hospital. J Med Microbiol 2003;
52:421-5.
31. Kaushik SL, Parmer VR, Grover N. Neonatal sepsis in
Pakistan, presentation and pathogens. Acta Pediatr
Scand 1991;80:596-601.
32. Leibovitz E, Flidel-Rimon O, Juster Reicher A. Sepsis
in neonatal intensive care unit, a four year restro-
spective study (1989-1992). Isr J Med Sci 1997; 33:734-
8.
33. Kokasal N, Hacimustafaoglu M, Bagei S. Meropenem
in severe infections due to multiresistant Gram nega-
tive bacteria. Indian J Pediatr 2001;68:15-9.
34. Terrone DA, Rinehart BK, Eintein MH. Neonatal sep-
sis and death caused by resistant Escherichia coli, pos-
sible consequences of extended maternal ampicillin ad-
ministration. Am J Obstet Gynecol 1999;180:1345-8.
35. Levin EM, Ghai V, Barton JJ. Intrapartum antibiotics pro-
phylaxis increases the incidence of Gram negative neo-
natal sepsis. Infect Dis Obstet Gynecol 1999;7:210-3.
36. Mercer BM, Carr TL, Beazley DD. Antibiotic use in
pregnancy and drug resistant infant sepsis. Am J Obstet
Gynecol 1999;181:816-21.
37. Rozaliyani A. Profile of neonatal candidemia and
resistency of Candida sp to azol derivates [thesis].
Jakarta: Parasitology Departement, Medical Faculty,
Cipto Mangunkusumo Hospital, Univ. Indonesia; 2004.
etiological study. J Pak Med Assoc 2000;59:91-4.
2. Dawadu A, Al-Umran K, Twum-Danso K. A case-con-
trol study of neonatal sepsis: Experience from Saudi
Arabia. J Trop Pediatr 1997;43:84-8.
3. Stool BJ, Holman RC, Schuchat A. Decline in sepsis
associated neonatal and infant deaths in the United
States, 1979 through 1994. Pediatrics 1998;102:18.
4. Bhutta ZA, Yusuf K. Neonatal sepsis in Karachi, fac-
tors determining outcome and mortality. J Trop Pediatr
1997;43:65-70.
5. Orrett FA, Shurland SM. Neonatal sepsis and mortal-
ity in a regional hospital in Trinidad, aetiology and risk
factors. Ann Trop Paediatr 2001;21:20-5.
6. Greenberg D, Shinwell ES, Yaguspsky P. A prospective
study of neonatal sepsis and meningitis in southern Is-
rael. Pediatr Infect Dis J 1997;16:768-73.
7. Ghiorghis B. Neonatal sepsis in Adis Ababa, Ethiopia,
a review of 151 bacteremic neonates. Ethiop Med
1997;35:169-76.
8. Joshi SJ, Ghole VS, Niphadkor KB. Neonatal Gram
negative bacteremia. Indian J Pediatr 2000;67:27-32.
9. Maryam W, Laeeg A, Maqbool S. Neonatal sepsis spec-
trum of antibiotic resistance. Proceedings of 10 th Na-
tional Annual Pediatric Conference;2001;p.57.
10. Kilani RA, Basamad M. Pattern of proven bacterial
sepsis in neonatal intensive care unit in Riyadh Arabia,
2 year analysis. J Med Libon 2000;48:77-83.
11. Friedman S, Shah V, Ohisson A. Neonatal Eschericha
coli infections: Concerns regarding resistance to cur-
rent therapy. Acta Paediatr 2000;89:686-9.
12. Rahman S, Raghani MT, Ullah R. A survey of perina-
tal care facilities in Pakistan. Proceedings of 10 th Na-
tional Annual Pediatric Conference;2001;p.34.
13. Weese Mayer DE, Fondriest DW, Brouillette RT, S
Hulman ST. Risk factors associated with candidemia
in the neonatal intensive care unit, a case-control
study. Pediatr Infect Dis J 1987;6:190-6.
14. Faix RG, Kovarik SM, Shaw TR, Johnson RV. Mucocu-
taneous and invasive candidiasis among very low birth
weight (<1500 grams) infants in intensive care nurser-
ies, a prospective study. Pediatrics 1989;83:101-7.
15. Darmstdt GL. Global newborn health challenges and
opportunities. Proceedings of 10 th a National Annual
Pediatric Conference;2001;p.22.
16. Siswanto JE, Marnoto BW, Firmansyah R. The mor-
tality rate of high risk infants with infection or sep-
ticemia in Harapan Kita Children and Maternity
Hospital Jakarta [abstract]. In: Garna H,
Nataprawira HMD, Alam A, editors. Proceedings
of the 13 th National Child Health Congress; 2005
July 4-7; Bandung, Indonesia. Bandung; 2005. p.
301.
17. Suarca K, Kardana M, Iswari IS. Blood culture and
sensitivity test pattern of early versus late onset sepsis
in neonatal ward Sanglah Hospital Denpasar [abstract].
In: Garna H, Nataprawira HMD, Alam A, editors. Pro-
ceedings of the 13 th National Child Health Congress;
2005 July 4-7, Bandung, Indonesia. Bandung; 2005. p.
110.
18. Ghiorghis B. Neonatal sepsis. Ethiop Med J 1991;28:
956-7.
19. Robbilard PY. Perez JM, Hulsey TC. Evaluation of neo-
natal sepsis screening in a tropical area, Part 1, major
risk factors for bacterial carriage at birth in Guadeloupe.
West Indian Med J 2000;49:312-5.
20. Koutouby A, Habib Ullah J. Neonatal sepsis in Dubai
United Arab Emirates. J Trop Pediatr 1995;41:177-80.
21. Ohlsson A, Balley T, Takieddine F. Changing etiology
and outcome of neonatal septicemia in Riyadh, Saudi
Arabia. Acta Pediatr Scand 1986;75:540-4.
22. Freedam RM, Ingram DI, Gross I. A half century of neo-
natal sepsis at Yale. Am J Dis Child 1981;13:140-4.
23. Somu N, Shetty MV, Moses LG. A critical analysis of
septicemia in infancy. Indian Pediatr 1976;13:443-6.
24. Bhakoo ON, Agarwal KC, Narang A. Prognosis and
the treatment of neonatal septicemia a clinical bacte-
rial study of 100 cases. Indian Pediatr 1974;11:519-28.
25. Gordon A, Isaacs D. Late onset infection and the role
of antibiotic prescribing policies. Curr Opin Infect Dis
2004;17:231-6.
26. Lautenbach E, Patel JB, Bilker WB, Edelstein PH,
Fishman NO. Extended-spectrum betalactamase-pro-
ducing Escherichia coli and Klebsiella pneumoniae, risk
factors for induction and impact of resistance of out-
comes. Clin Infect Dis 2001;32:1162-71.
27. Gupta A. Hospital acquired infections in the neonatal
unit-Klebsiella pneumoniae. Semin Perinatol 2002;
27:340-5.
28. Royle J, Halasz S, Eagles G, Gilbert G, Dalton D. Jelfs
P, et al. Outbreak of extended spectrum betalactamase-
producing Klebsiella pneumoniae in a neonatal unit.
Arch Dis Child Fetal Neonatal Ed 1999;80:64-8.
29. Pessoa-Silva CL, Meurer Moreira B, Camara Almeida
V, Flannery B, Almeida Lins MC, Mello Sampaio JL, et
al. Extended-spectrum betalactamase-producing Kleb-
siella pneumoniae in a neonatal intensive care unit, risk
factors for infection and colonization. J Hosp Infect
2003;53:198-206.
30. Jain A, Roy I, Gupta MK, Kumar M, Agarwal SK.
Prevalence of extended-spectrum betalactamase-pro-
ducing Gram-negative bacteria in septicaemic neonates
in a tertiary care hospital. J Med Microbiol 2003;
52:421-5.
31. Kaushik SL, Parmer VR, Grover N. Neonatal sepsis in
Pakistan, presentation and pathogens. Acta Pediatr
Scand 1991;80:596-601.
32. Leibovitz E, Flidel-Rimon O, Juster Reicher A. Sepsis
in neonatal intensive care unit, a four year restro-
spective study (1989-1992). Isr J Med Sci 1997; 33:734-
8.
33. Kokasal N, Hacimustafaoglu M, Bagei S. Meropenem
in severe infections due to multiresistant Gram nega-
tive bacteria. Indian J Pediatr 2001;68:15-9.
34. Terrone DA, Rinehart BK, Eintein MH. Neonatal sep-
sis and death caused by resistant Escherichia coli, pos-
sible consequences of extended maternal ampicillin ad-
ministration. Am J Obstet Gynecol 1999;180:1345-8.
35. Levin EM, Ghai V, Barton JJ. Intrapartum antibiotics pro-
phylaxis increases the incidence of Gram negative neo-
natal sepsis. Infect Dis Obstet Gynecol 1999;7:210-3.
36. Mercer BM, Carr TL, Beazley DD. Antibiotic use in
pregnancy and drug resistant infant sepsis. Am J Obstet
Gynecol 1999;181:816-21.
37. Rozaliyani A. Profile of neonatal candidemia and
resistency of Candida sp to azol derivates [thesis].
Jakarta: Parasitology Departement, Medical Faculty,
Cipto Mangunkusumo Hospital, Univ. Indonesia; 2004.
Published
2016-10-18
How to Cite
1.
Rohsiswatmo R. Multidrug resistance in the neonatal unit and its therapeutic implications. PI [Internet]. 18Oct.2016 [cited 29Nov.2024];46(1):25-1. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/850
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Received 2016-10-10
Accepted 2016-10-10
Published 2016-10-18
Accepted 2016-10-10
Published 2016-10-18
