Neonatal Septicaemia: A Hospital Based Study in Eastern Nepal

Abstract

Septicaemia  is  a  major  cause  of  neonatal  morbidity  and  mortality.  Premature  rupture  of  membrane, premature delivery, low birth weight and hospitalisation of the neonate are some of the predisposing factors, which influence the onset of infection and its outcome.   Depending on the time of onset and the causative factors, a wide variety of organisms are implicated in neonatal septicaemia.   The blood culture takes a minimum of 48 hrs to arrive at a definitive diagnosis. A prompt management of such cases along with empirical antibiotic therapy remains the mainstay of management. Hence, knowledge about the organisms prevalent in a particular hospital and their antibiotic susceptibility pattern is an important prerequisite. The study was carried out at the B.P. Koirala institute of health sciences, a tertiary care hospital, in Eastern Nepal for a period of 3-years from 1998 to 2001. Blood samples from 1567 neonates with suspected septicaemia were cultured using standard microbiological technique. 540 (35%) samples were culture positive. Gram- positive bacteria (74%) were more common than Gram-negative bacteria (27%). Staph aureus   (60%) was the most common bacterial isolate. Resistant to ampicillin was seen but most were susceptible to other antimicrobial  including  gentamicin,  amikacin,  cefotaxime,  and  ciprofloxacin.  Positivity  rate  decreased  in the 3rd  year to 25% as against first two years of 41% and 47% respectively, which was, attributed to training and implementation of various measures of infection control practices. Candida spp was not observed during the period of study. It was concluded that a continuous surveillance of the causative agents and their antimicrobial susceptibility pattern is required to control the infection in the hospital neonatal unit.

Key Words: Neonatal septicaemia, Organisms, Antimicrobial susceptibility pattern.