Neonatal Sepsis: Mortality and Morbidity in Neonatal Sepsis due to Multidrug-Resistant (MDR) Organisms: Part 1
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Neonatal Sepsis: Mortality and Morbidity in Neonatal Sepsis due to Multidrug-Resistant (MDR) Organisms: Part 1 Chand Wattal 1 & Neelam Kler 2 & J. K. Oberoi 1 & Anurag Fursule 2 & Anup Kumar 2 & Anup Thakur 2 Received: 21 August 2019 / Accepted: 22 October 2019 # The Author(s) 2019
Abstract The major causes of emergence of multidrug-resistant organisms (MDRO) in neonatal sepsis include empiric antibiotic prescriptions, unregulated use of over-the-counter drugs, high incidence of healthcare associated infections (HAI), lack of awareness about antibiotic stewardship program and under staffing of neonatal intensive care units. In general, mortality due to MDRO sepsis is significantly higher as compared to non MDRO sepsis. Reported morbidities include prolonged use of total parenteral nutrition, need for central venous catheter, invasive ventilation, increased duration of hospital stay and neurologic sequelae. Keywords Neonatal sepsis . MDR . Mortality . Morbidity . Financial burden
Introduction Neonatal sepsis is a clinical syndrome characterized by systemic signs and symptoms of infection and is accompanied by bacteremia in the first month of life [1]. Early-onset sepsis (EOS) is defined as sepsis occurring in the first 72 h of life and that occurring beyond 72 h is defined as late-onset sepsis (LOS) [2]. As per World Health Organization (WHO), neonatal sepsis is the third most frequent etiology of neonatal mortality [3]. In the year 2013, a systematic analysis of global, national and regional causes of child mortality found neonatal sepsis to be the leading cause of neonatal deaths in India [4, 5]. The National Neonatal Perinatal Database network (NNPD, 2002–03) comprising of 18 tertiary care neonatal units across India reported sepsis (septicemia/meningitis) as the commonest cause of neonatal mortality, causing 23.4% of all neonatal deaths [6]. The pattern of the bacterial pathogens responsible for neonatal sepsis has changed temporally and geographically. There is a difference in the causative organisms for neonatal sepsis between the developed and developing countries [2, 7]. As per NNPD, Klebsiella pneumoniae and Staphylococcus aureus * Chand Wattal [email protected] 1
Department of Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India
2
Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
are the commonest causative organisms for EOS and LOS in India [6]. On the contrary, data from developed countries shows that gram-positive organisms are the predominant causes of EOS as well as LOS [2, 8]. The ability of bacteria to resist or to become tolerant to several structurally and functionally distinct drugs simultaneously is known as multidrug resistance [9]. Simpler definitions quote “multidrug-resistant organisms (MDROs) are labelled as such because of their in-vitro resistance to more than one antimicrobial agent”. On the other hand, definitions vary as per specific organism [10]. It is estimated that in India, 56,524 neonatal deaths each year are att
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