1Department of Pediatrics, Microbiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110029
2Lab Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110029
3All India Institute of Medical Sciences, Ansari Nagar, New Delhi – 110029
*E-mail: ashokdeorari_56@hotmail.com
Sepsis remains a clinical challenge in the Indian intensive care nurseries. In view of limited prospective data on the microbial and demographic epidemiology, clinical intervention have usually not been policy driven but individualized by physician discretion
To review the clinical and microbial pattern of sepsis in an Indian tertiary level neonatal intensive care nursery such that accurate data area available for prospective policy and decision analysis.
Retrospective, observational. All infants with culture positive sepsis between January 1997 and December 2001 were included in the study.
A total of 1610 blood cultures were sent from 9918 babies. 300 positive blood cultures were obtained from 218 neonates. Of these, clinical details were available for 182 (82.4%) babies. The incidence of blood culture positive sepsis was 21.9 per 1000 live births and 94.7 per 1000 NICU admissions. As compared to babies with birth weight >2500 grams, odds of having sepsis was 15.34 (10.1–23.51) in babies <2500 grams, 102 (64.7–164.24) in babies <1500 grams and 129 (71.6–236.2) in babies <1000 grams. Gram-positive cocci constituted 48.3% of all isolates. These included S. aureus, Coagulase negative Staphylococci (CONS), Strep. viridans and Enterococci, in decreasing order of occurrence.
There was significant increase in occurrence of Coagulase negative staphylococci over the last 5 years. Gram-negative bacilli constituted 51.7% of all isolates. Klebsiella. pneumoniae (17%) was the commonest gram-negative organism. Other gramnegative bacilli included E. coli, Ps. aeruginosa, Acinetobacter sp., Citrobacter sp. 41.7% of all sepsis were early onset in nature. The overall mortality in the study group with sepsis was 62/182 (34%). The mortality was 52/154 (33.7%) in LBW babies, 33/92 (35.9%) in VLBW babies and 16/33 (48.5%) in ELBW babies (chi square for trend, p=0.01). Other risk factors for sepsis related mortality included female sex (p=0.05, OR=1.89, CI=0.95–3.6) and gram-negative septicemia (p=0.01, OR=2.95, CI=1.49–5.86). Mortality in early onset sepsis was similar (31.5%) to late onset sepsis (35.8%, p>0.05). Mortality was least with coagulase negative Staph septicemia (16%) and maximum with enterococci sepsis (40%) and gramnegative bacilli (40%).
Sepsis was common among low birth weight male babies. S. aureus, K. pneumoniae and CONS were the most frequent microbes though mortality was higher among females and with gramnegative septicemia.
