Prevalence and Antibiotic Resistance Patterns of Neonatal Bloodstream Pathogens in Tertiary Care Hospitals: A Retrospective Analysis

Abstract

Background: Neonatal bloodstream infections (BSIs) are a leading cause of mortality in developing countries, necessitating effective treatment strategies.

Objective: This retrospective study investigated the prevalence and antibiotic susceptibility patterns of bacterial pathogens causing neonatal BSIs in two tertiary hospitals in Dhaka, Bangladesh.  

Methodology: This is a retrospective study took place in Ad-din Women’s Medical College & Hospital, Dhaka & Rushmono specialized Hospital, Dhaka, Bangladesh in between the time period of July 2019 to December 2020. A total of 1825 blood samples were obtained from patients who were admitted at the Neonatal Intensive care unit of Ad-din Women’s Medical College & Hospital, Dhaka & Rushmono specialized Hospital, Dhaka, Bangladesh from July 2019 to December 2020. All the blood samples were processed for culture using a BACT/Alert blood culture machine. Further identification & antimicrobial susceptibility tests were performed using standard microbiological procedure.

Results: The analysis of 1825 blood samples obtained from neonatal intensive care facilities unveiled a bloodstream infection (BSI) rate of 17.2%. The predominant isolates identified were coagulase-negative Staphylococci (CONS) (10%) and Acinetobacter spp. (60%); these organisms are classified as Gram-positive and negative bacteria, respectively. The preponderance of infections was caused by Gram-positive organisms, specifically CONS, which evolved highly sensitive to imepenem, vancomycin, and linezolid but resistance to ampicillin, cephradine and erythromycin. Methicillin resistance is present in 31.5% of Staphylococcus aureus and nearly half (47%) of the CONS. Vancomycin resistance is present in one-tenth of the isolated Staphylococcus species. Acinetobacter spp. exhibited greater susceptibility to colistin (100%), meropenem (90.67%), piperacillin-tazobactum (92%), and amikacin (82.67%), but resistance to ampicillin (90%), cephradin (80%), cefuroxime (90%), and cefixime (61%). Proteus, Enterobacterieceae, including E. coli, Klebsiella, and Enterobacter, exhibited greater resistance to ampicillin, cephradin, and chloramphenicol while demonstrating greater sensitivity to meropenem (100%), piperacillin-tazobactum (95-98%), amikacin (80-82%), and gentamycin (76%-80%).

Conclusion: Major causative agents of neonatal blood stream infection were coagulase-negative Staphylococci (CONS) and Acinetobacter spp. Multidrug resistance among these bacteria was observed in the study ; which necessitate the implementation of antibiotic stewardship program to improve neonatal outcome.

Bangladesh Journal of Medical Microbiology, January 2024;18(1):22-29