Neonatal sepsis due to coagulase negative Staphylococci: a study from Kashmir valley, India

Authors

  • Asifa Nazir Department of Microbiology, Government Medical College, Bemina, Srinagar, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20190705

Keywords:

Antibiotic susceptibility, Blood culture, Coagulase negative Staphylococci (CoNS), Neonatal sepsis

Abstract

Background: Neonatal sepsis is a leading cause of neonatal mortality and morbidity. Early diagnosis and treatment with appropriate antibiotics are important to improve the prognosis of neonatal sepsis. Coagulase-negative Staphylococci (CoNS) have emerged as prominent pathogens in the neonatal intensive care unit. These infections are rarely fatal, but they cause significant morbidity, especially among very low birth weight infants. This study was done to know the prevalence of Coagulase-negative Staphylococci in neonatal sepsis and to determine their antibiotic susceptibility pattern.

Methods: A prospective study was conducted on blood samples of suspected neonatal septicaemia between August 2017 and May 2018 received at Department of Microbiology, Government Medical College, Srinagar. Blood culture was done by automated blood culture system, (BacT/Alert) and identification and antibiotic susceptibility was done by VITEK2 method.

Results: Out of 356 neonates screened, there were 185 (53.4%) positive blood cultures. Among the culture positive cases, 107 (57.83%) were male and 78 (42.16%) were female. Early Onset Septicaemia cases (130 [70.27%]) were found to be three times higher than late onset Septicaemia (55 [29.72%]). Coagulase-negative Staphylococci (CoNs) (30.27%) were the most common organisms isolated followed by Acinetobacter sp (15.1%), Klebsiella sp (5.4%) S. aureus (4.8%) and E. coli (4.8%). All the isolates of CoNS were sensitive to linezolid and vancomycin and tigecycline. Methicillin resistance was seen in 84% isolates.

Conclusions: Present study highlights the emergence of Coagulase-negative Staphylococci (CoNS) as predominant cause of neonatal septicaemia. Most of the isolates were resistant to methicillin which is alarming and a cause for concern.

References

Qazi SA, Stoll BJ. Neonatal sepsis: a major global public health challenge. Pediatr Infect Dis J. 2009;28: S1-2.

World Health Organization: Essential New born Care. In A report of a Technical Working Group WHO Geneva; 2009.

Neonatal morbidity and mortality; report of the National Neonatal-Perinatal Database. Indian Pediatr. 1997; 34:1039-42.

Report of the National Neonatal Perinatal Database (National Neonatology Forum) 2000.

Cloberty JP, Stark R. Manual of neonatal case; 1998:271-299.

Fisher G, Horton RE, Edelman R. Summary of the neonatal institute of health workshop on group B streptococcal infections. J Infect Disease.1983;148: 163-6.

Sharma PP, Halder D, Dutta A. Bacteriological profile of neonatal septicaemia. Indian Pediatr.1987;11:1010-7.

Hira V, Sluijter M, Estevão S, Horst-Kreft D, Ott A, de Groot R, et al. Clinical and molecular epidemiologic characteristics of coagulase-negative staphylococcal bloodstream infections in intensive care neonates. Pediatr Infectious Dis J. 2007;26(7):607-12.

Bouchami O, Achour W, Hassen AB. Species distribution and antibiotic sensitivity pattern of coagulase-negative staphylococci other than Staphylococcus epidermidis isolated from various clinical specimens. African J Microbiol Res. 2011;5(11):1298-305.

Diekema DJ, P faller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, et al. Sentry participants group. survey of infections due to staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the Sentry Antimicrobial Surveillance Program, 1997-1999. Clinical Infectious Dis.2001;32(Supplement_2):S114-32.

Goldmann DA. Bacterial colonization and infection in the neonate. Am J Med. 1981;70(2):417-22.

Adams-Chapman I, Stoll BJ. Prevention of nosocomial infections in the neonatal intensive care unit. Current Opinion Pediatr.2002;14(2):157-64.

Gray JE, Richardson DK, McCormick MC, Goldmann DA. Coagulase-negative staphylococcal bacteremia among very low birth weight infants: relation to admission illness severity, resource use, and outcome. Pediatr. 1995;95(2):225-30.

Clinical and laboratory institute. Performance standards for antimicrobial susceptibility testing.27 th informational supplement.2017; M100.

Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control.1988;16:128-40.

Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet.1999;354(9194):1955-61.

Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Late-onset sepsis in very low birth weight neonates: a report from the national institute of child health and human development neonatal research network. J Pediatr. 1996;129(1):63-71.

Isaacs DA. A ten-year, multicentre study of coagulase negative staphylococcal infections in Australasian neonatal units. Arch Dis Childhood-Fetal Neonatal Ed. 2003;88(2):F89-93.

Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD neonatal research network. Pediatr. 2002;110(2):285-91.

Nataro JP, Corcoran L, Zirin S, Swink S, Taichman N, Goin J, et al. Prospective analysis of coagulase-negative staphylococcal infection in hospitalized infants. J Pediatr. 1994;125(5):798-804.

Freeman J, Platt R, Sidebottom DG, Leclair JM, Epstein MF, Goldmann DA. Coagulase-negative staphylococcal bacteremia in the changing neonatal intensive care unit population: is there an epidemic?. Jama. 1987;258(18):2548-52.

Ruhe J, Menon A, Mushatt D, Dejace P, Hasbun R. Non-epidermidis coagulase-negative staphylococcal bacteremia: clinical predictors of true bacteremia. European J Clinic Microbiol Infectious Dis. 2004;23(6):495-8.

Bhattacharjee A, Sen MR, Prakash P, Gaur A, Anuprba S. Increased prevalence of extended spectrum beta lactamase producers in neonatal septicaemic cases at a tertiary referral hospital. Indian J Med Microbiol. 2008; 26:356-60.

Rahman S, Hameed A, Roghani MT, Ullah Z. Multidrug resistant neonatal sepsis in Peshawar, Pakistan. Arch Dis Child Fetal Neonatal Ed. 2002;87: F52-4.

Joshi SG, Ghole VS, Niphadkar KB. Neonatal gram-negative bacteremia. Indian J Pediatr. 2000;67(1):27-32.

Behrman RE, Klegiman RM, Jenson HB, eds. Nelson Text Book of Pediatrics: Infections of the neonatal infant. 17th ed. Philadelphia: W.B Saunders Company; 2004

Khatna SP, Das AK, Chaterjee BD. Neonatal Septicemia. Ind J Pediatr. 1986;53:509-14.

Glandstone IM, Ehrenkranz RA, Edberg SC, Baltimore RS. A Ten-Year Review of Neonatal Sepsis and Comparison with The Previous Fifty-Year Experience. Pediatr Infect Dis J. 1990;9:819-25.

Klein JO, Marchy SM. Bacterial sepsis and meningitis. In: Remington JS, Klein JO, eds. Infectious Diseases of the Fetus and Newborn Infants. 4th ed. Philadephia: W.B. Saunders;1995: 36-90.

Mustafa M, Ahmed SL. Bacteriological profile and antibiotic susceptibility patterns in neonatal septicaemia in view of emerging drug resistance. J Med Allied Sci. 2014;4:2‑8.

Thakur S, Thakur K, Sood A, Chaudhary S. Bacteriological profile and antibiotic sensitivity pattern of neonatal septicaemia in a rural tertiary care hospital in North India. Indian J Med Microbiol. 2016;34(1):67.

Ballot DE, Nana T, Sriruttan C, Cooper PA. Bacterial bloodstream infections in neonates in a developing country. ISRN pediatr. 2012;2012.

Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungal sepsis in very low birth weight infants. Clin Microbiol Rev. 2004;17:638-80

Ozkan H, Cetinkaya M, Koksal N, Celebi S, Hacımustafaoglu M. Culture‐proven neonatal sepsis in preterm infants in a neonatal intensive care unit over a 7-year period: Coagulase‐negative S taphylococcus as the predominant pathogen. Pediatr Int. 2014;56(1):60-6.

Jiang JH, Chiu NC, Huang FY, Kao HA, Hsu CH, Hung HY, et al. Neonatal sepsis in the neonatal intensive care unit: characteristics of early versus late onset. J Microbiol Immunol Infect.2004;37(5):301-6.

Shivanna V, Sunkappa SR, Venkatesha D. The rising trend of coagulase-negative staphylococci in neonatal septicemia. Indian J Pathol Microbiol. 2016;59:510-2.

Jain A, Agarwal J, Bansal S. Prevalence of methicillin-resistant, coagulase-negative staphylococci in neonatal intensive care units: findings from a tertiary care hospital in India. J Med Microbiol. 2004;53(9):941-4.

Kashid RA, Raghuraman K. Speciation and antimicrobial susceptibility of coagulase negative staphylococci, isolated from the anterior nares of health care workers, in a tertiary care hospital in South India, with special reference to methicillin resistance. Int J Contemporary Med Res. 2016;3(8):2329-3.

Ponce de Leon S, Wenzel RP. Hospital‑acquired bloodstream infections with Staphylococcus epidermidis. Review of 100 cases. Am J Med 1984; 77:639‑44.

Jean-Baptiste N, Benjamin DK, Cohen-Wolkowiez M, Fowler VG, Laughon M, Clark RH, et al. Coagulase-negative staphylococcal infections in the neonatal intensive care unit. Infection Control Hospital Epidemiol. 2011;32(7):679-86.

Marchant EA, Boyce GK, Sadarangani M, Lavoie PM. Neonatal sepsis due to coagulase-negative staphylococci. Clinic Development Immunol. 2013;2013.

Jyothi P, Basavaraj MC, Basavaraj PV. Bacteriological profile of neonatal septicemia and antibiotic susceptibility pattern of the isolates. J Natural Sci Biol Med. 2013;4(2):306.

Reimer LG, Wilson ML, Weinstein MP. Update on detection of bacteremia and fungemia. Clin Microbiol Rev.1997;10:444-65.

Garza-Gonzalez E, Morfin-Otero R, Llaca-Diaz JM, Rodriguez-Noriega E. Staphylococcal cassette chromosome mec (SCC mec) in methicillin-resistant coagulase-negative staphylococci. A review and the experience in a tertiary-care setting. Epidemiol Infect. 2010;138(5):645-54.

Planet PJ, LaRussa SJ, Dana A, Smith H, Xu A, Ryan C, et al. Emergence of the epidemic methicillin-resistant Staphylococcus aureus strain USA300 coincides with horizontal transfer of the arginine catabolic mobile element and speG-mediated adaptations for survival on skin. M Bio. 2013;4(6):e00889-13.

Downloads

Published

2019-02-23

Issue

Section

Original Research Articles