Antimicrobial Resistance and Microbiological Spectrum among Neonate Acquiring Healthcare-Associated Infections in South India

Abstract

Background: Each year, nearly 0.748 million new-born deaths occur in India, contributing to 1/3rd of the world’s neonatal death. Healthcare-associated infections (HAIs) are becoming a challenge to all healthcare providers across the globe. The spectrum of microorganism prevalent and its resistance pattern is alarming for the neonates with exceptionally low immunity. The current study is carried out to explore the microbiological pattern and antimicrobial spectrum causing HAIs among neonate. Methodology: A cross-sectional study among 2736 neonate acquiring HAIs (Using CDC and WHO criteria) was carried out to investigate the spectrum of the bacteriological pathogen at level III Neonatal Intensive Care Unit (NICU) associated with tertiary care teaching hospital of coastal Karnataka. Identified strains of microorganism were further classified as Multidrug-resistant (MDR), Extensive drug-resistant (XDR) and Pandrug resistant (PDR) organism based on an international expert proposal for interim definitions for acquired resistance. One millilitre of the blood sample from neonates acquiring HAIs was cultured in BacT, and then bacterial growth was exposed to MALDI-TOF for identification of the pathogen, and antibiotic sensitivity was checked with VITEK®MS system. Reporting of antibiotic susceptibility was done as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of total 2736 neonates admitted to NICU during the study period, 1233 neonates were admitted for >48 hours, of which 118 neonates acquired healthcare-associated infections with the rate of HAIs as 9.6 per 100 admissions for >48 hours. A total of 474 blood/ fluid samples from 118 neonates acquiring HAIs were sent to the microbiology lab for further culture and susceptibility testing. Growth of microorganism was obtained for 162 neonatal blood/ fluid samples. The prevalent microorganisms identified were Klebsiella pneumoniae (35%), coagulase-negative Staphylococcus aureus (CONS) (32%), Acinetobacter baumanii (12%), Enterobacter cloacae (8%) and E. coli (8%) and others (5%). The resistance pattern of these microorganisms showed multidrug resistance (MDR), extensive drug resistance (XDR) and pan drug resistance (PDR). Conclusion: Gram-negative microorganisms are posing threat to neonatal population in Southern India. Neonatal survival is challanged by Klebsiella pneumoniae, Enterobacter cloacae and Acinetobacter baumanii leading to nearly 30% mortality is a concern for draining out existing antimicrobial therapy. Increasing prevalence of MDR, XDR and PDR require a tragetted approach to exhibit resistance.