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EXTENSIVELY DRUG-RESISTANT (XDR) GRAM-NEGATIVE BACTERIAL SEPSIS AMONG NEONATES FROM LMIC: A RETROSPECTIVE COHORT STUDY
Abstract
Background
Extensively drug-resistant (XDR) Gram-negative bacterial (GNB) sepsis is emerging as a new threat among neonates admitted in Neonatal Intensive Care Unit (NICU).
Aims
To determine the proportion of neonates, the pathogen profile and outcome of XDR-GNB neonatal sepsis, in a newly established Level III NICU in Western India.
Methods
The data of all neonates admitted in NICU from July 2016 to June 2021 was retrospectively analyzed from our database. Standard CDC definition was used to define multi-drug resistance (MDR) and XDR.
Results
Of the total of 1230 NICU admissions, 973 were inborn and 257 were outborn neonates. The incidence of total and culture positive sepsis was 31.5% (387/1230) and 11.7% (144/1230) respectively. There were a total of 194 bacterial isolates with 73.2% (142) being GNB. Out of these, 73.2% (104) were MDR and 33.8% (48) were XDR GNB isolates. Fifty eight percent of XDR GNB were isolated from outborn referred neonates. Neonates with XDR GNB sepsis accounted for one third of the total neonates with culture positive sepsis. The distribution of these XDR GNB isolates was: Klebsiella (n=21, 44%), Acinetobacter (n=18, 38%), Escherichia species (n=6, 13%), Enterobacter (n=1; 2%), Citrobacter (n=1, 2%) and Chrysobacterium (n=1, 2%). Among 142 GNB isolates, 58% of Acinetobacter, 44% of Klebsiella and 38% of Escherichia were XDR. The case fatality rate was almost double among neonates with XDR GNB sepsis as compared to non-XDR GNB sepsis (RR 1.97 [95% CI 1.11-3.51; p 0.021]).
Conclusions
XDR-GNB accounted for one-third of the total GNB isolates with almost double case fatality rate.