Developing A Protocol For Empirical Antibiotics For Neonatal Sepsis Based On Data On Antibiotic Sensitivity Patterns At Two Tertiary Neonatal Units In Southern India
Diwakar KK, MD, FRCPCH (UK)
Head, Department of Neonatology,
Prof. Department of Pediatrics,
Malankara Orthodox Syrian Church
Medical College, Kolenchery , Kochi,
Kerala â€“ 682311, (India).
Sepsis continues to be a major challenge in neonatal care. The choice of first â€“line antibiotics to be commenced in at-risk neonates has always been a matter of debate.
To compare the bacteriological profiles of isolates from blood cultures at two neonatal centers situated in different states of India, and evaluate if a common â€˜first-line combinationâ€™ of antibiotics could be recommended for infants at-risk for sepsis.
Isolates obtained from neonatal blood culture done at the Kasturba Medical College, Manipal, Karnataka (Center A) and the Malankara Orthodox Syrian Church Medical College, Kochi, Kerala (Center B) were retrospectively analyzed. The sensitivity of common antibiotics and their combinations was analyzed in relation to the bacteriological profile and age of onset of sepsis (Early or late).
Six ninety seven isolates from 3077 samples of blood cultures done in at-risk neonates were retrospectively evaluated. Five twenty nine isolates were obtained from Center A and 168 from Center B. Coagulase negative staphylococcus (CONS) constituted the largest group (37.6%) of these isolates. Klebsiella species (18.5%), Pseudomonas (14.1 %), Acinetobacter sp. (7 %), Enterobacter sp. (4.9 %) were the other common isolates. The combination of Ampicillin + Amikacin covered 49% isolates, followed by Ciprofloxacin + Gentamicin (46.4%), Ciprofloxacin + Amikacin (44%) and Ampicillin + Gentamicin (38.6%). The types of isolates and the sensitivity pattern of isolates to combination antibiotics was found to be similar at both the centers (r = 0.81). Addition of a â€˜thirdâ€™ antibiotic Cefotaxime to the combination of Ampicillin + Amikacin did not reveal any significantly increase in the number of isolates covered. The antibiotic sensitivity patterns were similar among EOS and LOS and correlated at r= 0.9 (p<0.01) for individual antibiotics and at r = 0.97 (p < 0.01) for combination antibiotics.
The combination of Ampicillin + Amikacin , covers the maximum numbers of isolates and could be the best first-line antibiotics in neonatal sepsis. Addition of more antibiotics does not necessarily result in wider coverage of isolates. The initial combination of antibiotics could be the same for EOS and LOS. Blood cultures are mandatory in all neonatal sepsis for seeking specific sensitivity patterns and accordingly modifying the antibiotic therapy.