title: Multi-drug resistant gram negative bacilli causing early neonatal sepsis in India.
abstract: OBJECTIVE
  To study the organisms causing early and late onset neonatal sepsis, with special reference to multi-drug resistant gram negative bacilli, at two neonatal units (one urban, one rural) in India.
  
  
  METHODS
  Prospective surveillance study.
  
  
  RESULTS
  There were 159 episodes of sepsis (81 urban and 77 rural) affecting 158 babies. Gram negative bacilli caused 117 infections (68%) and predominated at both centres in both early and late sepsis. Klebsiella pneumoniae was the commonest organism, causing 61 infections (38.3%). In early sepsis (0-2 days), non-fermenting gram negative bacilli caused 42.1% of infections at the urban centre; there were no cases of early Group B Streptococcus sepsis. Late onset sepsis was mainly caused by gram negative bacilli at both centres. Multi-drug resistance of over 80% of early-onset gram negative organisms to ampicillin, third generation cephalosporins and gentamicin indicates that these multi-resistant organisms are almost certainly circulating widely in the community. The overall mortality from early sepsis was 27.3% (9 of 33) and from late sepsis was 26.2% (33 of 126). Gram negative bacilli caused all deaths from early sepsis and 87.5% of deaths from late sepsis.
  
  
  CONCLUSIONS
  This study shows that multi-drug resistant gram negative bacilli are a major cause of early and late neonatal sepsis in India and are almost certainly widespread in the community.
authors.affiliation: Department of Neonatology, IPGMER, Kolkata, India. docrumic@yahoo.co.in
authors.forename: Rajlakshmi
authors.initials: R
authors.lastname: Viswanathan
authors.forename: Arun Kumarendu
authors.initials: AK
authors.lastname: Singh
authors.forename: Sulagna
authors.initials: S
authors.lastname: Basu
authors.forename: Suparna
authors.initials: S
authors.lastname: Chatterjee
authors.forename: Syamal
authors.initials: S
authors.lastname: Sardar
authors.forename: David
authors.initials: D
authors.lastname: Isaacs
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001724:Birth Weight; D024901:Drug Resistance, Multiple, Bacterial; D005865:Gestational Age; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D011446:Prospective Studies; D012423:Rural Health / Q000706:statistics & numerical data; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology; D014504:Urban Health / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents