Multidrug-resistant organisms in neonatal sepsis in two tertiary neonatal ICUs, Egypt.
BACKGROUND
Neonatal sepsis remains a serious problem in any neonatal intensive care unit (NICU). Bacterial organisms have developed increased resistance to commonly used antibiotics. Because not enough data are available from Egypt, the aim of the present study was to determine the causative bacteria and the level of their resistance to commonly used antibiotics in tertiary NICUs in Cairo, Egypt.


METHODS
A 3.5-year retrospective study was carried out at NICUs of the Children's Hospital of Ain Shams University and that of El-Hussein Hospital, Al-Azhar University, Egypt. Records of neonates were reviewed. All neonates with culture-proven sepsis were included in the study.


RESULTS
Almost one-third of the admitted neonates (33.4%) were diagnosed as having neonatal sepsis, 32.25% of them culture-proven. Early/late onset sepsis was found in 35.4 and 64.6%, respectively. Gram-negative/gram-positive bacteria was found in 68 to 25.6%. Fungal infection was detected in 9% of the isolates. Escherichia coli was the main pathogen isolated in both early-onset sepsis (41.2%) and late-onset sepsis (24.5%). Overall, 77% of the isolates were multidrug-resistant (60% of gram-positive bacteria and 83.4% of gram-negative bacteria). Nearly 80% (79%) of mortality was caused by multidrug-resistant organisms. Gram-positive and gram-negative bacteria showed high resistance against commonly used antibiotics such as ampicillin, amoxicillin, cefotaxime, ceftriaxone, and gentamicin.


CONCLUSIONS
There is an alarming increase in antibiotic resistance to the commonly used antibiotics. Continuous surveillance for antibiotic susceptibility is needed to ensure proper empirical therapy. Improvement of infection control practices, avoidance of irrational use of antibiotics, and revision of the protocols are mandatory in the prevention of neonatal sepsis.
Departments of aNeonatology bClinical Pathology, Ain Shams University cDepartment of Neonatology, Al-Azhar University, Cairo, Egypt.
Hesham A
HA
Awad
Maha H
MH
Mohamed
Nabil F
NF
Badran
Manal
M
Mohsen
Al-Sayed A
AS
Abd-Elrhman
D003428:Cross Infection / Q000382:microbiology; D004352:Drug Resistance, Microbial; D004534:Egypt; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000382:microbiology*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D018805:Sepsis / Q000382:microbiology*