Bacteriological Characteristics of Early- vs Late-Onset Neonatal Sepsis in Nepal
Overview
This study compared bacterial pathogens and antibiotic resistance patterns in early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS) among neonates admitted to a tertiary care hospital in Nepal. It identified predominant bacteria, risk factors, and multidrug resistance profiles, providing insights for targeted antimicrobial therapy.
Background
Neonatal sepsis is a bloodstream infection occurring within the first 28 days of life and is a leading cause of neonatal mortality globally. It is classified as early-onset (within 72 hours of birth) or late-onset (after 72 hours up to 28 days), with differing risk factors and causative organisms. Maternal and perinatal factors contribute significantly to EONS, while LONS is often associated with nosocomial or community-acquired infections. Understanding the bacteriological profile and antibiotic susceptibility is crucial for effective management in resource-limited settings like Nepal.
Data Highlights
Parameter
Details
Study Period
January 2021 - June 2021
Sample Size
120 blood samples from neonates suspected of sepsis
Setting
NICU and neonatal wards, Tribhuvan University Teaching Hospital, Nepal
Inclusion Criteria
Neonates from birth to 28 days
Exclusion Criteria
Gross congenital malformations, severe cardiac abnormalities, DAMA cases
Blood Volume Collected
1.5 ml per neonate
Culture Method
BacT/ALERT automated system, incubation for 7 days
Antibiotic Susceptibility Testing
Kirby-Bauer disc diffusion on Muller Hinton Agar
Definitions
MDR: resistance to ≥1 agent in ≥3 antimicrobial categories; MRSA and MR-CoNS detected by cefoxitin disc diffusion
Key Findings
Early-onset neonatal sepsis (EONS) typically occurs within 72 hours of birth, while late-onset neonatal sepsis (LONS) occurs after 72 hours up to 28 days.
Common bacterial pathogens in EONS include Escherichia coli and Group B Streptococci; LONS is frequently caused by Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, and Coagulase-negative Staphylococci (CoNS).
Risk factors for EONS include low birth weight, prematurity, maternal febrile illness, prolonged rupture of membranes, and unclean vaginal examinations during labor.
LONS risk factors additionally include poor hygiene, unhygienic cord care, bottle feeding, and application of traditional substances to the umbilical cord.
Multidrug-resistant organisms (MDR), methicillin-resistant Staphylococcus aureus (MRSA), and extended-spectrum beta-lactamase (ESBL) producers were identified using standardized CLSI guidelines.
C-reactive protein (CRP) was used as an acute-phase reactant marker but has limitations due to low specificity.
Clinical Implications
Clinicians should consider the timing of sepsis onset when selecting empirical antibiotics, as causative organisms differ between EONS and LONS. Awareness of local antimicrobial resistance patterns, including MDR and MRSA prevalence, is essential to guide effective therapy. Emphasis on hygienic delivery practices and cord care can reduce neonatal sepsis incidence.
Conclusion
This study highlights distinct bacteriological profiles and antibiotic resistance patterns in early versus late-onset neonatal sepsis in Nepal, underscoring the need for tailored antimicrobial strategies and preventive measures to reduce neonatal morbidity and mortality.
References
American Society for Microbiology (ASM) Protocols
Clinical and Laboratory Standards Institute (CLSI) M100: 2019
