Article

Multidrug resistant Klebsiella pneumoniae in NICU - What next? Trend of antibiotic resistance

Authors:
  • Aditya Newborn care unit, Sangli
  • Independent Researcher
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Abstract

Multidrug resistant (MDR) Klebsiella pneumoniae an increasing cause of neonatal sepsis in India. This observational study was designed to monitor temporal change in prevalence of K. pneumoniae as a causative organism for neonatal sepsis and its sensitivity pattern. The time period was divided into four time frames of six months each [designated A (1/10/2006-31/03/2007) to D (1/04/2008-30/09/2008)]. K. pneumoniae isolation in all cultures sent from neonatal intensive care units doubled in time frame D (6.3%) compared to time frame A (3.0). Similarly, the percentage of total positive cultures in the neonatal intensive care unit that were K. pneumoniae also doubled (27.8% in A to 55.6% in D). K. pneumoniae sepsis tripled in inborn neonates (15.4% in A to 47.1% in D). Incidence of MDR K. pneumoniae increased from 0% in time frame A to 76.5% in time frame D. Resistance against ampicillin and third generation cephalosporins (cefotaxime and ceftazidime) remained 100% in all time frames. Carbapenem (meropenem and imipenem) resistance increased from 0% in time frame A and B to 41.2% in time frame D. Death due to K. pneumoniae sepsis showed brisk resurgence in time frame D (17.6%) compared to time frame C (10%). Lower gestational age and birth weight were associated with higher mortality. MDR K. pneumoniae is emerging as a more frequent cause of neonatal sepsis. There is an dincreasing threat of combined quinolone and carbapenem resistant MDR K. pneumoniae.

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... Compounding the difficulty and complexity of treating neonatal sepsis is antimicrobial resistance (AMR); as antibiotic use has increased and broader spectrum antibiotics are used more frequently, AMR has risen (4). Previously published longitudinal data from our neonatal intensive care unit (NICU) in western India from 2006 to 2008 already showed a worrying increase in multidrug-resistant (MDR) infection over the 2-year study period as well as persistently high rates of cephalosporin and carbapenem resistance (5). A more recent systematic review from 2019 on AMR in neonatal sepsis in South Asia (including 69 studies from India) shows that these challenges are ongoing and more widespread (6). ...
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... This alarming picture differs from the recent reports from Asia, 1 3 although a similar profi le was reported from western India. 17 The data are in stark contrast to the recent recommendations for the empirical treatment of neonatal sepsis in UK, 18 where amoxicillin, gentamicin and cefotaxime have been found adequate. ...
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