“Too little too late; low blood culture yields in a tertiary hospital in Nepal”

Setting:

Nobel Medical College and Teaching Hospital, Biratnagar, Nepal

Objective:

To
determine the pattern of antimicrobial resistance and hospital exit outcomes in
neonates with suspected sepsis in a tertiary Neonatal Intensive Care Unit
(NICU).

Design:

This
hospital-based, cohort study was followed patients from January to December 2019.

Results:

Sepsis
was suspected in 177 (88%) of the 200 cases admitted in NICU; 52 (29%) were
culture positive. Pseudomonas was the
predominant organism isolated (40; 78%) followed by coagulase negative staphylococcus (12; 23%). Nine
(17%) of the 52 isolates were resistant to Access and Watch group of antibiotics,
including some resistance to Reserve group like; imipenem and linezolid. Most treated
cases (170; 96%) improved, although 7 (4%) left against medical advice.

Conclusion:

Most
of the pathogens were resistant to WHO Access and Watch antibiotics and
occasional resistance was observed with Reserve group. Most sepsis was caused
by Gram negative bacilli. Improving turnaround times for antibiotic sensitivity
testing using point-of-care tests, and a greater yield of culture positive
results are needed to enhance the management of neonatal sepsis.