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

<b>Setting: </b> Nobel Medical College and Teaching Hospital, Biratnagar, Nepal<b></b> <b>Objective: </b> To determine the pattern of antimicrobial resistance and hospital exit outcomes in neonates with suspected sepsis in a tertiary Neonatal Intensive Care Unit (NICU). <b>Design:</b> This hospital-based, cohort study was followed patients from January to December 2019. <b>Results: </b> Sepsis was suspected in 177 (88%) of the 200 cases admitted in NICU; 52 (29%) were culture positive. <i>Pseudomonas</i> was the predominant organism isolated (40; 78%) followed by coagulase negative <i>staphylococcus</i> (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. <b>Conclusion:</b> 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.

【研究地点】：尼泊尔比拉特纳加尔诺贝尔医学院及教学医院
【研究目的】：明确三级新生儿重症监护病房（Neonatal Intensive Care Unit, NICU）内疑似脓毒症新生儿的抗菌药物耐药模式及出院结局。
【研究设计】：本项基于医院的队列研究纳入了2019年1月至12月的研究对象。
【研究结果】：200例入住NICU的患儿中，177例（88%）疑似为脓毒症；其中52例（29%）病原学培养呈阳性。分离得到的病原菌以假单胞菌属（Pseudomonas）为主（40株，78%），其次为凝固酶阴性葡萄球菌（coagulase negative staphylococcus，12株，23%）。52株分离菌中有9株（17%）对世界卫生组织抗菌药物分类中的可及类（Access）与监视类（Watch）抗菌药物耐药，且部分菌株对储备类（Reserve）抗菌药物如亚胺培南（imipenem）、利奈唑胺（linezolid）亦存在耐药性。多数接受治疗的患儿（170例，96%）病情好转，另有7例（4%）拒绝医嘱自行出院。
【研究结论】：多数病原菌对世界卫生组织可及类及监视类抗菌药物存在耐药性，且偶见储备类抗菌药物耐药株。新生儿脓毒症多由革兰阴性杆菌引起。亟需采用床旁检测技术缩短抗菌药物敏感性试验的周转时间，并提升病原学培养的阳性检出率，以优化新生儿脓毒症的临床诊疗管理。