A Study of Microbiological Pattern of Neonatal Sepsis

The aim of this cohort (prospective) analytic study was to determine the microbiological pattern of bacterial infection in the Neonatal Intensive Care Unit of Kasr El Eini Hospital, to investigate microbial colonization of neonates at birth before any interference and to examine whether surface cultures yielded information helpful in management. The study population comprised 70 high risk neonates whether full terms or preterm infants admitted to Kasr El Eini neonatal intensive care unit for a 6 months period from 1/3/2002 to 30/9/2002. Babies with congenital anomalies were excluded from the study. The included neonates were subjected to laboratory studies as CBC, CRP, IT ratio, superficial cultures in the form of ear and throat swabs and deep culture in the form of blood culture. We defined neonatal sepsis by positive blood culture. The results showed that 70 out of 101 neonates included in the study developed sepsis (69.3 %). The incidence of early onset sepsis (49.5 %) was higher than late onset sepsis (19.8%). The highest incidence of sepsis was in the gestational age group 30 -<32 weeks and the weight group 1500 <2500 grams. Clinical signs and laboratory investigation revealed no significance in relation to sepsis. The most prevalent organism recovered from blood culture was Klebsiella (40%), followed by coagulase negative Staph aureus, CONS (20%), Staph aureus (15.7%) and Enterobacter (15.7%). Colonization detected by ear swabs was 68.5% in septic neonates and 64.5% in non septic neonates. The predominant organisms recovered from ear swabs in the septic group were CONS (38.6%) followed by Staph aureus (18.6%) then Klebsiella (5.7%). Colonization detected by throat swabs was 55.7% in septic neonates and 42% in the non septic neonates. The most common organism recovered from throat swab in the septic group were Klebsiella (15.7%) and E.coli (14.3%) followed by CONS and Staph aureus (10%) each. Superficial swabs were of limited value in diagnosis of neonatal sepsis. Results of throat swabs were more significant than ear swabs with higher matching with blood culture (21.4% in contrast to 8.5% for ear swabs). Mortality among septic neonates was 44.2% and among non septic neonates was 25.8 %. Conclusion: Incidence of sepsis was still high in our unit (69.3%). Early onset sepsis was much higher than late onset sepsis. Klebsiella was the predominant organism causing sepsis followed by CONS and Staph aureus. Superficial swabs were of limited value in diagnosis of neonatal sepsis. Throat swabs showed more matching with blood culture than ear swabs. Blood culture is still the gold standard for the diagnosis of neonatal sepsis.