Neonatal Intensive Care Unit Apocalypse—Rise of the World Health Organization Priority Pathogens
Apurva Kawdiya, Swati Bhalse, Gaurav Mogra, Kewal K Arora
Keywords :
Antibiotic resistance, Neonatal sepsis, World Health Organization priority pathogens
Citation Information :
Kawdiya A, Bhalse S, Mogra G, Arora KK. Neonatal Intensive Care Unit Apocalypse—Rise of the World Health Organization Priority Pathogens. Pediatr Inf Dis 2024; 6 (1):10-13.
Background: With higher neonatal survival, increasing neonatal intensive care unit (NICU) admissions, and rampant use of antibiotics, highly resistant organisms have become a major hurdle in the path of intact survival of neonates. In 2017, a list of World Health Organization (WHO) global priority pathogens (GPP) was released. Identifying the burden of these organisms in NICU will pave the way for devising further antibiotic strategies in their management.
Aims and objectives: Primary objective was to study the burden of WHO GPPs and their antibiotic sensitivity pattern. Secondary objective was to assess their virulence by studying their outcome.
Materials and methods: Retrospective data of positive blood cultures was collected for a period of 1.5 years (April 2022 to September 2023) from neonates admitted to the level three NICU of a medical college. Antibiotic sensitivity patterns and final outcome were noted.
Results: A total of 105 positive blood cultures were analyzed. Of these, 64% (n = 68) amounted to WHO GPPs. These pathogens were more commonly associated with late-onset sepsis 63% (n = 43) and hence more likely to be nosocomial. Most of these (89%) were gram-negative. Of these, Klebsiella pneumoniae (carbapenem/third-generation cephalosporin-resistant) was the most commonly isolated organism found in 28% (n = 30). Colistin, tigecycline, and cotrimoxazole were some of the antibiotics to which these strains were sensitive variably. Acinetobacter baumannii (carbapenem-resistant) was found to be the most virulent, with a fatality rate of 62%. Among gram-positive organisms, Enterococcus faecium was found in five cases, and all were sensitive to linezolid and tigecycline.
Conclusion: Burden of drug-resistant organisms in NICU is increasing at an alarming rate. They are not only difficult to treat but are also associated with poor outcomes. This study highlights the alarming increase of resistant organisms in the NICU.
GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1151–1210. DOI: 10.1016/S0140-6736(17)32152-9
Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015;385(9966):430–440. DOI: 10.1016/S0140-6736(14)61698-6
Sundaram V, Kumar P, Dutta S, et al. Blood culture confirmed bacterial sepsis in neonates in a North Indian tertiary care center: changes over the last decade. Jpn J Infect Dis 2009;62(1):46–50.
WHO. Media Centre. News Release. WHO publishes list of bacteria for which new antibiotics are urgently needed. 2017 [cited 2017 March].
National Neonatal Perinatal Database. [Internet]. NNPD report 2002-03. 2005.
Viswanathan R, Singh AK, Ghosh C, et al. Profile of neonatal septicaemia at a district-level sick newborn care unit. J Health Popul Nutr 2012;30(1):41–48. DOI: 10.3329/jhpn.v30i1.11274
Agnihotri N, Kaistha N, Gupta V. Antimicrobial susceptibility of isolates from neonatal septicemia. Jpn J Infect Dis 2004;57(6):273–275.
Chaurasia S, Sivanandan S, Agarwal R, et al. Neonatal sepsis in South Asia: huge burden and spiralling antimicrobial resistance. BMJ 2019;364:k5314. DOI: 10.1136/bmj.k5314
Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study. Lancet Global Health 2016;4(10):e752–e760. DOI: 10.1016/S2214-109X(16)30148
Pavan Kumar, Mohan J, Rakesh PS, et al. Bacteriological profile of neonatal sepsis in a secondary care hospital in rural Tamil Nadu, Southern India. J Family Med Prim Care 2017;6(4):735–738. DOI: 10.4103/jfmpc.jfmpc_66_17
Zaidi AK, Huskins WC, Thaver D, et al. Hospital-acquired neonatal infections in developing countries. Lancet 2005;365(9465):1175–1188. DOI: 10.1016/S0140-6736(05)71881-X
Ramasethu J, Kawakita T. Antibiotic stewardship in perinatal and neonatal care. Semin Fetal Neonatal Med 2017;22(5):278–283. DOI: 10.1016/j.siny.2017.07.001
Saha SK, Schrag SJ, El Arifeen S, et al. Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study. Lancet 2018;392(10142):145–159. DOI: 10.1016/S0140-6736(18)31127-9