Molecular Characterisation and Profile of Extended Spectrum Beta Lactamase Producing Enterobacteriaceae Isolates Causing Neonatal Sepsis at a Tertiary Care Center

Abstract

Introduction: Emergence of extended spectrum beta-lactamase producing strains of gram-negative bacteria is increasing and it affects outcome of neonatal sepsis. Present study was done to assess the prevalence, antibiogram and molecular characterisation of ESBL producing enterobacteriaceae organisms in neonatal sepsis.

Methods: A cross-sectional study was conducted at a tertiary care centre in Agra from January 2016 to June 2017. Total 700 patients satisfying inclusion and exclusion criteria were enrolled. Workup for sepsis screen, blood culture, antibiotic susceptibility, disk approximation test for detection of ESBL producing organism and polymerase chain reaction were performed.    

Results: Out of 700 patients, blood culture was positive in 238 (34%) cases. Among all the blood-culture isolates, Gram - positive, Gram - negative and candida species were (54%), (39%) and (7%) respectively. Among gram - negative isolates, Klebsiella (16%), E. coli (10%), Pseudomonas (6%), and Burkholderia (5%) were isolated. Prevalence of ESBL producing Enterobacteriaceae isolates was 42.42%. Among ESBL producers 13 were E. Coli and 15 were Klebsiella. ESBL producing bacilli were more common in males (p = 0.015) and out born patients (p = 0.042). CNS symptoms were the commonest manifestations (35.71%). All ESBL producing Klebsiella and 92.3% of E. coli were resistant to co-amoxyclav. All the ESBL producing Klebsiella and E. coli were sensitive to imipenem and colistin. CTXm gene was the commonest gene present in ESBL producing E. coli (61.54%) and Klebsiella (26.67%).

Conclusions: ESBL producing Klebsiella and E. coli were resistant to most of the commonly used antibiotics but they were sensitive to carbapenems and colistin. CTXm gene was the commonest gene, associated with ESBL producing enterobacteriaceae.