Clinical and Bacteriological Profile of Neonates on Ventilatory Support Suffering from Neonatal Sepsis in the Nicu of a Tertiary Care Teaching Hospital of Rural North India: a Cross Sectional Observational Study

Abstract

Background: Neonatal sepsis remains a leading contributor to morbidity and mortality in neonatal intensive care units (NICUs), and the emergence of multidrug resistant pathogens complicates timely empirical therapy. Data that integrate clinical risk factors with contemporary microbiological trends are essential for constructing evidence based antibiotic policies, particularly for ventilated neonates who constitute a high risk cohort.

Methods: We conducted a cross sectional observational study (30 April 2023 – 30 October 2024) among 50 consecutive neonates on invasive mechanical ventilation with a positive sepsis screen admitted to the NICU of a rural tertiary care teaching hospital in North India. Specimens (blood, urine, cerebrospinal fluid, endotracheal tube tip, tracheobronchial aspirate, umbilical venous catheter tip) were cultured using standard techniques; isolates were identified and their antimicrobial susceptibilities determined by the turbidimetric method in accordance with CLSI guidelines. Demographic, perinatal and clinical variables were recorded prospectively. Associations between culture positivity and predefined risk factors were analysed using χ² or Student’s t test, as appropriate; p < 0.05 was considered significant.

Results: The cohort comprised 28 males (56 %) and 22 females; mean (±SD) birth weight was 2.31 ± 0.75 kg, with 58 % weighing < 2.5 kg and 56 % born pre term. Early onset sepsis (≤72 h of life) predominated (58 %). Twenty one neonates (42 %) required ventilation within 72 h of admission. Overall culture positivity was 38 % (19/50). Klebsiella pneumoniae and Acinetobacter baumannii (each 19 %) were the most frequent pathogens, followed by Pseudomonas aeruginosa (10 %). Blood was the commonest source (77 %), followed by endotracheal tube tips (18 %). Tigecycline (20 % of isolates), colistin (16 %) and meropenem/vancomycin (12 %) displayed the highest in vitro activity. Male sex, prematurity, low birth weight and maternal complications (prolonged rupture of membranes, gestational diabetes, hypertensive disorders) were independently associated with culture proven sepsis (p < 0.05 for all).

Conclusions: Ventilated neonates in our rural NICU face a substantial burden of multidrug resistant Gram negative sepsis. Unit specific surveillance data underscore the need to incorporate tigecycline or colistin into second line empirical regimens while strengthening infection control practices targeting pre term, low birth weight male infants and mothers with obstetric complications.