Nosocomial out break of neonatal septicemia sensitive only to quinolones in a tertiary care nursery

Background: Nosocomial infections are an important cause of morbidity and mortality in neonatal intensive care units (NICUs). A Nosocomial outbreak of neonatal septicemia occurred in theNICUs of a tertiary care hospital in Kashmir during Nov-Dec 2008. Aims and objectives: The present study was undertaken to study various aspects of this nosocomial infection outbreak. Materiel and Methods: This was a retrospective observational study carried out in NICU of a tertiary care referral pediatric hospital in Srinagar Ja nd K, India.Total of 31 patients who developed nosocomial sepsis during the study period of 2 months were taken as subjects. The neonates whose diagnosis at admission was probable sepsis or who were obviously septic were excluded from the study. Cultures from all the newborns were obtained by sterile vein puncture technique and incubated for 24-48 hours for identification of the organism and determination of sensitivity pattern by disc diffusion method. Antibiotics tested included cephalosporins, aminoglycosides, aminopenicillins, vancomycin, sulbactam and quinolones. Routine investigations like Haemogram, urine culture, CSF exam and culture, X-ray chest, CRP and liver and renal function tests were done when indicated. Results: 31 neonates developed sepsis during the hospital stay. Klebsiella was the predominant organism isolated in 25 cases (81%).Acinetobacter was isolated from 2 cases (6.5%) E-coli from 2 cases (6.5%) and Pseudomonas and Staph.aureus in one case each. All the cases that grew Klebsiella from blood had thrombocytopenia (platelet count<50,000) with the predominant presentation being purpura and upper GI bleed. Cholestasis was frequently seen associated with Klebsiella sepsis. All the isolates were uniformly resistant to aminopenicillins. Aminogylcoside resistance was also very high i.e. 90%. Cephalosporin’s showed an intermediate resistance pattern with some showing 80-90 %( cefotaxime-ceftriaxone) and some showing only 30-40% resistance (cefperazone-salbactam and ceftazidime). The outbreak was caused by Klebsiella which was multi drug resistant with sensitivity only to quinolones. The number of neonates infected was thirty one and the mortality was 55%. Majorty of the neonates had thrombocytopenia and cholestasis. The outbreak was traced to a common source of an intravenous solution used for diluting drugs. Our study helped to change nosocomial infection control policy in this hospital. Conclusion: The outbreak was caused by Klebsiella which was multi drug resistant with sensitivity only to quinolones. The number of neonates infected was thirty one and the mortality was 55%. Majorty of the neonates had thrombocytopenia and cholestasis. Our study helped to change nosocomial infection control policy in this hospital.