In this cohort study, teams prospectively followed up neonates born in one of three tertiary care centres in Delhi, India (Vardhaman Mahavir Medical College, Maulana Azad Medical College, and All India Institute of Medical Sciences [coordinating centre]) and subsequently admitted to the intensive care unit. Neonates were followed up daily until discharge or death. On clinical suspicion, neonates underwent sepsis work-up including blood cultures. The isolated organisms were identiﬁ ed and tested for antimicrobial susceptibility. The authors deﬁned Gram-negative isolates resistant to any three of ﬁ ve antibiotic classes (extended-spectrum cephalosporins, carbapenems, aminoglycosides, ﬂuoroquinolones, and piperacillin-tazobactam) as multidrug resistant.
Findings 13 530 neonates of 88 636 livebirths were enrolled between July 18, 2011, and Feb 28, 2014. The incidence of total sepsis was 14•3% (95% CI 13•8–14•9) and of culture-positive sepsis was 6•2% (5•8–6•6). Nearly two-thirds of total episodes occurred at or before 72 h of life (deﬁned as early onset; 1351 [83%] of 1980). Two-thirds (645 [64%]) of 1005 isolates were Gram-negative including, Acinetobacter spp (22%), Klebsiella spp (17%), and Escherichia coli (14%). The pathogen mix in early-onset sepsis did not diﬀer from that of late-onset sepsis (ie, after 72 h). High rates of multidrug resistance were observed in Acinetobacter spp (181/222, 82%), Klebsiella spp (91/169, 54%), and Escherichia coli (52/137, 38%) isolates. Methicillin resistance prevailed in 61% (85/140) of coagulase-negative staphylococci and 38% (43/114) of Staphylococcus aureus isolates. Nearly a quarter of the deaths were attributable to sepsis. The population attributable risks of mortality were 8•6% in culture-negative sepsis, 15•7% in culture-positive sepsis by multidrug resistant organisms, and 12•0% in culture-positive sepsis by non-multidrug-resistant organisms.
Alarming numbers: >75% were ESBL producers, carbapenem resistance was reported in Acinetobacter spp (0–30%) and E coli (0–15%). NDM-1 has been documented in nearly a quarter of Acinetobacter spp and three-quarters of Klebsiella spp among the pool of carbapenem-resistant strains.