Neonatal sepsis in rural India: timing, microbiology and antibiotic resistance in a population-based prospective study in the community setting

P Panigrahi; D S Chandel; N I Hansen; N Sharma; S Kandefer; S Parida; R Satpathy; L Pradhan; A Mohapatra; S S Mohapatra; P R Misra; N Banaji; J A Johnson; J G Morris Jr; I H Gewolb; R Chaudhry

doi:10.1038/jp.2017.67

Neonatal sepsis in rural India: timing, microbiology and antibiotic resistance in a population-based prospective study in the community setting

J Perinatol. 2017 Aug;37(8):911-921. doi: 10.1038/jp.2017.67. Epub 2017 May 11.

Authors

P Panigrahi¹, D S Chandel², N I Hansen³, N Sharma⁴, S Kandefer⁵, S Parida⁶, R Satpathy⁷, L Pradhan⁸, A Mohapatra⁹, S S Mohapatra⁷, P R Misra¹⁰, N Banaji¹¹, J A Johnson¹², J G Morris Jr¹³, I H Gewolb¹⁴, R Chaudhry⁴

Affiliations

¹ Department of Epidemiology and Pediatrics, Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
² Department of Environmental, Agricultural, &Occupational Health, Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
³ Division of Biostatistics &Epidemiology, RTI International, Research Triangle Park, NC, USA.
⁴ Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
⁵ Division of Social Policy, Health, &Economics Research, RTI International, Research Triangle Park, NC, USA.
⁶ Department of Pediatrics, SCB Medical College, Cuttack, Odisha, India.
⁷ Social Pediatrics and Minority Health, Asian Institute of Public Health, Bhubaneswar, Odisha, India.
⁸ Neonatal Unit, Department of Pediatrics, Capital Hospital, Bhubaneswar, Odisha, India.
⁹ Center for Translational Research, Asian Institute of Public Health, Bhubaneswar, Odisha, India.
¹⁰ Disease Surveillance Laboratories, Asian Institute of Public Health, Bhubaneswar, Odisha, India.
¹¹ Department of Microbiology, Indira Gandhi Medical College &Research Institute, Puducherry, India.
¹² Department of Pathology, Immunology and Laboratory Medicine, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA.
¹³ Department of Medicine, College of Medicine, Emerging Pathogens Institute, University of Florida, Gainesville FL, USA.
¹⁴ Department of Pediatrics, Division of Neonatology, Sparrow Hospital - Neonatology, Lansing, MI, USA.

Abstract

Objective: To examine the timing and microbiology of neonatal sepsis in a population-based surveillance in the Indian community setting.

Study design: All live born infants in 223 villages of Odisha state were followed at home for 60 days. Suspect sepsis cases were referred to study hospitals for further evaluation including blood culture.

Results: Of 12 622 births, 842 were admitted with suspected sepsis of whom 95% were 4 to 60 days old. Culture-confirmed incidence of sepsis was 6.7/1000 births with 51% Gram negatives (Klebsiella predominating) and 26% Gram positives (mostly Staphylococcus aureus). A very high level of resistance to penicillin and ampicillin, moderate resistance to cephalosporins and extremely low resistance to Gentamicin and Amikacin was observed.

Conclusion: The bacterial burden of sepsis in the Indian community is not high. Judicious choice of empiric antibiotics, antibiotic stewardship and alternate modalities should be considered for the management or prevention of neonatal sepsis in India.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Anti-Bacterial Agents* / classification
Anti-Bacterial Agents* / therapeutic use
Disease Management
Drug Resistance, Microbial
Female
Humans
Incidence
India / epidemiology
Infant, Newborn
Klebsiella* / drug effects
Klebsiella* / isolation & purification
Male
Neonatal Sepsis* / epidemiology
Neonatal Sepsis* / microbiology
Neonatal Sepsis* / prevention & control
Staphylococcus aureus* / drug effects
Staphylococcus aureus* / isolation & purification

Substances

Anti-Bacterial Agents

Grants and funding

U01 HD040574/HD/NICHD NIH HHS/United States