P2B078: Bacteriology of Neonatal Sepsis at the University Hospital of the West Indies, 2011 Through 2020

Background: Bacterial sepsis is reported to be the most common cause of neonatal sepsis. While global studies have provided insights into changing trends and antibiotic resistance of neonatal culture-positive sepsis, there is a paucity of similar demographic and microbiological data from University Hospital of the West Indies over the last decade.

Methods: This retrospective study assessed trends in isolated organisms and resistance patterns of bacterial sepsis in the NICU/SCN of the UHWI during the 10-year period of 2011-2015 (phase 1) and 2016-2020 (phase 2). Demographic and microbiological data were studied. Data were analyzed using SPSS software, measuring central tendencies for continuous variables; chi-square testing for categorical variables; likelihood ratio and Fisher's exact tests to evaluate significance of association; and Cramer's V test to measure the strength of association. We used p< 0.05 as statistically significant.

Results: There were 337 subjects with 392 cultured organisms. The culture positivity rate was highest in 2013 at 10.3% and lowest in 2016 at 6.6%. Late-onset sepsis was noted to be more common and gram-positive organisms were seen predominantly in both phases. Coagulase-negative staphylococcus was most prominent at 42.1% (N=165); followed by Klebsiella pneumoniae at 15.1% (N=59), Serratia marcescens at 6.6% (N=26); Group B streptococcus, Escherichia coli and Pseudomonas aeruginosa at 6.4% (N=25). Klebsiella pneumoniae and Escherichia coli increased while Serratia marcescens and Pseudomonas aeruginosa decreased from phase 1 to phase 2 (p < 0.05). The incidence of gram-positive septicemia was greater in term neonates while that of gram-negative septicemia was greater in preterm infants. The healthcare-associated infection rate was 71% (N=194). Multidrug-resistant Coagulase negative staphylococcus was noted in both phases with multiple-drug-resistant Klebsiella pneumoniae emerging in phase 2. Increased ampicillin resistance was also reported in organisms cultured. Crude all-cause mortality in the study population was 22.8% (N=77), with 29 deaths occurring within the first week of life, related to sepsis.

Conclusion: With increasing multi-drug resistant infections and changes in predominant bacteria, antibiotic stewardship needs to be studied and guidelines adjusted appropriately to help curb neonatal sepsis. Ongoing research is needed.