Clinical Characteristics and Outcome of Klebsiella Pneumonae Sepsis in Neonates

Zahid  Anwar; Alia  Batool; Nuram  Hashmi; Noor  Huda; Sidra  Niamat

doi:10.29054/apmc/2022.1330

Zahid Anwar Associate Professor, Department of Paediatrics (Neonatology), Fatima Memorial Hospital and College for Medicine and Dentistry, Lahore Pakistan
Alia Batool Associate Professor, Department of Microbiology (Pathology), Fatima Memorial Hospital and College for Medicine & Dentistry, Lahore Pakistan
Nuram Hashmi Final Year Student, Fatima Memorial Hospital & College for Medicine & Dentistry, Lahore Pakistan
Noor Huda Final Year Student, Fatima Memorial Hospital and College for Medicine and Dentistry, Lahore Pakistan
Sidra Niamat Sister In-Charge, Neonatal Intensive Care Unit, Neonatal Unit, Fatima Memorial Hospital, Lahore Pakistan

DOI: https://doi.org/10.29054/apmc/2022.1330

Keywords: Neonatal sepsis, Klebsiella sepsis, Klebsiella pneumonae, Neonatal mortality, Multi-drug resistance, Carbapenem-resistant

Abstract

Background: Klebsiella Pneumonae is one of the most frequent isolates in blood cultures for neonatal sepsis. Of special concern, are the varied mortality rates and sensitivity patterns in different studies done from the same region or country.

Objective: This study was conducted to define the frequency, clinical and laboratory profiles of Klebsiella Pneumonae sepsis cases in our neonatal intensive care unit at Fatima Memorial Hospital, Lahore. Study Design: Retrospective cross-sectional study. Settings: Neonatal Intensive care unit at Fatima Memorial Hospital (FMH), Lahore Pakistan. Duration: 1^st-Jan-2019 to 31st Dec 2020. Methods: A retrospective analysis of blood culture result data was done for 2 years from Jan 2019 to Dec 2020. The clinical records of the babies with Klebsiella positive in their blood culture were accessed for the epidemiological, clinical and laboratory data, and analysed with SPSS 21. Results: A total of 28 cases, 26 with Klebsiella Pneumonae and one each with Klebsiella oxytoca and non-specific klebsiella, were included in the study. The incidence was 58.3% (28 out of total 48 positive blood cultures). The mean gestation was 34.9 ± 3.8 weeks, and the mean weight was 2.45 ± 0.96 kg. Most were male (64.3%) and delivered via C-section (60.7%). Most of the babies were referred to us (75%) and 64.3% had klebsiella Pneumonae growth at the time of admission to our unit. Most cases were Late-onset sepsis (24 out of 28). The maximum sensitivity was to colomycin (71.4%) and then to meropenem (50%). There was about 60% resistance to aminoglycosides, ciprofloxacin, imipenem, tazobactam-piperacillin and co-trimoxazole. The 3^rd generation cephalosporins had poor sensitivity of 3.5-17.8%. The mortality was 39.3% (11 out of 28), which was significantly associated with prematurity (<32 weeks), low birth weight (<1500gm), referred cases (out-born), hospital acquired infection, use of mechanical ventilation, and the use of long lines and TPN. Conclusion: Klebsiella sepsis is the commonest cause of neonatal sepsis with high mortality. It is common in preterms and low birth weight babies, referral of babies, mechanical ventilation, use of long lines and TPN. Carbapenem resistance is 50-60%, thus limiting antibiotic choices.