Surveillance of antimicrobial resistance in neonatal intensive care unit of Alexandria University Children’s Hospital

Abstract

Antimicrobial drugs are fundamental to modern medicine. The rise and spread of drug-resistant microorganisms jeopardize our ability to manage common infections and perform critical medical interventions. The present work aimed to assess and analyze antimicrobial resistance and sensitivity in the neonatal intensive care unit of Alexandria University Children's Hospital to improve antibiotic choices in the neonatal intensive care unit. A medical record-based study of 1105 neonates with sepsis admitted to the NICU during the four-year study period (2019 to 2022) was conducted, with no exclusion criteria. The data were uploaded to the WHONET system after being collected. The results can be recorded as interpreted values: "R" (Resistant), "I" (Intermediate), and "S" (Sensitive). Interpretation guidelines for most standardized testing methodologies were built into the system. In addition, the program also permits retrieval and correction of clinical records. Among the 1105 neonates included in our study, Male patients accounted for 56.4%, with a mean gestational age of 32.67 ± 2.86 weeks. Early-onset neonatal sepsis (EOS) was detected in 329(29.7%), while late-onset neonatal sepsis (LOS) was detected in 776(70.2%) neonates. Klebsiella was the predominant pathogen, accounting for 554 (50.1%). This organism was responsible for 136(24.5%) neonates in 2019, 148(26.7%) neonates in 2020, 137(24.7%) neonates in 2021 and 133(24.0%) neonates in 2022. Candida species was the second most common pathogen in our NICU; 126 (11.4%) cases were distributed as follows: 31 (24.6%), 32 (25.4%), and 40 (31.7%). 23 (18.2%) cases occurred in 2019, 2020, 2021, and 2022, respectively. Across the 4 years of the study, 2020 had the highest sepsis frequency. Drug resistance was high in most of the isolates. It was maximum (94-80%) for Cefotaxime, Piperacillin, Amoxicillin/Clavulanic acid, and ceftriaxone. It varied between 60 and 80% for Piperacillin/Tazobactam, Imipenem, Ceftazidime, Cefoperazone/Sulbactam, Meropenem, Ampicillin/Sulbactam, and Ciprofloxacin. The current study found that neonatal sepsis had a nosocomial infection profile shared by both early-onset and late-onset sepsis. K. pneumoniae was the predominant pathogen in both EOS and LOS in our study, similar to other developing countries, and is totally different from developed countries.