Neonatal Gram-Negative Bacteremia S.G. JoshP, V.S. Ghole 2 and K.B. Niphadkar 3 ~Departments of Pathology and Microbiology, D.S.H. Medical College, Pune; 2Molecular Biology Laboratory, Department of Chemistry, University of Pune; SDepartment of Microbiology, K.E.M. Hospital, Pune Abstract. A 22 months prospective study of neonatal gram-negative bacteremia was undertaken in a 15 bed NICU to find out the incidence and antibiotic resistance patterns. Clinically suspected 1326 cases of neonatal sepsis were studied during this period. More than 25% of the cases were microbiologically positive for sepsis. Among 230 (67.2%) cases of gram-negative bacteremia, the predominant isolates were Pseudomonas aeruginosa (38.3%), Klebsiella pneurnoniae (30.4%), Escherichia carl (15.6%) and Acinetobactersp. (7.8%). Fifty-nine per cent of the neonates were born in hospital while 41% were from community and referral cases. Lower respiratory tract infection, umbilical sepsis, central intravenous line infection and infection following invasive procedures were the most commonly identified sources of.septicemia. Prematurity and low birth weight were the main underlying conditions in 60% of the neonates. Total mortality was 32%. Increased mortality was mainly associated with neutropenia, nosocomial infection and inappr6priate antibiotic therapy. Resistance was increasingly noted agains't many antibiotics. The isolates were predominantly resistant to extended spectrum cephalosporins (25%-75%), piperacillin (68%-78%), and gentamicin (23%-69%). The commonest microorganisms causing gram-negative bacteremia were Pseudomonas aeruginosa followed by Klebsiella pneumoniae. The community-acquired bacteremia was mainly due to E. coil The proportion of preterm and low birth weight babies was significantly high, and the major contributing factor in total mortality. Sensitivity to different antibiotics conclusively proved that a combination of ampicillin + sulbocfam with amikocin or ampicillin + sulbactam with ciprofloxacin is most effective. (Indian J Peflalr 2000; 67 : 27-32) Key words: Antibiotic resistance; Bacteremia; Clinicalisolates,.Neonatal sepsis;Nosocomial infection. Gram-negative bacteremia is a major cause of sepsis in neonates, contributing substantially to the mortality and morbidity IJ. Septicemia due to Pseudomonas, Klebsiella, Citrobacter is commonly reported in neonates from various countries 3. Gram-positive organisms are mainly responsible for early onset of infection whereas gram-negative organisms are mainly encountered during late onset of infection in neonates 3'4. An incidence of nosocomial infections in neonates is also very high. The sources for gram-negative septicaemia are mainly urinary tract infection (UTI), gastro-intestinal tract infection (GITI), and lower respiratory tract infection (LRTI). Neonatal sepsis is commonly associated with central intravenous catheters and the extensive use of antibiotics leading to high incidences of nosocomial infection 5. Early identification of an organism and appropriate antibiotic treatment is essential to prevent the increasing mortality and morbidity. Many underlying conditions and Reprint requests : Suresh Joshi, Department of Pathology and Microbiology, D.S.H. Medical College and Hospital, Off Karve Road, Pune 411 004 (india). E-mail : molbio@chem.unipune. ernet.in diseases, however, should be considered alongwith possible sources of infection, invasive procedures including central intra-venous catheter, empiric therapy and host defence system while calculating morbidity and mortality. Personal hygiene of the staff in neonatal intensive care unit (NICU), and newborn babies and skin and umbilical stump care are very important in prevention of neonatal infection, particularly wound infection and septicemia 5,~'7. The objective of this study was to analyse the incidence of gram-negative bacteremia and assess the antibiotic resistance patterns of the isolates in NICU. MATERIALS AND METHODS A prospective study of neonatal gram-negative bacteremia was undertaken between October 1994 through August 1996, at a 15-bed NICU, in Pune. An average annual admission of neonates in this centre is 1300. During the period, 1326 suspected cases of neonatal sepsis were studied. The neonates were selected as septicemic based on the following clinical criteria : hyper-thermic or hypo-thermic, respiratory distress or spells of apnoea, bradycardia, Indian Journal of Pediatrics, 2000; 67 (1) : 27-32