Bacterial Pattern and Antibiotic Susceptibility in the Perinatology

Unit of Haji Adam Malik General Hospital Medan, Indonesia

Nisa Nurjannah

, Beby Syofiani Hasibuan

Faculty of Medicine, Universitas Sumatera Utara, Dr. Mansyur st. 5, Medan, Indonesia

Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

*Corresponding author

Keywords: bacterial pattern, antibiotic susceptibility, neonatal sepsis

Abstract: Neonatal sepsis affects the high mortality and morbidity rates of the newborns. The causative bacteria are

different between countries or hospitals, it affects the choice of antibiotics usage. Irrational antibiotic

administration can cause resistance problem and aggravate patients’ conditions. Culture and sensitivity test

can be done to determine the species of bacteria and their antibiotic susceptibilities, allowing appropriate

and rational antibiotic administration. This is a retrospective observational descriptive study, describing the

bacterial pattern and antibiotic susceptibility of patients admitted to the perinatology ward at Haji Adam

Malik General Hospital in 2016. Neonates suspected with sepsis underwent blood culture and sensitivity

test. Secondary data from the medical record was obtained using total sampling method. Of 97 subjects, and

neonatal sepsis patients were found predominantly in males (68%). Aterm neonates who had sepsis (75.3%)

with late-onset sepsis were more dominant (87.6%). Mean age of neonatal sepsis patients was 14.9 days.

Acinetobacter baumannii was the most common etiology (19.6%), the most sensitive antibiotics were

amikacin (57.7%) and levofloxacin (57.7%). In addition, antibiotic with the highest resistance is cefotaxime

(74.2%).

1 INTRODUCTION

The first 28 days of life are the most vulnerable

periods in human’s life. One of the main causes of

neonatal death is sepsis and with lack of proper

treatment, the mortality rates will increase.

Therefore, sepsis is still a problem in the field of

neonatology to date (Rasyidah, 2014; Wardlaw et

al., 2014; World Health Organization, 2016)

Bacteria that cause sepsis are different for each

country and each hospital so that will affect the

selection of antibiotics. The Centers for Disease

Control and Prevention (CDC) estimates that as

many as 50% of antibiotics prescriptions are not

optimal or not necessary (Rasyidah 2014; Schulman

et al. 2015).

Antibiotics are drugs commonly used in the

Neonatal Intensive Care Unit (NICU). Irrational use

of antibiotics at the NICU will increase the adverse

events, such as increased morbidity, mortality, costs,

hospital length of stay and is also associated with

antibiotic resistance problem.

In order to use antibiotics rationally, the most

likely etiology and the susceptibility patterns should

first be identified (Irene et al. 2013; Katarnida et al.

2013; Schulman et al. 2015). This study objective is

to describe the bacterial pattern of neonatal sepsis

and antibiotics susceptibility in Perinatology of Unit

Haji Adam Malik General Hospital, Medan,

Indonesia in 2016.

2 METHOD

This study was a retrospective observational

descriptive study based on medical records in Haji

Adam Malik General Hospital, Medan, Indonesia in

2016. All perinatology unit patients in Haji Adam

Malik General Hospital suspected with sepsis who

underwent blood culture and sensitivity test during

2016 was included in this study, using total sampling

technique. If data from medical records were not

complete or could not be read, the samples were

excluded. Data were then analyzed with statistical

software. This study was approved by the Research

Nurjannah, N. and Hasibuan, B.

Bacterial Pattern and Antibiotic Susceptibility in the Perinatology Unit of Haji Adam Malik General Hospital Medan, Indonesia.

DOI: 10.5220/0009861601150118

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 115-118

ISBN: 978-989-758-469-5

115

Ethics Committee, Faculty of Medicine, Universitas

Sumatera Utara, Medan, Indonesia.

3 RESULTS

Table 1 shows the baseline characteristics of

patients. Male patients were more common in this

study (68%), 75.3% were term neonates, and late-

onset sepsis was more commonly found (87.6%).

The subject’s mean of age was 14.8 days.

Table 1: Characteristics of neonates with positive blood

culture in Haji Adam Malik General Hospital during 2016.

Characteristics n=97

Gender, n (%)

Boys 66 (68)

Girls 31 (32)

Gestational week, n (%)

Preterm 24 (24.7)

Atom 73 (75.3)

The onset of sepsis, n (%)

Early 12 (12.4)

Late 85 (87.6)

Mean of age, days (SD) 14.88 (8.14)

Table 2 shows the cause of neonatal sepsis in

this study. Gram-negative bacteria were the most

common etiology found in neonatal sepsis, with

Acinetobacter baumanii as the leading organism

(19.6%), followed by Klebsiella pneumonia

(16.5%). The most common gram-positive bacteria

found in neonatal sepsis was Staphylococcus

haemolyticus (6.2%) followed by Bacillus spp

(4.1%).

Table 2: Bacteria and the etiology of neonatal sepsis in

Haji Adam Malik General Hospital.

Bacteria Percentage (%)

Gram-

negative

Acinetobacter

baumannii

19.6

Klebsiella pneumonia 16.5

Enterobacter cloacae 8.2

Burkholderiacepacia 4.1

Pantoeaspp 4.1

Gram-

positive

Staphylococcus

haemolyticus

6.2

Bacillus spp 4.1

Staphylococcus

epidermidis

3.1

Clostridium spp 2.1

Enterococcus faecium 2.1

Table 3 shows that amikacin (57.7%) and

levofloxacin (57.7%) as the most sensitive

antibiotics obtained from the susceptibility test on

bacteria that cause neonatal sepsis on the

perinatology unit. Those were followed by

meropenem and ciprofloxacin, and

cefoperazone/sulbactam with sensitivity rates of

45.4%, 41.2%, and 35.1%, respectively.

Table 3: Antibiotic susceptibility in neonatal sepsis in Haji

Adam Malik General Hospital.

Antibiotics n (%)

Amikacin 56 (57.7)

Levofloxacin 56 (57.7)

Meropenem 44 (45.4)

Ciprofloxacin 40 (41.2)

Cefoperazone/Sulbactam 34 (35.1)

Doxycycline 33 (34.0)

Imipenem 31 (32.0)

Gentamicin 27 (27.8)

Tetracycline 21 (21.6)

Fosfomycin 21 (21.6)

Table 4 showed that cefotaxime, as one of the

cephalosporin group antibiotics, had the highest

resistance rate in this study (74.2%), followed by

ampicillin and ceftriaxone with resistance rates of

73.2% and 72.2% respectively.

Table 4: Antibiotic resistance in neonatal sepsis in Haji

Adam Malik General Hospital.

Antibiotics n (%)

Cefotaxime 72 (74,2)

Ampicillin 71 (73,2)

Ceftriaxone 70 (72,2)

Ceftazidime 66 (68,0)

Gentamicin 55 (56,7)

Ampicillin/Sulbactam 53 (54,6)

Tetracycline 47 (48,5)

Amoxicillin / Clavulanic acid 44 (45,4)

Netilmicin 41 (42,3)

Meropenem 37 (38,1)

In this study, we found that Klebsiella

pneumonia and Enterobacter cloacae were still

sensitive to amikacin (100%). On the other hand,

Bacillus spp. had a high sensitivity rate to

Ciprofloxacin (100%). Enterobacter cloacae had the

highest resistance to antibiotics such as cefotaxime,

ampicillin, and ceftriaxone, with resistance rate to

each antibiotic at 100%, respectively.

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4 DISCUSSION

Neonatal sepsis in this study was found to be more

common in males. This is similar to other studies

which stated that males were more common to have

neonatal sepsis than females. There are several

factors that might be associated with it. First is

Glucose-6-Phosphate Dehydrogenase (G6PD)

deficiency. It is a genetic defect that affects males

more than females and this defect increases the risk

of infection. Other studies showed that factors

associated with gamma globulin synthesis were

located on the X chromosome so that immunological

protection on females was better than males (Far Z

et al. 2016; Verma et al. 2017).

Neonatal sepsis in this study was more

predominant in term neonates. It was similar to the

study by Afridi, in 2015 where a term neonates were

more commonly found to have neonatal sepsis than

preterm neonates. It might be due to the more

vulnerable preterm babies to have neonatal sepsis

with higher mortality rates which caused them a

delay to reach the health facilities. This situation

caused more a term neonates to be more often to be

diagnosed with neonatal sepsis.

Late-onset sepsis was associated with

horizontal transmissions, such as very low birth

weight in preterm neonates. It was due to the

immaturity of the immune system, prolonged

mechanical ventilation, prolonged length of hospital

stay, vascular catheterization, and other invasive

procedures. Those factors made opportunist

pathogens, like Acinetobacter baumannii, could

infect neonates easier (Shah and Padbury 2014; Wei

et al. 2015).

The most common bacteria isolated from

neonatal sepsis in this study was Acinetobacter

baumannii, an opportunist bacteria that become

pathogen in immunocompromised subjects and

worsen in neonatal infection (Wei et al. 2015). Study

in Iran comparing bacterial patterns in two decades

found that in 1992 the most common bacteria were

Staphylococcus aureus (59%) while in 2015 the

most common was coagulase-negative

Staphylococci (CoNS) (33.9%). It showed that

bacterial pattern changed over time and was

different in every center (Radfar et al. 2017).

Most bacteria isolated from this study were still

sensitive to amikacin and had a high resistance to

cefotaxime. The previous study in Haji Adam Malik

General Hospital Medan showed that vancomycin

had high sensitivity rate while ampicillin,

gentamicin, and cefotaxime had high resistance

rates. It explained that there were no significant

antibiotics susceptibilities changes in neonatal sepsis

during these recent years in Haji Adam Malik

General Hospital Medan (Sianturi et al. 2012).

5 CONCLUSION

The most frequent etiology of neonatal sepsis was

Acinetobacter baumannii. Amikacin and

levofloxacin were the most sensitive antibiotics

while cefotaxime was the least.

ACKNOWLEDGMENTS

The researchers especially thank, to the counselor,

Haji Adam Malik General Hospital for giving

permission to the researchers.

REFERENCES

Far Z, Rostami et al. 2016. Glucose 6 Phosphate

Dehydrogenase as A Risk Factor of Male Neonatal

Sepsis. Journal of Medicine and Life 9(1): 34–38.

Irene, Yuniar, Mulya Rahma Karyanti, Taralan Tambunan,

and Nanda Asyura Rizkyani. 2013. Evaluasi

Penggunaan Antibiotik Dengan Kartu Monitoring

Antibiotik Gyssens. Sari Pediatri 14(6): 384–90.

Katarnida, Sri Sulastri, Mulya Rahma Karyanti, Dewi

Murniati Oman, and Yusticia Katar. 2013. Pola

Sensitifitas Bakteri Dan Penggunaan Antibiotik.Sari

Pediatri 15(2): 122–26.

Radfar, Mitra, Minoo Fallahi, Mohammad Kazemian, and

Samira Borhani. 2017. A Comparative Evaluation of

Microbial Pattern and Antibiotic Susceptibility in a

Level III NICU between Two Decades. Pediartric

Infections Research Center 5(2): 2–7.

Rasyidah. 2014. Pola Kuman Dan Uji Kepekaan

Antibiotik Pada Sepsis Neonatorum Di Unit

Perawatan Neonatus. Sari Pediatri 3(1): 431–36.

Schulman, J. et al. 2015. Neonatal Intensive Care Unit

Antibiotic Use. PEDIATRICS 135(5): 826–33.

http://pediatrics.aappublications.org/cgi/doi/10.1542/p

eds.2014-3409.

Shah, Birju A, and James F Padbury. 2014. Neonatal

Sepsis, An Old Problem with New Insights. Virulence

5(1): 170–1778.

Verma, Pradeep et al. 2017. Neonatal Sepsis:

Epidemiology, Clinical Spectrum, Recent

Antimicrobial Agents and Their Antibiotic

Susceptibility Pattern.” International Journal of

Contemporary Pediatrics 2(3): 176–80.

http://www.ijpediatrics.com/index.php/ijcp/article/vie

w/465/429.

Wardlaw, Tessa et al. 2014. UNICEF Report: Enormous

Bacterial Pattern and Antibiotic Susceptibility in the Perinatology Unit of Haji Adam Malik General Hospital Medan, Indonesia

117

Progress in Child Survival but Greater Focus on

Newborns Urgently Needed. Reproductive Health: 1–

4.https://reproductive-health-

journal.biomedcentral.com/articles/10.1186/1742-

4755-11-82.

Wei, Hsui-Mei et al. 2015. Multidrugs-Resistant

Acinetobacter Baumannii Infection Among Neonates

in A Neonatal Intensive Care Unit At A Medical

Center in Central Taiwan. Journal of Microbiology,

Immunology and Infection 48(1): 531–39.

World Health Organization. 2016. Newborns: Reducing

Mortality.http://www.who.int/mediacentre/factsheets/f

s333/en/.

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