Neonatal sepsis due to multidrug-resistant Klebsiella terrigena in the neonatal intensive care unit in Gaza, Palestine

Background

Bloodstream infection (BSI) is a major cause of morbidity and death encountered in the neonatal intensive care units (NICUs). The rates of BSIs vary significantly in NICUs across the nation. Klebsiella spp. led to serious concern about septicaemic neonates in NICUs due to high resistance against commonly used antimicrobial agents. The objective of the study was to report the prevalence and resistance pattern of Klebsiella terrigena isolated from cases of neonatal septicaemia at Alshifa Hospital, the largest tertiary hospital in Palestine.

Methods

Blood taken from newborn babies admitted to the NICU at Alshifa Hospital, Gaza, Palestine with a clinical diagnosis of neonatal sepsis was cultured. A total of 355 positive blood cultures isolated from January to December 2005 were studied. Antimicrobial susceptibility was determined by disc diffusion method.

Results

A total of 355 blood cultures positive were studied; the most common organism found were Klebsiella spp. 202/355 (56.9%), and 56/202 (25.5%) were K. terrigena. K. terrigena showed a high degree of resistance to commonly used antibiotics (Ampicillin, Piperacillin, Cephalexin, Cefuroxime, Cefaclor and Gentamicin), a moderate degree of resistance to Cefotaxime, Ceftazidim, Ceftriaxone and Amikacin, and most of the isolates were sensitive to Meropenem.

Conclusion

Neonatal sepsis remains one of the leading causes of neonatal admission, morbidity, and mortality in developing countries. Klebsiella spp. were the major cause of neonatal sepsis in Gaza in 2005. The rare Klebsiella species (K. terrigena) have developed multidrug resistance, and management of patients infected with them is becoming a problem in developing countries. There is a need to carefully formulate therapeutic strategies to control infections in NICUs.