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Neonatal sepsis in rural India: timing, microbiology and antibiotic resistance in a population-based prospective study in the community setting

Journal of Perinatology volume 37, pages 911–921 (2017)Cite this article

Subjects

Abstract

Objective:

To examine the timing and microbiology of neonatal sepsis in a population-based surveillance in the Indian community setting.

Study Design:

All live born infants in 223 villages of Odisha state were followed at home for 60 days. Suspect sepsis cases were referred to study hospitals for further evaluation including blood culture.

Results:

Of 12 622 births, 842 were admitted with suspected sepsis of whom 95% were 4 to 60 days old. Culture-confirmed incidence of sepsis was 6.7/1000 births with 51% Gram negatives (Klebsiella predominating) and 26% Gram positives (mostly Staphylococcus aureus). A very high level of resistance to penicillin and ampicillin, moderate resistance to cephalosporins and extremely low resistance to Gentamicin and Amikacin was observed.

Conclusion:

The bacterial burden of sepsis in the Indian community is not high. Judicious choice of empiric antibiotics, antibiotic stewardship and alternate modalities should be considered for the management or prevention of neonatal sepsis in India.

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Acknowledgements

This study is dedicated to late Dayananda Das, former director of Jana Sikhshan Sansthan, Rourkela for his sincere commitment, superlative management skills, flawless execution, and successful completion of the study protocol in 223 villages of Odisha. We are thankful to the Government of Odisha, Department of Health and Family Welfare, the Indian Council of Medical Research and the Ministry of Health and Family Welfare Government of India for their review and providing timely approvals for this study. Ms. Meena Gupta, Principal Secretary of Health and Family Welfare, Government of Odisha deserves our earnest gratitude for her proactive assistance in enabling the first study of this nature being conducted at a government facility in Odisha and establishing the first neonatal special care unit in Bhubaneswar city, and also for coordinating with the Department of Woman and Child Development for involving the Anganwadi workers in the surveillance. Keshab Pradhan and Kallola Mishra conducted data entry and overall management in the hospital. We appreciate the 223 courageous Anganwadi workers who embarked on a medical project of this nature and performed at a level comparable to any other paramedical personnel in the government system. This study was funded by NIH grant U01 HD 40574 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, USA.

Author contributions

PP conceived and designed the study and wrote the first draft of the paper. PP, SP, JM, IG, NB, JJ and RC wrote the protocol and manual of operations. RS, LP, AM and SM were responsible for clinical diagnosis and case management. PM, DC and NS were in-charge of lab management. NH and SK conducted data analyses. All authors contributed during the development of study forms and multiple aspects of clinical, laboratory and data management, and contributed during revision and preparation of the final version of the manuscript.

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Authors and Affiliations

  1. Department of Epidemiology and Pediatrics, Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA

    P Panigrahi

  2. Department of Environmental, Agricultural, & Occupational Health, Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA

    D S Chandel

  3. Division of Biostatistics & Epidemiology, RTI International, Research Triangle Park, NC, USA

    N I Hansen

  4. Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India

    N Sharma & R Chaudhry

  5. Division of Social Policy, Health, & Economics Research, RTI International, Research Triangle Park, NC, USA

    S Kandefer

  6. Department of Pediatrics, SCB Medical College, Cuttack, Odisha, India

    S Parida

  7. Social Pediatrics and Minority Health, Asian Institute of Public Health, Bhubaneswar, Odisha, India

    R Satpathy & S S Mohapatra

  8. Department of Pediatrics, Neonatal Unit, Capital Hospital, Bhubaneswar, Odisha, India

    L Pradhan

  9. Center for Translational Research, Asian Institute of Public Health, Bhubaneswar, Odisha, India

    A Mohapatra

  10. Disease Surveillance Laboratories, Asian Institute of Public Health, Bhubaneswar, Odisha, India

    P R Misra

  11. Department of Microbiology, Indira Gandhi Medical College & Research Institute, Puducherry, India

    N Banaji

  12. Department of Pathology, Immunology and Laboratory Medicine, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA

    J A Johnson

  13. Department of Medicine, College of Medicine, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA

    J G Morris Jr

  14. Department of Pediatrics, Division of Neonatology, Sparrow Hospital – Neonatology, Lansing, MI, USA

    I H Gewolb

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  1. P Panigrahi
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  2. D S Chandel
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  3. N I Hansen
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  4. N Sharma
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  5. S Kandefer
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  6. S Parida
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  7. R Satpathy
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  8. L Pradhan
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  9. A Mohapatra
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  10. S S Mohapatra
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  11. P R Misra
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  13. J A Johnson
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  14. J G Morris Jr
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  15. I H Gewolb
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  16. R Chaudhry
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Corresponding author

Correspondence to P Panigrahi.

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The authors declare no conflict of interest.

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Panigrahi, P., Chandel, D., Hansen, N. et al. Neonatal sepsis in rural India: timing, microbiology and antibiotic resistance in a population-based prospective study in the community setting. J Perinatol 37, 911–921 (2017). https://doi.org/10.1038/jp.2017.67

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  • DOI: https://doi.org/10.1038/jp.2017.67

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