Multidrug resistance in the neonatal unit and its therapeutic implications

Background Neonatal septicemia constitutes an important cause of morbidity and mortality among neonates in Indonesia. The excessive use of antibiotics may cause antibiotic resistant bacteria and may cause neonatal fungal infection.Objective To investigate the spectrum of organisms which cause neonatal sepsis and assess their sensitivity to various groups of drugs in the neonatal unit.Methods A prospective study conducted on newborn babies delivered in Cipto Mangunkusumo Hospital, Jakarta from July 2004-May 2005 who presented clinical signs of septicemia were subjected for blood culture. Those sensitive to antibiotics for 7 days yet showed no clinical improvement were also cultured for fungi.Results A total of 499 blood cultures were taken, 320 were positive for bacteria (positivity rate was 65.3%). There were 192 samples cultured for fungi, and the positivity rate was 64% (all for Candidasp). Acinetobacter calcoaceticus was the most common bacteria found (35.7%), followed by Enterobacter sp (7.0%), and Staphylo-coccus sp (6.8%). Most bacteria showed high degrees of resistance to commonly used antibiotics (ampicillin and gentamicin).There were also high degrees of resistance to cephalosporins by both Gram negative and Gram positive organisms. Only 61.7% ofA. calcoaceticus, and 45.7% of Enterobacter sp were sensitive toceftazidime. Gram negative organisms were also highly resistantto amikacin, but Staphylococcus sp was only moderately resistant. Resistance to carbapenem (meropenem and imipenem) varied from moderate to low. Drugs which were not used for new born babies (quinolones/ciprofloxacin and chloramphenicol) varied from moderate to high resistance.Conclusion Neonatal sepsis remains one of the major causes of mortality in our neonatal unit. Most organisms have developed multi drug resistance, and management of patients infected with these organisms and especially those with fungi infection are be-coming a problem in developing countries