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222 10-year review of pathogens and their antimicrobial resistance patterns at a tertiary neonatal intensive care unit. Do we have the right antibiotic policies?
  1. Monica Arend-Trujillo,
  2. Manjusha Narayanan,
  3. Isha Rizal,
  4. Naveen Athiraman
  1. UK


Background The presentation of neonatal sepsis is typically non-specific, and empirical antimicrobial treatment is generally commenced before a causative organism is identified. Using surveillance systems to identify pathogens and their antimicrobial resistance patterns, helps to inform clinicians of what isolates to target and assists them in using antibiotics judiciously.

Local antibiotic guideline

  • First line antibiotics:

  • Penicillin + Gentamicin.

  • Second line: Amoxicillin + Gentamicin + Flucloxacillin.

  • Second line where CoNS identified or very likely (e.g., preterm with long line but not systemically ‘sick’): Vancomycin

  • Third line: Vancomycin and Ceftazidime


  • To compile all positive cultures from blood, cerebrospinal fluid and respiratory secretions in a 10 year period

  • To identify common causative pathogens in the neonatal intensive care unit.

  • To detect susceptibility and resistant patterns to antibiotics recommended in local guideline

Methods Retrospective analysis of data from the microbiology department between 1st April 2010 and 31st March 2020.

Data included all positive blood, cerebrospinal fluid, and respiratory secretions cultures, together with their antimicrobial susceptibility and resistance profile

Results A total of 1642 positive cultures were identified in the 10-year period, from which 68.4% came from respiratory secretions, 28.9% from blood and 2.7% from cerebrospinal fluid samples.

The five most prevalent organisms in all combined cultures were Coagulase negative staphylococci (CoNS), Staphylococcus aureus, Escherichia coli, Enterobacter species and Klebsiella pneumoniae.

CoNS was the most prevalent organism in blood and cerebrospinal fluid cultures, at 56% and 34.88% respectively. GBS was always susceptible to Penicillin and E. coli was resistant to Gentamicin in 5% of cases.

CoNS was 100% susceptible to Vancomycin and Linezolid but mostly resistant to Gentamicin and Flucloxacillin.

Conclusions Similar pathogens were seen to national data from other NICUs. No significant difference was seen for most prevalent pathogens in a 10-year period.

First line antibiotics in our local guideline provided good coverage for early onset sepsis organisms.

Second line antibiotics did not cover CoNS, for patients without central line in situ. However, they provided good cover for all other prevalent pathogens involved in late onset sepsis.

A step up from third line antibiotics is considered, when resistant organisms are suspected or grown, in discussion with the microbiologist.

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