Abstract:

Background: The developments in neonatal intensive care units (NICUs) have led to an increase in the survival rate of newborns. However, there is also an increase in nosocomial infections (NE). In this study, we aimed to investigate the predisposing factors in the neonatal sepsis due to Klebsiella strains in the NICU, clinical and laboratory features, mortality rates and antibiotic resistance of these cases. Material and Methods: The patients hospitalized in the neonatal intensive care unit were within 2015-2017 years. They were proven sepsis cases due to Klebsiella pneumoniae and retrospectively analyzed. Demographic, laboratory and clinical features and microbiological results of the patients were recorded. Results: Of the 59 blood culture samples with K. pneumoniae sepsis, 55 (93.2%) had late-onset neonatal sepsis (LNS) and 4 (6.8%) had early-onset neonatal sepsis (ENS). 47 (79.7%) of the cases were preterm. The primary diagnoses of the patients were preterm and respiratory distress syndrome (n: 47, 79.7%), common pathologies include preterm + necrotizing enterocolitis (n: 9, 15.3%), intracranial hemorrhage + hydrocephalus (n: 5, 8.5%), onfalocele or gastroschisis (n: 7, 11.9%), intesttinal atresia (n: 4, 6.8%), severe congenital heart disease (n: 1, 1.7%). More than two invasive procedures were performed in 53 (89.8%) cases before bacteremia developed. The most effective antibiotics against K. pneumoniae strains were colistin (87.3%), meropenem (51.7%) and ciprofloxacin (49.1%). The mortality rate of K. pneumoniae infection was found to be 30%. Resistance rates were 86% against piperacillin, 85% against ceftazidime, 91% against ceftriaxone and 95% against cefaperozone. The percentages of Klebsiella strains resistant to gentamycin, were 67.8% and 68% to both amikacin and trimethoprim-sulfamethoxazole. Conclusion: Klebsiella infections associated with health care are mainly caused by K. pneumoniae. Low birth weight, birth at early gestational weeks, invasive procedures and underlying serious diseases predispose to Klebsiella infections in the newborn. Today, multidrug resistance is a major problem. Mortality is associated with sepsis and underlying primary disease.

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