Detection of ESBL and Carbapenemase-Producing Gram-Negative Bacteria in Neonatal Sepsis and their Correlation with Semi-Quantitative CRP

Authors

  •   R. Suriya Praba Department of Microbiology, Government Kilpauk Medical College, Chennai - 600010, Tamil Nadu
  •   D. K. Kalpana Raj Department of Microbiology, Government Kilpauk Medical College, Chennai - 600010, Tamil Nadu
  •   Ravinder Thyagarajan Department of Microbiology, Government Kilpauk Medical College, Chennai - 600010, Tamil Nadu

Keywords:

Antimicrobial Resistance, C-Reactive Protein, Carbapenemase, ESBL, Gram-Negative Bacteria, Neonatal Sepsis

Abstract

Background: Neonatal sepsis continues to be a major contributor to morbidity and mortality globally, especially when induced by multidrug-resistant Gram-negative bacteria. This study sought to identify Extended-Spectrum Beta-Lactamase (ESBL) and carbapenemase-producing Gram-negative bacteria isolated from neonates with sepsis and to connect these findings with semi-quantitative C-Reactive Protein (CRP) levels, and correlated with the presence of resistant organisms. Aim and Objectives: This study seeks to isolate Gram-negative bacteria from neonates with clinically suspected sepsis admitted to the Neonatal Intensive Care Unit (NICU), identify the presence of ESBL and carbapenemase production among these isolates, and evaluate their correlation with semi-quantitative CRP levels. Materials and Methods: A cross-sectional descriptive study was performed over three months. Blood samples were collected for culture and CRP testing. Isolates were identified using standard microbiological methods. ESBL production was confirmed by the combined disk diffusion method, and carbapenemase production by the E-test and Carbapenem Inactivation Method. CRP levels were measured using a latex agglutination assay. Results: Out of 75 Gram-negative isolates from neonatal sepsis cases, Klebsiella pneumoniae was predominant (50.7%), followed by Acinetobacter baumannii (24%) and Escherichia coli (13.3%). ESBL production was observed in 18 isolates (24%), predominantly in K. pneumoniae (39.5%). Carbapenemase production was noted in 8 isolates (10.7), predominantly in A. baumannii (11.1). No significant statistical correlation was found between CRP levels and resistance (p > 0.05). However, elevated CRP levels (>24 mg/L) were more commonly associated with resistant isolates, suggesting potential as an early indicator. Conclusion: This study highlights the increasing burden of antibiotic resistance in neonatal sepsis, emphasising the need for routine detection of ESBL and carbapenemase producers. Semi-quantitative CRP can be a valuable, rapid, and cost-effective tool to aid in early diagnosis and guide empirical treatment strategies.

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Published

2025-03-30

How to Cite

Praba, R. S., Raj, D. K. K., & Thyagarajan, R. (2025). Detection of ESBL and Carbapenemase-Producing Gram-Negative Bacteria in Neonatal Sepsis and their Correlation with Semi-Quantitative CRP. Journal of Health and Technology, 1(1), 23–33. Retrieved from https://ejournal-tnmgrmu.ac.in/index.php/health/article/view/29

Issue

Volume 1, Issue 1, March 2025

Section

Research Article

License

Copyright (c) 2025 Journal of Pre and Para Clinical Specialities

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

References

1. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017; 390(10104):1770-1780. https://doi.org/10.1016/S0140-6736(17)31002-4 PMid:28434651.

2. Agarwal R, Sankar J, Narsaria P, et al. Clinical presentation and antimicrobial resistance profile of neonatal sepsis: A hospital-based study in India. Indian J Pediatr. 2014; 81(4):326-331.

3. Paterson DL, Bonomo RA. Extended-spectrum betalactamases: A clinical update. Clin Microbiol Rev. 2005; 18(4):657-686. https://doi.org/10.1128/CMR.18.4.657686.2005 PMid:16223952 PMCid:PMC1265908

4. Bradford PA. Extended-spectrum beta-lactamases in the 21st century: Characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev. 2001; 14(4):933-951. https://doi.org/10.1128/CMR.14.4.933951.2001 PMid:11585791 PMCid:PMC89009.

5. van Duin D, Doi Y. The global epidemiology of carbapenemase-producing Enterobacteriaceae. Virulence. 2017; 8(4):460-469. https://doi.org/10.1080/21505594.2016 .1222343 PMid:27593176 PMCid:PMC5477705.

6. Logan LK, Weinstein RA. The epidemiology of carbapenemresistant Enterobacteriaceae: The impact and evolution of a global menace. J Infect Dis. 2017; 215(Suppl_1):S28-S36. https://doi.org/10.1093/infdis/jiw282 PMid:28375512 PMCid:PMC5853342.

7. Hengst JM. The role of C-reactive protein in the evaluation and management of infants with suspected sepsis. Adv Neonatal Care. 2003; 3(1):3-13. https://doi.org/10.1053/adnc.2003.50010 PMid:12882177.

8. Mathai E, Christopher S, Mathai M, et al. Detection of extended-spectrum beta-lactamase producers in clinical specimens. Indian J Med Microbiol. 2001; 19(2):87-91.

9. World Health Organisation. Newborns: Reducing mortality; 2023.

10. National Neonatal Perinatal Database. Report 2002-2003.

11. Thaver D, Zaidi AKM. Burden of neonatal infections in developing countries: A review of evidence from communitybased studies. Pediatr Infect Dis J. 2009; 28(1 Suppl):S3-S9 https://doi.org/10.1097/INF.0b013e3181958755 PMid: 19106760.

12. Roy S, Datta S, Das P, et al. Carbapenem resistance in Gram-negative bacteria causing neonatal sepsis in India. J Infect Dev Ctries. 2013; 7(11):802-809.

13. Manoharan A, Premalatha K, Chatterjee S, Mathai D, SARI Study Group.Correlation of TEM, SHV and CTX-M extended-spectrum beta-lactamases among Enterobacteriaceae with their in vitro antimicrobial susceptibility. Indian J Med Microbiol. 2011; 29(2):161-164. https://doi.org/10.4103/0255-0857.81799 PMid:21654112.

14. Agarwal R, Kaistha N, Singh NP, et al. Characterization of ESBL and AmpC beta-lactamase-producing isolates from neonatal septicemia. J Infect Dev Ctries. 2012; 6(5):377383.

15. Neonatal infections caused by carbapenemase producers are associated with high mortality and treatment failure.

16. Becker KL, et al. Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004; 89(4):1512-1525. https://doi.org/10.1210/jc.2002-021444 PMid:15070906.

17. Kocabas E, Sarikcioglu A, Aksaray N, et al. Role of procalcitonin, C-reactive protein, and interleukin-6 in the diagnosis of neonatal sepsis. Turk J Pediatr. 2007; 49(1):720.

18. Hengst JM. The role of C-reactive protein in the evaluation and management of infants with suspected sepsis. Adv Neonatal Care. 2003; 3(1):3-13 https://doi.org/10.1053/adnc.2003.50010 PMid:12882177.

19. Nagata M, Takahashi K, Harada Y, et al. Elevated CRP as a potential predictor of multidrug-resistant Gram-negative bacteremia. BMC Infect Dis. 2020; 20:132.

20. Nordmann P, Naas T, Poirel L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis. 2011; 17(10):1791-1798. https://doi.org/10.3201/eid1710.110655 PMid:22000347 PMCid:PMC3310682.

21. Roy I, Jain A, Kumar M. Bacterial isolates in neonatal sepsis and their antibiotic susceptibility pattern. Indian J Pediatr. 2020.

22. Joseph N, et al. Epidemiology and resistance pattern of neonatal bloodstream infections in a tertiary NICU. J Neonatol. 2022.

23. Ghosh A, Banerjee P, et al.. Multidrug resistance in neonatal sepsis: ESBL and carbapenemase-producing organisms. Indian J Med Microbiol. 2020.

24. Becker KL, et al. Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: A journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004; 89(4):1512-1525. https://doi.org/10.1210/jc.2002-021444 PMid:15070906.

25. Ray P, Manchanda V, Bajaj J, et al. Correlation of C-reactive protein levels with sepsis and its usefulness as a marker for diagnosing nosocomial infections in the neonatal intensive care unit. Indian J Pathol Microbiol. 2007; 50(2):297-300.