More babies are struck with neonatal sepsis, a series of blood stream infections, within the first month of birth in India than anywhere else in the world. Several of them die due to failure of antibiotics against lethal bugs.

Doctors from All India Institute of Medical Sciences (AIIMS) have highlighted these findings in the latest paper, ‘Neonatal Sepsis in South Asia: Huge burden and spiralling antimicrobial resistance,’ published in the British Medical Journal .

Casualty rates

The paper estimates that 16 per thousand live births in India are infected with confirmed neonatal sepsis, which is detected through blood culture tests. Also, one third of them die for want of drugs that worked.

Of all the cases, 62 per cent infections in South Asia occur within first 72 hours, an incidence of 9.8 per thousand live births which is 10-fold higher than in the US.

What is more distressing is the babies acquire these infections from mothers who have been subjected to unhygienic practices in the labour rooms and neonatal intensive units of the hospitals.

Antibiotic overuse

“For all practical purposes, we have lost most antibiotics due to their unbridled use. For so many newborns, the resources are insufficient. Everything becomes a portal of entry of resistant bugs — through the hands of caregivers, shortage of disinfected equipment etc,” said Ramesh Agarwal, professor of Paediatrics in AIIMS, and co-author of the paper.

While AIIMS Neonatal Intensive Care Unit (NICU), a facility of 35 beds with close to 18 ventilators, boasts a reduced hospital-acquired infection setting, it hardly caters to growing need of sick babies.

“We refuse almost ten times higher number of babies than we admit, because of lack of capacity. Only those sick babies, of high-risk mothers, that have been admitted find way into the NICU,” said Agarwal indicating the acute dearth of resources to treat neonates.

Last-resort drugs

Poor lab support and difficulty in obtaining adequate blood from babies mostly fail to confirm the presence of infection, as a result of which they fall off the radar, the paper notes.

Different bugs

The bugs that strike in South Asia are different from those found in high-income countries. “South Asia has majority occurrence of gram negative organisms such as klebsiella, e.coli and acinetobacter isolated from hospital settings, which are known to cause more deaths than gram positive organisms found in Western countries,” said Agarwal.

Until recently, antibiotics such as crbapenem and colistin, which were last-resort drugs, have fallen out of favour in most set-ups because of rise in resistant bugs, he said.

Antibiotic resistance has worsened in the last decade, rendering most antibiotics obsolete.

Severe resistance

Resistance to even ‘reserve’ antibiotics has increased — 50-70 per cent of the common gram negative isolates are now resistant to more than one drug.

The bugs uniformly exhibit high degree of resistance to World Health Organisation-recommended first-line drugs such as ampicillin, gentamicin and third-generation cephalosporins such as cefotaxime. Most bugs are susceptibile to meropenem and vancomycin, the paper said, adding that the choice of drugs for treating babies has increasingly narrowed over the last ten years.