Skin colonization by pathogenic bacteria as a risk factor for neonatal sepsis

Background: Neonatal sepsis continues to be a leading cause of mortality among the NICU admitted neonates. The most common causative organisms have been proven to be hospital-acquired organisms.

Aims and objectives: This study was planned with aim of understanding the pathological colonization of neonatal skin and associated risk factors as well as finding a possible correlation between blood culture isolates and neonatal skin colonizers and their antimicrobial resistance patterns.

Methods: This prospective cohort study was conducted at a tertiary care centre in Northern India from January 2021 to June 2022. The study participants were 50 pre-term neonates and 50 term neonates, who were born in our hospital and subsequently admitted to the NICU. Skin swabs, taken from 5 body sites within 24 h of birth and at discharge, were cultured for isolation of pathological bacteria. Neonates were followed-up during their hospital stay for observing any occurrence of blood culture positive sepsis.

Results: Out of 100 neonates, 31 pre-term and 28 term neonates were colonized within 24 h of birth while almost all were colonized by discharge. Posterior auricular fossa was the most colonized site. Coagulase Negative Staphylococcus (n = 195) and Escherichia coli (n = 51) were the most common isolates. Risk factors found to be significantly associated with colonization were low birth weight (<2500g), premature rupture of membranes (PROM), invasive mechanical ventilation and positive urine and vaginal cultures of mothers. Neonates with culture positive sepsis also had colonization with MDROs.

Conclusions: Neonatal skin colonization and their antimicrobial resistance rates increased over the course of hospital stay, having a possible contribution towards culture positive sepsis.