Determination of Antibiotic Resistance Pattern of Bacteria Isolated from Blood, Cerebrospinal Fluid, and Urine Samples in Neonatal Intensive Care Unit of Ali Asghar Hospital, Iran during 2013-15

Document Type : Original Article


1 Ali Asghar Hospital, Iran University of Medical Sciences, Tehran, Iran.

2 Ali Asghar Hospital, Iran University of Medical Sciences, Tehran, Iran


Background: Infections are one of the most important causes of death in infants, especially in developing countries. Inappropriate use and administration of antibiotics can contribute to the resistance and spread of infection. In this study, we determined the antibiotic resistance pattern of the bacteria isolated from clinical samples of blood, cerebrospinal fluid, and urine in the neonatal intensive care unit (NICU) of Ali Asghar Hospital, Iran during 2013-2015.
Methods: For the purposes of the study, clinical samples of blood, cerebrospinal fluid, and urine were collected from the NICU of Ali Asghar Hospital during 2013-15. The type of bacterial strain and antibiotic susceptibility pattern was determined by routine microbiological tests. The collected data were analysed in SPSS software (version 19), using χ2, Student’s t-test, and ANOVA test for comparison.
Results: In total, 240 positive culture samples (118 blood, 117 urine, and 5 cerebrospinal fluid samples) were collected for this research. The most common isolates in the blood, urine, and cerebrospinal fluid samples were Staphylococcus epidermidis (63.6%), Klebsiella (35%), and Acinetobacter Baumannii (40%), respectively. The highest antibiotic resistance in S. epidermidis isolated from blood samples was found against amikacin and cefotaxime, while linezolid and vancomycin were the most effective antibiotics against S. epidermidis. Moreover, ciprofloxacin and nitrofurantoin were the most effective antibiotics against Klebsiella isolated from urine samples, while this bacterial strain had the highest resistance to imipenem and ampicillin. Despite the fact that A. Baumannii strains were resistant to most studied antibiotics, ceftazidime and ceftriaxone had an acceptable antibacterial effect against these isolates.
Conclusion: Continuous surveillance for antibiotic susceptibility, rational use of antibiotics, and the strategy of antibiotic cycling can provide some answers to the emerging problem of antibiotic resistance.


1. World Health Organization. Neonatal and perinatal mortality country, regional and global estimates. Geneva: World Health Organization; 2006.
2. Dear P. Infection in the newborn. In: Rennie JM, Rpberton NR, editors. Textbook of neonatology. 3rd ed. London: Churchill Livingstone; 1999. P. 1109-27.
3. Bizzarro MJ, Raskind C, Baltimore RS, Gallagher PG. Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics. 2005; 116(3):595-602.
4. Hyde TB, Hilger TM, Reingold A, Farely MM, O'Brien KL, Schuchat A, et al. Trends in incidence and antimicrobial resistance of early-onset sepsis: population-based surveillance in San Francisco and Atlanta. Pediatrics. 2002; 110(4):690-5.
5. Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 1996; 129(1):63-71.
6. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med. 2002; 347(4):240-7.
7. Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011; 127(5):817-26.
8. Behrman RE, Vaughan III VC. Nelson textbook of pediatrics. Philadelphia: WB Saunders Company; 2016.
9. Fanaroff AA, Korones SB, Wright LL, Verter J, Poland RL, Bauer CR, et al. Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. The national institute of child health and human development neonatal research network. Pediatr Infect Dis J. 1998; 17(7):593-8.
10. Ramlakhan S, Singh V, Stone J, Ramtahal A. Clinical options for the treatment of urinary tract infections in children. Clin Med Insights Pediatr. 2014; 8:31-7.
11. Brown RD, Campoli-Richards DM. Antimicrobial therapy in neonates, infants and children. Clin Pharmacokinet. 1989; 17(1):105-15.
12. Howard A, O’Donoghue M, Feeney A, Sleator RD. Acinetobacter baumannii: an emerging opportunistic pathogen. Virulence. 2012; 3(3):243-50.
13. Shrestha S, Adhikari N, Rai B, Shreepaili A. Antibiotic resistance pattern of bacterial isolates in neonatal care unit. JNMA Nepal Med Assoc. 2010; 50(180): 277-81.
14. Rajabi Z, Soltan Dallal MM. Study on bacterial strains causing blood and urinary tract infections in the neonatal intensive care unit and determination of 
their antibiotic resistance pattern. Jundishapur J Microbiol. 2015; 8(8):e19654.
15. Fahmey SS. Early-onset sepsis in a neonatal intensive care unit in Beni Suef, Egypt: bacterial isolates and antibiotic resistance pattern. Korean J Pediatr. 2013;56(8):332‐337.
16. Sorsa A, Früh J, Loraine S, Abdissa S. Blood culture result profile and antimicrobial resistance pattern: a report from neonatal intensive care unit (NICU), Asella teaching and referral hospital, Asella, south East Ethiopia. Antimicrob Resist Infect Control. 2019; 8:42.