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Year : 2002  |  Volume : 20  |  Issue : 2  |  Page : 110-112

Enterobacter cloacae: A predominant pathogen in neonatal septicaemia

Dept. of Microbiology MKCG Medical College, Berhampur - 760 004, Orissa, India

Correspondence Address:
Dept. of Microbiology MKCG Medical College, Berhampur - 760 004, Orissa, India

 ~ Abstract 

A total of 120 blood samples from neonates presenting with clinical signs of septicaemia were subjected for culture using brain heart infusion agar biphasic medium (BHI BPM) and glucose broth. Bacterial agents were isolated from 48 numbers (40%) of cultures. Gram-negative bacilli were isolated in maximum percentage (88.45%) of cases whereas gram-positive bacteria (coagulase negative staphylococci and group B streptococci) in 11.6% of cultures. E.cloacae (39.5%) was maximally isolated among the pathogenic bacteria followed by K.pneumoniae (23.2%), E.coli (11.6%) and others like Acinetobacter spp. (6.9%), Citrobacter freundi (4.6%) and P.mirabillis (2.3%). All the gram-negative bacilli isolates showed 100% susceptibility to amikacin, whereas 85% of E.cloacae isolates were sensitive to the same. Thus E.cloacae was found to be a predominant moderately sensitive pathogen in neonatal septicemia.

How to cite this article:
Mahapatra A, Ghosh S K, Mishra S, Pattnaik D, Pattnaik K, Mohanty S K. Enterobacter cloacae: A predominant pathogen in neonatal septicaemia. Indian J Med Microbiol 2002;20:110-2

How to cite this URL:
Mahapatra A, Ghosh S K, Mishra S, Pattnaik D, Pattnaik K, Mohanty S K. Enterobacter cloacae: A predominant pathogen in neonatal septicaemia. Indian J Med Microbiol [serial online] 2002 [cited 2021 Mar 5];20:110-2. Available from:

In India, septicaemia is a leading cause of neonatal mortality next to perinatal hypoxia.1 A significant proportion of admissions in Neonatal Intensive Care Units (NICU) consists of babies born outside the hospital and coming with septicemia. The bacteriological profile of neonatal septicaemia is constantly under change with advances in early diagnosis and treatment. Thus a rational protocol for sepsis management must be based on adequate knowledge of the causative organisms and their antibiotic sensitivity pattern.[2] The gold standard for diagnosis of septicaemia is the isolation of the bacteria from a blood culture which takes at least 48 hours to confirm the diagnosis; a delay which a neonate can ill afford for initiation of appropriate therapy.[3]
In developed countries group B streptococci and coagulase negative staphylococci are the most common aetiologic agents for early onset and late onset sepsis (EOS&LOS) respectively.[2] However, in the developing countries, these organisms are rare with an entirely different bacterial spectrum. This study conducted in south Orissa is aimed at describing the bacteriological spectrum of neonatal septicaemia in the NICU of MKCG Hospital, Berhampur, Orissa.

 ~ Materials and Methods Top

The present study was conducted prospectively with 120 neonates admitted to the NICU of MKCG Medical College Hospital with clinical signs of septicaemia like lethargy, poor activity, inability to suck, abdominal distension etc.
Using dehydrated media (Himedia), glucose broth and brain heart infusion agar biphasic media were prepared and used simultaneously for blood culture with a view to compare their individual efficacy. Two millilitre of blood was drawn under aseptic measures from any peripheral vein of the neonate and 1mL. Of blood was transferred to each media. The bottle was shaken gently and incubated at 37oC aerobically for a maximum period of 7 days. The bottles were observed daily and as soon as signs of growth like turbidity, air bubbles or colonies over the solid slant portion of the biphasic medium were detected in either medium, subculture was done on blood agar and MacConkey's agar. Then preliminary identification tests like Gram stain, motility, catalase, oxidase and coagulase were done from an isolated colony. When presumptively identified as a pathogen sensitivity test was performed on the same day by Kirby-Bauer disc diffusion method. Final identification was made on the next day after setting up sugar fermentation and other specific biochemical tests as per standard methods.

 ~ Results Top

Out of the 120 blood cultures, 48 (40%) were bacteriologically positive among which 43 were pathogenic and 5 were either skin or external contaminants. Of the 43 pathogens isolated 38 (88.4%) were gram-negative bacilli and 5 (11.6%) were gram-positive cocci (Table:1). Among the gram-negative bacilli all belonged to family Enterobacteriaceae except 3, which were nonfermenters (Acinetobacter spp.).
Enterobacter cloacae was isolated in 39.5% followed by Klebsiella pneumoniae in 23.2%, E.coli in 11.6% and others ( C.freundii   4.6%,   P.mira  bilis   2.3%). All Gram negative isolates showed 100% susceptibility to amikacin except in case of E.cloacae where 85% of the isolates were sensitive to the same.
Of the 48 positive blood cultures the total growth in glucose broth was 79% and in BHIBPM it was 94%. The BHIBPM and GB allowed growth of 25% and 11% of isolates respectively by second day.

 ~ Discussion Top

Sepsis is still a major cause of mortality and morbidity in the first month of life. New treatment alternatives are being explored throughout the world because of its changing bacterial profile and high mortality rate. Gram-negative organisms continue to be a menace to the sick, fragile and debilitated newborns. Among these, Klebsiella septicaemia continues to be a challenge to the neonatologists, microbiologists and hospital administators.[5]
In the present study E.cloacae has been isolated as the leading cause of sepsis. Forty percent of the cultures were bacteriologically positive out of which 36% were pathogenic and 4% were contaminants. The contaminants were aerobic spore bearing bacilli, diphtheroids and coagulase negative staphylococci. Among the pathogens isolated, gram-negative bacilli predominated (88.4%) and all were members of the family Enterobacteriaceae except 3 isolates, which were nonfermenters. The gram-negative bacterial preponderance, specifically Enterobacteriaceae, has been reported by various authors as the cause of neonatal septicaemia.[6],[7] Chugh et al[6] and Gupta et al[7] reported Klebsiella to be the number one causative organism. But in other studies E.coli was found to be the predominanat agent.[11],[12] E.cloacae was found to be maximum in the present study followed by Klebsiella. This organism has been reported to be isolated in varying percentages ranging from 1.5 to 14.6 by various authors.[2],[8],[9] Present study shows a higher percentage in comparison to the result reported by above authors. Kuruvilla isolated E.cloacae in significant numbers from late onset sepsis.2 But there was no significant difference in bacteriology between EOS and LOS in the present study, which was also reported by Bhakoo.[10]
In the present study gram-positive isolates are very few accounting to only 11.6%. Acinetobacter spp. and coagulase negative staphylococci each accounted for only 6.9% of all pathogenic isolates in comparison to Mondal who had isolated 15.2% and 21.2% of the above organisms respectively.11
E.cloacae septicaemia should be emphasised and taken into account for its rising incidence. Moreover E.cloacae affects the most vulnerable age group i.e. neonates and its growing resistance to conventional and even newer antibiotics is a serious cause for concern. Thus, its containment and prevention needs special consideration. 

 ~ References Top

1.Thora S, Awadhya A, Chansoria A. Perinatal and infant mortality in urban slums under ICDS scheme. Indian Pediatr 1986; 23:595-598.  Back to cited text no. 1    
2.Kuruvilla KA, Pillai S, Jesudasan M, Jena AK. Bacterial profile of sepsis in a neonatal unit in South India. Indian Pediatr 1989; 35:851-585.  Back to cited text no. 2    
3.Ramji S. Rapid diagnosis of neonatal septicemia. Indian Pediatr 1989; 26:111-113.  Back to cited text no. 3    
4.Khatua SP, Das AK, Chaterjee BD, et al. Neonatal septicemia. Indian J Pediatr 1986; 53:509-514.  Back to cited text no. 4    
5.Sharma PP, Halder D, Dutta AK, et al. Bacteriological profile in neonatal septicemia. Indian J Pediatr 1987; 24:1011-1017.  Back to cited text no. 5    
6.Chugh K, Agarwal BB, Kaul Vk, et al. Bacteriological profile of neonatal Septicemia. Indian J Pediatr 1988; 55:961-965.  Back to cited text no. 6    
7.Gupta P, Murli MV, Faridi MMA, et al. Clinical profile at Klebsiella septicemia in neonates. Indian J Pediatr 1993; 60:565-572.  Back to cited text no. 7    
8.Mehrotra N, Kumar A, Chansoria A, Kaul KK. Neonatal Sepsis - Correlation of maternal and neonatal factors of positive bacterial cultures. Indian Pediatr 1985; 22:275-280.  Back to cited text no. 8    
9.Sinha N, Dev A, Mukherjee AK. Septicemia in neonates and early infancy. Indian J Pediatr 1986; 53:249-256.  Back to cited text no. 9    
10.Bhakoo ON. Neonatal bacterial infection at Chandigarh - A decade experience. Indian J Pediatr 1980; 47:419-424.  Back to cited text no. 10    
11.Mondal GP, Raghavan M, Vishnu B, Srinivasan S. Neonatal septicemia among inborn and outborn babies in a referral hospital. Indian J Pediatr 1991; 58:529-533.   Back to cited text no. 11    
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