After approval from the Institute’s Ethics Committee, we screened blood culture records of outborn neonates admitted to our hospital between October 2011 and June 2015. We retrieved case records of neonates with one or more episodes of BCC sepsis, defined as isolation of Burkholderia cepaciae from blood or sterile body fluids along with clinical signs of sepsis. Positive cultures from neonates whose clinical course was not consistent with sepsis and not treated as culture-positive sepsis by the treating team, were considered as contaminants and excluded from the study. Cultures were performed using BacT/Alert continuous microbial detection system. Positive signals were followed by identification of species using Vitek-2 (Biomerieux, France). Antimicrobial susceptibility pattern was tested as per Clinical and Laboratory Standards Institute (CLSI) guidelines [6]. Intravenous piperacillin-tazobactam and amikacin were used as empirical first line antibiotic in both early- and late-onset sepsis.

Among the 3265 admissions, 65 neonates had positive cultures with BCC. After excluding six contaminants, 59 neonates had BCC sepsis (18 per 1000 admissions). Most neonates (59%) had early-onset sepsis. The most common clinical presentation was respiratory distress (97%), followed by hemodynamic instability (83%). C-reactive protein was elevated (>5 mg/L) in 71% neonates [7]. Highest antimicrobial sensitivity was observed for cotrimoxazole (95%), followed by meropenem (49%), ceftazidime and minocycline (31% each) and levofloxacin (27%). Case fatality rate was 17% (Table I).

TABLE I	Clinical Profile and Laboratory Abnormalities in Neonates with Sepsis due to Burkholderia cepacia (n=59)

An earlier study from Chandigarh noted an increase in the proportion of neonatal sepsis due to NFGNB, subsequently identified as BCC from 0% in 1998 to 30% in 2006 [2]. Although 59% neonates in our series had early onset sepsis with BCC, only 29% had maternal risk factors. This supports the claim that majority of early-onset infections in hospital-born neonates in the developing world may be hospital-acquired, rather than of maternal origin [8]. Microbiological reports often identify both Pseudomonas species and Burkholderia cepacia as NFGNB, but their antimicrobial susceptibility and treatment options are different. BCC is intrinsically resistant to aminoglycosides, polymyxin (Colistin), and often to piperacillin-tazobactam, while these drugs are useful for infection with Pseudomonas [9].

The limitations of our study include its retrospective design and potential inaccuracy in differentiating neonates truly infected with BCC from contaminants.

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