High Rate of Antibiotic Resistance in a Neonatal Intensive Care Unit of a University Hospital

Egbule, Olivia Sochi; Ehwarieme, Ayobola Daniel; Owhe-Ureghe, U. B.

doi:10.9734/bmrj/2016/25324

Cited by 1 publication

(5 citation statements)

References 10 publications

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“…Only few studies reported use of Etest 72,73,106,107 or microdilution 59 on all or some isolates. Several established guidelines for resistance interpretation were referenced: Clinical and Laboratory Standards Institute (CLSI; 36 stu dies), 24,31,36,56,59,63,70,72,73,84,[86][87][88]93,96,99,103,106,[108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125] EUCAST, 107 British Society for Antimicrobial Therapy, 60,61,71,97 and French Society of Microbiology. 91 Only 12 (15%) of 81 observational studies provided context by describing the pathway of neonatal presentation.…”

Section: Resultsmentioning

confidence: 99%

“…22 studies 36,63,74,79,84,86,88,91,93,97,98,106,112,113,118,[123][124][125][126][127]132,135 reported resistance among Klebsiella spp (predominantly K pneumoniae, with few cases of Klebsiella oxytoca), documenting a non-susceptibility to gentamicin of 66% (95% CI 47-83), ceftriaxone of 49% , and cefotaxime of 78% . Reported resistance to amikacin, an alternative to gentamicin, was low (14%, 7-23).…”

Section: Resultsmentioning

confidence: 99%

“…Pooled prevalence of non-susceptibility of E coli isolates to ampicillin 63,74,79,84,86,88,98,106,112,113,118,124,125,127,132,135 was 89% (95% CI 77-97) and was 47% (25-69) to gentamicin. 63,74,79,84,86,88,91,97,98,106,126,127,113,118,132,135,[123][124][125] A third of E coli isolates were resistant to ceftriaxone. 74,79,84,86,88,97,98,106,112,113,118,122,133 The reported prevalence of ESBL-producing E coli isolates ranged from 12% (7/58) in South Africa 24 to 46% (10/22) in Tanzania.…”

Section: Resultsmentioning

confidence: 99%

“…126 For S aureus infection, WHO recommends first-line treatment with cloxacillin, which has a pooled resistance of 40% (95% CI 8-79), 79,84,93,97,98,123,124,127 and gentamicin, for which the pooled resistance was 27% (14-41). 63,79,84,88,93,97,98,106,111,113,118,123,124,127,135 Meticillin resis tance was reported by eight studies, 24,86,112,118,121,126,131,137 with 50% (30-70) of isolates non-susceptible. Resistance to cefoxitin, the recommended antibiotic to identify meticillin-resistant S aureus strains (MRSA) when using the disk diffusion method, 138 was reported in 27% (13/49) of isolates in an Ethiopian study, 113 and 26% (6/23) of isolates in a Nigerian study.…”

Section: Resultsmentioning

confidence: 99%

“…Ampicillin 36,63,74,79,84,86,88,98,106,112,118,124,125,127,132 Gentamicin 36,63,74,79,84,86,88,91,97,98,106,113,118,[123][124][125][126][127]132 63,86,88,91,106,125, improved infection prevention measures particularly in congested neonatal units with high antimicrobial exposure and poor infection control. 14,81,150,155 In our study, we identified a high prevalence of resistance to recommended empirical therapies, in keeping with reports from older paediatric and adult populations in Africa.…”

Section: Escherichia Colimentioning

confidence: 99%

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Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines

Okomo

Akpalu

Doaré

et al. 2019

The Lancet Infectious Diseases

185

207

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Background Aetiological data for neonatal infections are essential to inform policies and programme strategies, but such data are scarce from sub-Saharan Africa. We therefore completed a systematic review and meta-analysis of available data from the African continent since 1980, with a focus on regional differences in aetiology and antimicrobial resistance (AMR) in the past decade (2008-18). Methods We included data for microbiologically confirmed invasive bacterial infection including meningitis and AMR among neonates in sub-Saharan Africa and assessed the quality of scientific reporting according to Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE-NI) checklist. We calculated pooled proportions for reported bacterial isolates and AMR. Findings We included 151 studies comprising data from 84 534 neonates from 26 countries, almost all of which were hospital-based. Of the 82 studies published between 2008 and 2018, insufficient details were reported regarding most STROBE-NI items. Regarding culture positive bacteraemia or sepsis, Staphylococcus aureus, Klebsiella spp, and Escherichia coli accounted for 25% (95% CI 21-29), 21% (16-27), and 10% (8-10) respectively. For meningitis, the predominant identified causes were group B streptococcus 25% (16-33), Streptococcus pneumoniae 17% (9-6), and S aureus 12% (3-25). Resistance to WHO recommended β-lactams was reported in 614 (68%) of 904 cases and resistance to aminoglycosides in 317 (27%) of 1176 cases. Interpretation Hospital-acquired neonatal infections and AMR are a major burden in Africa. More population-based neonatal infection studies and improved routine surveillance are needed to improve clinical care, plan health systems approaches, and address AMR. Future studies should be reported according to standardised reporting guidelines, such as STROBE-NI, to aid comparability and reduce research waste.

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