Neonatal sepsis at Mulago national referral hospital in Uganda: Etiology, antimicrobial resistance, associated factors and case fatality risk

Abstract

Background Sepsis is the third most common cause of death among neonates, with about 225,000 newborns dying every year globally. Data concerning the microbial etiology of neonatal sepsis and antimicrobial resistance profiles of its causative agents are necessary to inform targeted and effective treatment and prevention strategies. Objective To determine the proportion of newborns with symptoms and signs of sepsis who had a positive blood culture, its bacterial etiology, the antimicrobial resistance patterns as well as the factors associated with culture-positivity and case fatality at Mulago national referral hospital in Uganda. Methods We conducted a cross-sectional study among 359 neonates with symptoms and signs of sepsis who presented to the pediatric emergency care unit of Mulago national referral hospital from mid-January to end of December 2018. We performed blood culture and antimicrobial susceptibility testing, and conducted polymerase chain reaction to identify methicillinresistant Staphylococcus aureus (MRSA) isolates. We used multivariable logistic regression to estimate the association between potential risk factors and culture-positive neonatal sepsis. Findings Of the 359 neonates recruited, 46 (12.8%; 95% CI 9.5%, 16.7%) had a positive blood culture. The predominant isolated bacteria were Staphylococcus aureus in 29 (63.0%),

Antibiotic resistance profiles and population structure of disease-associatedStaphylococcus aureusinfecting patients in Fort Portal Regional Referral Hospital, Western Uganda

“…The resistance profiles observed in this study were largely similar to those described elsewhere in Uganda. Nevertheless, the largest discrepancies between this and other studies were the universal susceptibility to clindamycin at FPRRH, whilst a relatively high 41% resistance was found at Mulago, and for trimethoprim (43% in this study, and ≥89% in Mulago), and chloramphenicol, for which although rates of resistance vary between 14% - 88% elsewhere [9, 13, 14, 46, 50], FPRRH strains were almost all susceptible. National advice on control strategy based on national clinical guidelines, or data that may be focused upon major urban centres, are not always aligned with antibiotic susceptibility observed at the local level, emphasising the requirement for local knowledge such as that described here [16].…”

“…AST suggested that 71% of isolates (29/41) were susceptible to erythromycin and these phenotypes matched the genotype in most cases (26/29). Thirteen isolates (32%) were found to be resistant to erythromycin, which is considerably lower than reported by several other Ugandan studies [35, 46, 49, 50] and all erythromycin-resistant isolates were susceptible to clindamycin. For some isolates, this could be explained by the presence of an inducible efflux pump gene ( msrA ), which is implicated in resistance to erythromycin [51].…”

“…Aminoglycoside resistance is complex, and conflicts between genotype and phenotype have been previously reported [54], but may also be representative of the short read sequencing, which could be clarified using long-read technologies or complementary techniques. Phenotypic and genotypic analysis of chloramphenicol susceptibility were largely in agreement, with 97% of isolates being susceptible to chloramphenicol (36/37) CARD analysis predicted only one isolate (sample 149) to be resistant, which did not correlate with several other studies from Mulago hospital, Kampala that suggest much higher rates of chloramphenicol resistance ranging between 14% and 88% [9, 13, 14, 46, 50].…”

Antibiotic resistance profiles and population structure of disease-associated Staphylococcus aureus infecting patients in Fort Portal Regional Referral Hospital, Western Uganda

“…AST suggested that 71 % of isolates (29 of 41) were susceptible to erythromycin and these phenotypes matched the genotype in most cases (26 of 29). Thirteen isolates (32 %) were found to be resistant to erythromycin, which is considerably lower than reported by several other Ugandan studies [35,47,50,51] and all erythromycin-resistant isolates were susceptible to clindamycin. For some isolates, this could be explained by the presence of an inducible efflux pump gene (msrA), which is implicated in resistance to erythromycin [52].…”

Bacteriological Profile, Antibiotic Susceptibility and Factors Associated with Neonatal Septicaemia at Kilembe Mines Hospital, Kasese District Western Uganda

“…SVD was also associated with neonatal septicaemia, here babies could have been exposed to maternal vaginal and fecal bacteria [46]. which was contrary to other studies that showed cesarean section was more associated with culture-positive cases [47]. This justi es the need for infection control practices and improving mother hygiene as reported by Ahmed [48].…”