Neonatal sepsis in a Nigerian Tertiary Hospital: Clinical features, clinical outcome, aetiology and antibiotic susceptibility pattern

Abstract

Background: Neonatal sepsis is a significant cause of neonatal mortality in developing countries. The aetiological agents and their antimicrobial susceptibility patterns are dynamic. Objectives: This study determined clinical features, aetiology, antimicrobial susceptibility and clinical outcome of neonatal sepsis in a Nigerian Tertiary Hospital. Methods: Neonates undergoing sepsis evaluation at a Nigerian Tertiary Hospital were included in the study. Demographic and clinical information were obtained using standard questionnaires. Blood samples were cultured on MacConkey, Blood and Chocolate agar. Isolated bacteria were identified based on morphology, Gram stain appearance and standard commercially prepared biochemical tests. Antimicrobial susceptibility testing was performed on Mueller-Hinton agar using the Kirby-Bauer method.Results: Eighty-five of the 180 neonates admitted during the study period were recruited. Fifty-five neonates presented with early-onset sepsis and 30 with late-onset sepsis. Culture-proven sepsis was detected in 19 (22.4%) neonates. The incidence of culture-proven sepsis in the hospital was 2.8/100 live-births. The most common clinical feature at presentation was respiratory distress. Gram-negative bacteria accounted for 78.9 percent of all isolates and were the only organisms encountered in earlyonset sepsis. Isolated pathogens were predominantly Klebsiella spp (31.6%), Enterobacter spp (21.1%) and coagulase-negative Staphylococci (15.8%). The isolates were most sensitive to ofloxacin. Gram-negative bacteria showed high resistance to cefuroxime and ampicillin. The case-fatality rate was 26%. Conclusion: Gram-negative bacilli, especially Klebsiella spp, was predominant. Neonatal sepsis persists as a cause of mortality in this region. Regular antimicrobial surveillance for empirical treatment remains an important component of neonatal care.

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

“…Additionally, most neonates with culture proven bacteremia were born at a health institution where most neonatal sepsis is arising from hospital acquired infections. Resistance rates of isolated Gram-positive bacteria against third generation Cephalosporines were also high in our study which is consistent with studies from Nigeria, Tanzania, Georgia, Iran and other developing countries [11, 12, 15, 17, 19–23].…”

“…Guidelines on neonatal sepsis management in most centers [7, 19] recommend Ampicillin and Gentamycin as first-line empiric therapy. Unfortunately, most identified bacteria were highly resistant in this current report.…”

C-Reactive Protein as an Index of Early Diagnosis of Neonatal Sepsis

“…These deaths result mainly from infections, prematurity and perinatal asphyxia [5], while neonatal sepsis alone accounts for about 1.4 million of neonatal deaths annually and about 75% of these deaths occur in the first week of life [6]. Recent studies in developing countries show varying incidence of neonatal sepsis, aetiological agents and antimicrobial sensitivity pattern [7][8][9].…”

Epidemiologic Changes of Neonatal Early-onset Sepsis After the Implementation of Universal Maternal Screening for Group B Streptococcus in Hong Kong

“…2–4 The predominant pathogens are usually Gram-negative bacteria in developing regions, while in developed regions, they are group B Streptococcus (GBS) and Escherichia coli . 5–7 Recently, studies have suggested changes in the spectrum of EOS pathogens and bacterial resistance patterns, which are important factors that require adjustments in EOS management. 2,8…”