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.

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

“…63 Hospital-based studies were mostly tertiary referral facilities (university or large national hospitals), and only 23 from district or secondary referral hospitals. 34,48,51,54,[59][60][61][62][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78] 139 studies were in urban settings whereas others reported data from predominantly rural populations: five studies from Kenya, 54,61,64,65,68 three from Mozambique, 59,72,73 two from Nigeria, 79,80 and one from Cameroon. 77 88 studies involved prospective data collection, 61 were retrospective reviews (26 laboratory-based surveillance of aetiological data), and two studies had both retrospective and prospective components.…”

“…Case ascertainment by physician diagnosis was reported in 44 (54%) of 81 observational studies, 26 of which documented the individual clinical signs used for the diagnosis of neonatal sepsis or meningitis. Only seven studies 36,63,74,[86][87][88][89] reported using the WHO/IMCI clinical algorithm, two studies 90,91 used the French National Agency for Accreditation and Health clinical diagnostic criteria, 92 and one Ugandan study 93 reported using criteria adopted from International Paediatric Sepsis Consensus 94 and Indian Academy of Paediatrics. 95 30 (37%) of these observational studies reported microbiological or laboratory criteria for diagnosis of neonatal infection syndromes (sepsis or meningitis), and 56 studies (69%) described micro biological sample type and sampling strategy (clinical indication vs routine sampling) as well as number of neonates sampled.…”

“…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).…”

Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand

“…Data from four other countries, including Thailand, found an incidence of 5 per 1000 live births [17]. The prevalence was 21.8 or more in Nigeria [12,13]. A report from the largest hospital in Indonesia found an incidence of 35% [44].…”

“…The exact data of neonatal sepsis in the LMIC is limited [8][9][10][11]. Two studies from Nigeria showed a prevalence rate of 47.2 and 21.8% [12,13]. A study from Indonesia found 46.6% prevalence [14].…”