Neonatal septicaemia: prevalence and antimicrobial susceptibility patterns of common pathogens at Princess Marina Hospital, Botswana

Abstract

Background: Septicaemia is the third most common cause of neonatal death after prematurity and birth asphyxia. The prevalence of neonatal sepsis and the spectrum of causative microorganisms fluctuates over time, thus facility-specific surveillance of neonatal bloodstream infections is important. Increasing levels of antimicrobial resistance documented worldwide, necessitate regular monitoring of institutional resistance patterns to ensure appropriate and effective empirical antimicrobial therapy. Method:The laboratory blood culture reports and patient records from a neonatal unit at a Botswana referral hospital were retrospectively reviewed to determine the one-year prevalence of neonatal sepsis and the antimicrobial susceptibility patterns of common pathogens. Results: Of 909 neonates investigated for suspected sepsis using 1 119 blood cultures, 89 (9.8%) had laboratory-confirmed episodes of bloodstream infection (septicaemia). The most prevalent pathogens included Klebsiella pneumoniae (29.4%), group B streptococcus (16.3%) and Escherichia coli (11.9%). Blood culture contamination rates were high at 18.6% (208/1 119). Gramnegative pathogens showed low susceptibility to gentamicin (40%) and cefotaxime (47%), but high susceptibility to amikacin (86%). Streptococci and enterococci were moderately sensitive to ampicillin (79%), and fully susceptible to vancomycin. Methicillin-resistant Staphylococcus aureus was not isolated. Exposure to maternal syphilis and previous antibiotic exposure were significantly associated with neonatal septicaemia. Conclusion: Neonatal sepsis is common, with a predominance of Gram-negative pathogens. The high rate of blood culture contamination should be addressed. Emerging antibiotic resistance may require clinicians to review currently used antibiotics for the empirical treatment of late-onset neonatal septicaemia.

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

“…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.…”

“…However, among the studies that reported CoNS as a pathogen, few provided a rationale for identifying the clinical significance of the infection. 24,36,122,131,132,135 Four studies 36,60,107,121 cited laboratory quality control measures, and only one study 107 sent samples to an external laboratory for confirmation. (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and Escherichia coli 10% (8-13; table 1).…”

“…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).…”

“…Reported resistance to amikacin, an alternative to gentamicin, was low (14%, 7-23). 63,113,[124][125][126]132,135 High frequencies of extended spectrum β-lactamase (ESBL)-producing K pneumoniae were reported from South Africa, 24,126,131,132 Tanzania (49%; 24/50), 86 and Botswana (60%; 16/27). 135 In one South African study, 126 resistance to piperacillintazobactam, was higher among ESBL-producing K pneumoniae isolates (90%; 9/10) than in the non-ESBL producing isolates (43%; 3/7).…”

“…63,113,[124][125][126]132,135 High frequencies of extended spectrum β-lactamase (ESBL)-producing K pneumoniae were reported from South Africa, 24,126,131,132 Tanzania (49%; 24/50), 86 and Botswana (60%; 16/27). 135 In one South African study, 126 resistance to piperacillintazobactam, was higher among ESBL-producing K pneumoniae isolates (90%; 9/10) than in the non-ESBL producing isolates (43%; 3/7). Non-susceptibility to carbapenems was reported in at least one country in each region, 63,86,88,91,106,125,126,132 with low resistance rates (4%, 95% CI 1-10).…”