Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza- Tanzania

Abstract

BackgroundNeonatal sepsis is a significant cause of morbidity and mortality in neonates. Appropriate clinical diagnosis and empirical treatment in a given setting is crucial as pathogens of bacterial sepsis and antibiotic sensitivity pattern can considerably vary in different settings. This study was conducted at Bugando Medical Centre (BMC), Tanzania to determine the prevalence of neonatal sepsis, predictors of positive blood culture, deaths and antimicrobial susceptibility, thus providing essential information to formulate a policy for management of neonatal sepsis.MethodsThis was a prospective cross sectional study involving 300 neonates admitted at BMC neonatal unit between March and November 2009. Standard data collection form was used to collect all demographic data and clinical characteristics of neonates. Blood culture was done on Brain Heart Infusion broth followed by identification of isolates using conventional methods and testing for their susceptibility to antimicrobial agents using the disc diffusion method.ResultsAmong 770 neonates admitted during the study period; 300 (38.9%) neonates were diagnosed to have neonatal sepsis by WHO criteria. Of 300 neonates with clinical neonatal sepsis 121(40%) and 179(60%) had early and late onset sepsis respectively. Positive blood culture was found in 57 (47.1%) and 92 (51.4%) among neonates with early and late onset neonatal sepsis respectively (p = 0.466). Predictors of positive blood culture in both early and late onset neonatal sepsis were inability to feed, lethargy, cyanosis, meconium stained liquor, premature rupture of the membrane and convulsion. About 49% of gram negatives isolates were resistant to third generation cephalosporins and 28% of Staphylococcus aureus were found to be Methicillin resistant Staphylococcus aureus (MRSA). Deaths occurred in 57 (19%) of neonates. Factors that predicted deaths were positive blood culture (p = 0.0001), gram negative sepsis (p = 0.0001) and infection with ESBL (p = 0.008) or MRSA (p = 0.008) isolates.ConclusionOur findings suggest that lethargy, convulsion, inability to feed, cyanosis, PROM and meconium stained liquor are significantly associated with positive blood culture in both early and late onset disease. Mortality and morbidity on neonatal sepsis is high at our setting and is significantly contributed by positive blood culture with multi-resistant gram negative bacteria.

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

“…7,19,24 K. pneumoniae was the predominant pathogen, as has been reported in other studies. 9,16,21,23 Group B streptococcus was the most prevalent Gram-positive pathogen in our study, which contrasts with the findings in other published literature from low-to middleincome settings, in which the total absence of this pathogen was reported. 19,22,24 Pregnant women are not routinely screened for group B streptococcus in our setting and the isolation of group B streptococcus in our study is an indication of missed opportunities for antenatal screening.…”

“…Our study and others from Africa report a higher prevalence of late-onset neonatal sepsis. 12,17,23,24 This pattern represents horizontal infection transmission, i.e. hospitalacquired infections, which are largely preventable by good infection control practices.…”

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“…Similar results were observed in studies done by Aletayeb and Shrestha who showed 90 % and 100 % sensitivity towards imepenam, respectively 11,7 . In contrast to our study, Kayagne showed only 2 % sensitivity to meropenem and Shahian showed only 33 % sensitivity to imepenem 15,9 .…”

“…This was in accordance with the study by Shrestha, which showed that vancomycin was effective in 100 % isolates 7 . However, in study conducted by Kayagne vancomycin was effective against 14 % strains only while study by Shahian showed that ceftazidime was effective only in 22% 15,9 .…”

“…Other studies to be compared are, by Shrestha showing 100 % sensitivity to imepenem but 100 % resistance aztreonam, Shahian showing 67 % and 33 % sensitivity to imepenem and gentamycin respectively, Mhada showing 43 % sensitivity to gentamycin, Kayagne showing 0% and 68 % sensitivity to meropenem and gentamycin 7,9,8,15 .…”