Risk factors and etiology of neonatal sepsis after hospital delivery: A case-control study in a tertiary care hospital of Rajshahi, Bangladesh

Abstract

Background Sepsis is one of the major causes of neonatal death worldwide as well as in Bangladesh. The objective of the present study was to identify the risk factors and causative organisms of neonatal sepsis after delivery in a tertiary care hospital, Bangladesh. Methods This was a case-control study conducted in the neonatal ward of Rajshahi Medical College Hospital (RMCH), a 1000-bed tertiary hospital situated in Rajshahi, Bangladesh. Neonates diagnosed as neonatal sepsis by clinical and laboratory parameters were included as cases in this study. Admitted neonates unsuspected or undiagnosed for sepsis were considered as controls. Maternal and neonatal information and their laboratory reports were collected and analyzed. Both bivariate and multiple logistic regression models were used to identify the risk factors of neonatal sepsis. Results A total of 91 cases and 193 controls were included in the study. Maternal history of urinary tract infection (UTI) during the third trimester of pregnancy (aOR 2.75, 95% CI: 1.04–7.23, p <0.05), premature birth (aOR 2.77, 95% CI: 1.08–7.13, p <0.05) and APGAR score <7 at five minutes (aOR 2.58, 95% CI: 1.04–6.39, p <0.05) were associated with onset of neonatal sepsis in multiple logistic regression model. All these factors were also associated with developing early-onset neonatal sepsis, while maternal UTI and male sex of neonates were associated with developing late-onset neonatal sepsis. Escherichia coli (40.7%), Staphylococcus aureus (27.5%), and Klebsiella pneumoniae (18.7%) were the commonly isolated organisms causing neonatal sepsis. All these organisms were highly resistant to common antibiotics like amoxicillin, cephalosporins, aminoglycosides and quinolones. Carbapenemase group of drugs along with amikacin, nitrofurantoin and linezolid were the most sensitive drugs. Conclusions Strengthening the existing facility for antenatal screening for early diagnosis and treatment of maternal infection during pregnancy as well as identifying high-risk pregnancy for adequate perinatal management is necessary to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics according to local epidemiology and culture and sensitivity reports may minimize the increasing hazards of antibiotic resistance.

Risk Factors for Neonatal Sepsis in Secondary and Tertiary Care Hospitals of a District in Sri Lanka: A Case–Control Study

“…The results were consistent with five other studies. 23,[26][27][28][29] A total of >3 vaginal examinations before delivery were a risk factor for neonatal sepsis regardless of whether the membranes were ruptured or not. This is consistent with the finding of another study, 30 which discovered that having more than three vaginal examinations was a risk factor for neonatal sepsis in India.…”

Asociación entre morbilidad materna extrema y sepsis en neonatos atendidos en el Instituto Nacional Materno Perinatal, Lima 2016 – 2019

“…Al analizar los factores neonatales asociados a sepsis neonatal, apreciamos diferencias significativas en relación al peso al nacer en el grupo de sepsis neonatal, en nuestro caso de los pacientes con sepsis neonatal 16% eran menores de 1500gr y 27% un peso entre 1500 a 2499gr; con (p<0,001); mientras que Adatara et al encontró 26.8% de recién nacidos con diagnóstico de sepsis con un peso menor a 2500 gramos al nacer (p<0.036) ( 14). Rafi et al 15 encontró que el 53.8% de recién nacidos que presentaron sepsis neonatal nacieron con un peso menor de 2500 gramos, comparado que el grupo control que el 25.4% (p<0.001).…”

“…Respecto al APGAR al primer y al quinto minuto mostró diferencias significativas entre el grupo de sepsis neonatal y los que no desarrollaron esta complicación (p<0.001); Adatara et al no encontró una diferencia significativa en su serie considerando un puntaje menor a 7 puntos de Apgar en el primer y quinto minuto ( 14); mientras que Rafi et al 15 encontró que el 30.8% del grupo de neonatos que presentaron sepsis tuvieron menos de 7 puntos de APGAR, comparado con el 11.4% de recién nacidos que no presentaron sepsis (p<0.001).…”

“…El 23.9% de pacientes que presentaron sepsis neonatal presentaron una edad gestacional menor de 37 semanas comparado con el grupo control que 13.3%14 . Rafi et al15 , realizaron un estudio casos control en Bangladesh, donde demostraron que el 46.2% de recién nacidos que presentaron sepsis tuvieron una edad gestacional menor a 37 semanas en comparación al grupo control que se evidencio en el 18.7% (p<0.001). 83% de los niños que desarrollaron sepsis neonatal en nuestra serie nacieron por cesárea, a diferencia de lo encontrado por Pokhrel et al16 , quien no encontró asociación con la ruta de nacimiento y sus casos de sepsis neonatal; sin embargo, Al-Matary y cols17 , demostró una fuerte asociación en relación al nacimiento por cesárea.…”

Development of an Immunochromatographic Strip Using Conjugated Gold Nanoparticles for the Rapid Detection of Klebsiella pneumoniae Causing Neonatal Sepsis

“…These leading causes of neonatal sepsis vary depending on the region and time frame surveyed, as well as socioeconomic levels [ 13 ]. The Klebsiella species is one of the most common causative agents of neonatal sepsis, especially in LMICs [ 14 , 15 , 16 ]. The pathogen is especially problematic in the Neonatal Intensive Care Units (NICUs) of Egyptian hospitals accounting for up to 61.3% of neonatal sepsis cases in some settings [ 17 , 18 , 19 , 20 ].…”