Trend Analysis of Multidrug-Resistant Bacterial Pathogens Causing Neonatal Sepsis at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: A Retrospective Study

Background

Neonatal sepsis is the most common cause of mortality and morbidity. It is a major global public health challenge, particularly in developing countries. Therefore, knowing the current status of bacterial isolates and their antimicrobial resistance profile is essential to physicians and health workers to implement appropriate intervention. The aims of this study was to assess a ten-year trend of bacterial prevalence isolates from blood culture among neonates (<1 month of age).

Method

A hospital-based retrospective study was conducted on 1854 neonatal patients who were admitted at University of Gondar Specialized Comprehensive Hospital between 2010 and 2020. Sociodemographical and laboratory data were collected from medical records. Quality of the data was assured through standard operational procedures. Data were entered and analysed using SPSS version 20. Bivariate analysis was employed to determine strings of association between the outcome variable and sociodemographic variables. A P value less than 0.05 will be considered to be statically significant.

Results

In a total of 1854 patients, 538 (29%) were culture positive. The overall neonatal sepsis infection rate was 287 (53.5%) for male and 249 (46.5%) for female. The highest proportion of neonatal sepsis infection rate was observed among the patients in the age range between 3 and 28 days and gestational at birth <37 weeks, 461(86%) and 278 (52%), respectively. Gestational at birth (P ≤ 0.001, AOR = 5.81, CI: 4.63–7.29) is significantly associated with bacterial isolates. The predominant pathogens were Staphylococcus aureus, 18 (76.6%), Klebsiella pneumoniae, 146 (38%), and E. coli, 45 (11.7%) among the age range less than one weak. Klebsiella spp, S. aureus, and E. coli showed a high level of resistance to most tested antimicrobials. Amikacin, ciprofloxacin and norfloxacin, and erythromycin were the most effective antibiotics whereas ampicillin, amoxicillin, and cotrimoxazole were the least effective antibiotics for isolates.

Conclusion

Neonatal sepsis infection is common in the 3–28 days of age range. S. aureus, E. coli, and K. pneumonia were the most common isolates. Most the bacterial pathogens were resistant to commonly prescribed antibiotics. Therefore, an antimicrobial sensitivity test for bacterial isolates is recommended to provide updated data for the physician in choosing the appropriate antibiotic for better patient treatment outcome.

Methicillin and multidrug resistant pathogenic Staphylococcus aureus associated sepsis in hospitalized neonatal infections and antibiotic susceptibility

BACKGROUND

Neonatal infection is infection of the newborn or neonate acquired in first four weeks of life or during prenatal development. Microorganism associated neonatal infections caused severe mortality in recent years. It is developed either prenatally or within 28 days of neonatal period. This infection is mainly transmitted from mother to child through placenta. It has been well associated with the premature rupture of membranes which markedly enhances the risk of neonatal sepsis.

METHODS

The present experiment was designed to analyze bacteria, their antibiotic resistance pattern and possible risk factors among neonatal patients with sepsis. The neonates specimen was subjected for the isolation of bacteria and antibiotic susceptibility test. Neonates were analyzed with previous clinical history such as, previous admission in hospitals, mode of delivery, birth weight, and feeding type in accordance with questionnaire.

RESULTS

Gram-positive bacteria isolates were found to be high (79 strains, 64.22%) than the Gram-negative bacteria (44 strains, 32.5%). Staphylococcus aureus (33 strains, 26.9%) was the major Gram-positive groups of bacteria. Multidrug resistance analysis accounted more S. aureus (26.9%) and 5 strains (15.15%) showed methicillin resistance, whereas 84.9% were found to be sensitive to methicillin.

CONCLUSION

In this study, S. aureus and K. pneumoniae were the highest frequency of isolates. The overall percentage of multidrug resistant isolates was high in this study. Highest degree of resistance was observed in ampicillin against all isolates. Hence much attention is required while diagnosing sepsis among neonates. To analyze the risk for neonatal sepsis, it is not preferable for caesarian mode of delivery. Moreover, frequent screening of mother, suitable prenatal care of newborns with proper clinical interventions isthe key elements to control sepsis.

Bacterial Isolates and Resistance Patterns in Preterm Infants with Sepsis in Selected Hospitals in Ethiopia: A Longitudinal Observational Study

Background: Neonatal sepsis is the third leading cause of neonatal mortality, behind prematurity and intrapartum-related complications. The main objectives of this study are to assess the proportion of sepsis in preterm newborns and identify the etiologic agents and their antibiotic sensitivity patterns. Methods: A longitudinal observational study was done from July 2016 to May 2018. Whenever clinical diagnosis of sepsis was made, blood cultures and antibiotic susceptibility tests were done. Result: We did 690 blood cultures, 255 (36.9%) showing bacterial growth. The most commonly isolated bacteria were Klebsiella species 78 (36.6%), Coagulase negative Staphylococcus 42 (19.7%) and Staphylococcus aureus 39 (18.3%). Gram-positive bacteria showed high resistance to penicillin (98.9%) and ceftriaxone (91.3%) whereas Gram-negative bacteria were highly resistant to gentamicin (83.2%) and ceftriaxone (83.2%). Conclusion: Resistance to the more commonly used antibiotics such as ampicillin and gentamycin was very high, necessitating reconsideration of the empiric use of these antibiotics.

Bacterial etiologic agents causing neonatal sepsis and associated risk factors in Gondar, Northwest Ethiopia

Background

Neonatal sepsis is a blood stream infection which is seen in the first month of life of the neonate. Bacterial profile of neonatal septicemia is constantly changing thus, current knowledge on the patterns of bacterial isolates, its antibiotic resistance profile, and associated factors, are essential to design and implement appropriate interventions. Therefore, the aim of this study was to identify bacterial etiologic agents, their antimicrobial susceptibility pattern and associated risk factors of neonatal sepsis among neonates.

Methods

A cross- sectional study was conducted among neonates suspected to sepsis attending University of Gondar Hospital from September/2015 to May/2016. A total of 251 consecutive neonates with clinical sign and symptoms of sepsis were included in the study. Blood sample was collected and directly inoculated into Trypton soya broth bottle and incubated at 37 °C. After 24 h of incubation it was sub- cultured in to blood agar plate, chocolate agar plate, manitol salt agar and Macconkey. The bacterial pathogens and antimicrobial susceptibility tests were identified using standard microbiological methods. Bivariate and multivariate logistic regressions were used to identify possible associated risk factors. Prior to the study ethical clearance was obtained from the School of Biomedical and Laboratory Sciences, University of Gondar.

Results

Of the 251 study participants suspected of neonatal sepsis, 117 (46.6%) showed bacterial growths, of them 120 bacteria were isolated. Gram positive bacteria were commonly isolated 81 (67.5%).The commonly isolated bacterial species were S. aureus 49 (40.8%) followed by coagulase negative Staphylococci 26 (21.6%) and K. pneumoniae19 (15.8%). The overall rate of multidrug resistance isolates was 78 (65%: CI 95%: 56.7–72.5%). Multidrug resistant (MDR) among Gram positive and negative bacteria were 56 (69.1%) and 22 (56.4%), respectively. Independent risk factors for the occurrence of neonatal sepsis were; Apgar score < 7/5 min (Adjusted odds ratio [AOR] =0.5), birth weight < 1.5 kg (AOR = 12.37), birth weight, 1.5–2.5 kg (AOR = 2.6), gestational week <37 weeks (AOR = 9) and caesarian section delivery (AOR = 5.2).

Conclusion

The isolation rate of bacterial pathogens in neonatal sepsis was considerably high. In addition, nearly 70% of isolates were MDR strains. Low birth weight, low Apgar score, preterm delivery and caesarian section modes of delivery were associated risk factors. Therefore, appropriate antenatal care follow up, and health education should be encouraged, especially on the importance of natural way of delivery.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-017-0892-y) contains supplementary material, which is available to authorized users.