Late Onset Neonatal Sepsis in Sudan: Incidence, Bacteriological Profiles, Patterns of Antimicrobial resistance and Fatality
Academic Journal of Pediatrics & Neonatology
Introduction Neonatal sepsis refers to systemic and generalized bacterial infection of newborns, documented by a positive blood culture in the first 4 weeks of life with high mortality rates in developing countries. It is characterized by fever, hypothermia, malaise, tachycardia, hyperventilation, toxicity and/or prostration which results from circulating multiplying bacteria. Neonatal sepsis is an important cause of mortality and morbidity and is a life-threat ening emergency where prompt
... y where prompt antibiotics treatment is essential for favorable outcomes. It accounts for 30-50% of total neonatal deaths each year. Neonatal sepsis is classified into early (EOS) and late onset (LOS) on the basis of presentation within 72 hours or after 72 hours to 30 days of life respectively. The timing of the transition from EOS to LOS is not clear-cut and depends on the causative pathogen. The causative organisms of neonatal sepsis vary from Abstract Objective: Neonatal sepsis is a systemic bacterial infection of newborns with high mortality rates in developing countries. This study aimed to determine the incidence, bacteriological profiles, antibacterial susceptibility patterns and mortality of neonates with septicemia in ICUs of a referral maternal hospital in Sudan. Materials and Methods: Following parents' consent, neonates with clinical suspicion of septicemia were enrolled [n=317]. Blood cultures were collected. Identification of organisms and their antibacterial susceptibility patterns were done. Results and Discussion: The incidence of septicemia was calculated at 14.6% (146/1000 neonates/year). Around half (149/317; 47.0%) of neonates had positive blood cultures, more than half (55.7 %; 83/149) grew one organism, while 44.3% (66/149) had poly-microbial infections. A fifth (29/149, 19.5 %) of culture-proven septicemic neonates perished the majority (62%, 18/29) due to K. pneumoniae. Hospitalization for more than 7 days (OR: 5.7, 95% CI: 3.3-9.7), low birth weight [1500-2499 grams] (OR: 4.5, 95% CI2.7-7.6) and prematurity (OR: 3.8, 95% CI: 2.05 -5.56) were incriminated in culture positive neonatal septicemia. Pseudomonas spp. were seen in about a third (34.2%, 76/222), Staphylococcus aureus in 22% (49/222) and Klebsiella spp. in 15.8% (35/222). Staphylococci were highly sensitive to Vancomycin and Meropenem, high levels of resistance to the penicillin G, cephalosporins and aminoglycosides were detected among gram negative bacteria. Conclusion: Neonatal septicemia incidence and mortality rate were 146/1000 neonates/day and 195 deaths/ 1000 live births respectively. Pseudomonas spp, S. aureus and Klebsiella spp. were the commonest organisms. Hospitalization for >7 days, low birth and pre-maturity were important risk factors. Blood sampling and processing: Blood samples were drawn aseptically, 2mls of venous blood were collected and immediately inoculated directly into a tube containing Thioglycollate broth. Samples were incubated aerobically at 37 °C for18-24 hours and were examined daily for 7 days for visible signs of bacterial growth as manifested by turbidity in the media above the red cell level, gas production, heamolysis or/and coagulation of the broth.