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|Title: ||NEONATAL SEPSIS: BACTERIAL ETIOLOGIC AGENTS AND THEIR ANTIBIOTIC SUSCEPTIBILITY PATTERN IN TIKUR ANBESSA UNIVERSITY HOSPITAL, ADDIS ABABA, ETHIOPIA.|
|Authors: ||DEMISSIE, SHITAYE|
|Advisors: ||Dr. Daniel Asrat Associate professor (MD, MSc, PhD)|
Dr. Yimtubezinash W/Amanuel Associate professor (MD, MSc, PhD)
antimicrobial susceptibility pattern
|Copyright: ||Oct-2008 |
|Date Added: ||3-May-2012 |
|Abstract: ||BACKGROUND: Neonatal sepsis is one of the most common reasons for admission to
neonatal units in developing countries. It is also a major cause of mortality in both developed
and developing countries. The type and pattern organisms that cause neonatal sepsis changes
over time and vary from one hospital to another hospital, even in the same country. In
addition the causative organisms have developed increased drug resistance for the last two
decades. Maternal, neonatal and environmental risk factors have contributed for the
development of sepsis.
OBJECTIVES: This study was undertaken to determine the pattern of bacterial agents
causing neonatal sepsis and to assess their susceptibility pattern to various antimicrobial
agents in the Ethiopian setting. An attempt has been also made to identify the possible
maternal and neonatal risk factors responsible for neonatal septicemia.
METHODS: During the period of October 2006 and March 2007 a cross-sectional
prospective study was conducted at the Department of Pediatrics and Child Health, Ethio-
Swedish Children’s Hospital, Addis Ababa, Ethiopia. Blood cultures were performed from
newborn babies (n=302, age: 0-28 days) admitted to the hospital with a clinical diagnosis of
neonatal sepsis. Antimicrobial susceptibility testing was performed for all blood culture
isolates according to the criteria of the National Committee for Clinical Laboratory Standards
by disk diffusion method.
RESULTS: Of the 302 patients, 46.4% were males and 53.6% were females (p >0.05)
resulting in an overall male to female ratio of 0.8:1. The mean age of the neonates was 1.23 ±
8.96 days and 70.2% of neonates were below age of 1 day. A total of 298 (98.7%) neonates
presented with early-onset sepsis (EOS) and four (1.3%) presented with late-onset sepsis
(LOS). Out of the 302 neonates, 57.3% were preterm and 62.7% had low birth weight. The
most prevalent clinical features of sepsis were hypothermia (84.8%), respiratory distress
(72.8%), failure to feed (71.5%) and lethargy (30.1%). Among the 302 neonates admitted
with suspected cases of sepsis, 59 (19.5%) had abnormal white blood cell count (high and
low). Immature/total neutrophil ratio > 0.2 and <0.2 was observed in 58.0% and 42.0%
peripheral blood smear examined respectively. Of the 302 neonates investigated for sepsis,
135 (44.7%) were positive for blood culture. The Gram-positive and negative bacteria
accounted for 43.7% and 56.3% respectively (p> 0.05). The most common isolated organisms
were Klebsiella spp. (39.2%) and Staphylococcus aureus (22.2%). Neonatal risk factors such
as prematurity, low birth weight, abnormal WBC count (high and low) and I:T ratio > 0.2
were strongly associated with culture proven neonatal sepsis. No maternal risk factors were
identified. In general both gram positive and negative bacteria isolated from blood culture
showed low resistance rates (<60%) to ciprofloxacin, doxycycline, kanamycin, streptomycin,
trimethoprim-sulphamethoxazole and tetracycline. Gram-negative bacteria showed high-level
resistance (>80%) to ampicillin, ceftriaxone, cephalothin, chloramphenicol, and gentamicin.
Ciprofloxacin was the most effective drug against the tested gram-positive and gram-negative
bacteria. Multiple resistance (resistance to two or more drugs) was observed in 45.7% and
84.2% gram positive and gram negative bacteria respectively (p<0.05).
CONCLUSION AND RECOMMENDATIONS: Klebsiella spp. and S. aureus were the
most common organisms causing neonatal sepsis. Prematurity, low birth weight, abnormal
WBC counts and I: T ratio > 0.2 were strongly associated with blood culture proven neonatal
sepsis. Gram-negative bacteria showed high level of resistance to commonly used antibiotics.
Ciprofloxacin was the most effective drug when compared to other drugs tested against the
gram-positive and gram-negative bacteria. Multi-drug resistance detected in 67.4% isolates.
The detection of multi-drug resistant isolates may further limit therapeutic options. Routine
bacterial surveillance and the study of their resistance patterns must be an essential
component of neonatal care. A knowledge of these patterns is essential when local polices on
the uses of antibiotics are being devised.|
|Appears in:||Thesis - Medical Microbiology|
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