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???metadata.dc.contributor.*???: Dr. Daniel Asrat Associate professor (MD, MSc, PhD)
Dr. Yimtubezinash W/Amanuel Associate professor (MD, MSc, PhD)
Keywords: Ethiopia;antimicrobial susceptibility pattern;risk factors;bacterial pathogens;clinical features;Neonatal sepsis
Issue Date: 3-May-2012
Publisher: aau
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 Collections:Thesis - Medical Microbiology

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