Antimicrobial resistance in bacteria isolated from blood cultures from babies with sepsis in neonatal intensive care units in the Gaza Strip: a cross-sectional study

Abstract

BackgroundNeonates are vulnerable and can quickly develop septicaemia and sepsis. We investigated patterns of bacterial isolates and local antimicrobial resistance in neonates with sepsis. MethodsThis was a hospital-based, cross-sectional study that was done from Nov 1, 2017, to March 31, 2019, in all neonatal intensive care units in Gaza Strip. Neonates with clinical signs of early or lately sepsis were included. A standard disc diffusion technique was used to identify antibiotic resistance after identifying the bacterial isolates from routinely collected blood specimens. All laboratory results for the study variables were documented in a standardised data collection sheet. Characteristics of patients were obtained from the patients’ culture request forms and case notes without access to identifying information. Ethics approval for the study was obtained from the Palestinian Ministry of Heath. Findings4151 blood specimens were screened, and bacterial growth was detected in 333 (8·0%). The main isolated bacteria were coagulase-negative staphylococci (CoNS) in 81 (24·3%) samples, Staphylococcus aureus in 65 (19·5%), Escherichia coli in 46 (13·8%), Acinetobacter sp in 39 (11·7%), and Klebsiella sp in 25 (7·5%). Resistance rates for CoNS were as follows: ampicillin 75·7% (28 of 37 samples tested), cefalexin 56·3% (36 of 64), ciprofloxacin 18·9% (7 of 37), cefotaxime 18.6% (8 of 43), vancomycin 17·2% (ten of 58), gentamycin 15·7% (eight of 51), and amikacin 5·9% (two of 34). For S aureus resistance to ampicillin was seen in 91·7% (22 of 24 samples tested), to ciprofloxacin in 37·5% (15 of 40), to cefotaxime in 37·4% (ten of 27), to gentamycin in 21·4% (six of 28), to vancomycin in 13·3% (four of 30), and to amikacin 6·9% in (two of 29). For E coli resistance rates were cefalexin 67·9% (19 of 28), cefotaxime 62·9% (22 of 35), gentamycin 39·3% (11 of 28), ciprofloxacin 24·3% (nine of 37), and amikacin 15·4% (four of 26), with none of 21 samples tested showing resistance to meropenem. Resistance rates for Acinetobacter sp were ciprofloxacin 93·8% (30 of 32), meropenem 91·3% (21 of 23), cefotaxime 91·3% (21 of 23), gentamycin 86·7% (26 of 30), and amikacin 71·43% (15 of 21), but none of 27 samples tested showed resistance to colistin. Resistance rates of Klebsiella sp were cefalexin 92·9% (13 of 14), cefotaxime 75.0% (12 of 16), gentamycin 50·0% (seven of 14), meropenem 20·0% (two of 10), and amikacin 9·5% (two of 21). InterpretationCoNS, S aureus, E coli, Acinetobacter sp, and Klebsiella sp were the leading causes of bacterial neonatal sepsis in this study. They were highly resistant to first-line and second-line antibiotics. So far, these isolated bacteria remain susceptible to third-line antibiotics. FundingNone.