Bacterial Bloodstream Infections in Neonates in a Developing Country

Daynia E Ballot,Charlotte Sriruttan,Peter A Cooper,Trusha Nana

doi:10.5402/2012/508512

Daynia E Ballot, Charlotte Sriruttan + Show 2 more

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https://doi.org/10.5402/2012/508512

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Abstract

Background. Ongoing surveillance of antimicrobial sensitivity patterns of bacteria isolated in bloodstream infections guides empiric antibiotic therapy in neonatal sepsis. Methods. Sensitivity profiles of neonatal bacterial bloodstream infections in a tertiary hospital were reviewed between 01/06/2009 and 30/06/2010 . Results. There were 246 episodes of bloodstream infection in 181 individuals—(14.06 episodes in10.35 patients/1000 patient days or 14.4 episodes in 10.6 babies/1000 live births. The majority were (93.5%) were late onset and most (54.9%) were gram positive. There were 2.28 sepsis-related deaths /1000 patient days or 2.3/1000 live births. Death was significantly associated with gram-negative infections (P < 0.001), multiple gestation (P < 0.001), shock (P = 0.008), NEC (P = 0.002), and shorter duration of hospital stay (P < 0.001). Coagulase-negative staphylococcus was isolated in 19.1%, K. pneumoniae ESBL in 12.1%, and A. baumanni in 10.9%. S. agalactiae predominated in early onset sepsis. Methicillin resistance was present in 86% of CoNS and 69.5% of S. aureus; 46% enterococcal isolates were ampicillin resistant. The majority (65%) of K. pneumoniae isolates were ESBL producers. Ampicillin resistance was present in 96% of E. coli. Conclusions. Penicillin and an aminoglycoside would be suitable empiric therapy for early onset sepsis and meropenem with gentamycin or ceftazidime with amikacin for late onset sepsis.

Highlights

Ongoing surveillance of antimicrobial sensitivity patterns of bacteria isolated in bloodstream infections guides empiric antibiotic therapy in neonatal sepsis
The aim of this study was to describe bacterial isolates from blood cultures obtained from the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) neonatal unit, to review antibiotic sensitivity patterns, and to provide guidelines for empiric antibiotic therapy for neonatal sepsis in a developing country
Infections were classified as early onset (EOS) if the positive culture was obtained before 72 hours of life and late onset (LOS) if the positive blood culture was obtained after 72 hours of life

Summary

Introduction

Ongoing surveillance of antimicrobial sensitivity patterns of bacteria isolated in bloodstream infections guides empiric antibiotic therapy in neonatal sepsis. Neonatal sepsis has significant morbidity and mortality and is difficult to diagnose on presentation. For this reason, those with suspected sepsis are commenced on empiric antibiotic therapy until sepsis can be ruled out. Overuse of antibiotics results in the development of antimicrobial-resistant organisms (ARO). Infection with ARO results in delay in starting effective antibiotic therapy, fewer possible treatment options and increased morbidity and mortality, with prolonged hospital stay and greater costs of hospitalisation [1]. Antibiotic stewardship, including appropriate choice and administration of antibiotics, deescalation of therapy, and a multidisciplinary team approach to managing neonatal sepsis, is recommended to limit inappropriate antibiotic use and prevent the development of ARO [1]

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