Abstract
BackgroundAntimicrobial resistance is one of the major public health emergencies worldwide, and this trend didn’t spare developing countries like Ethiopia. The objective of this study was to evaluate patterns of bacterial isolates and local antimicrobial susceptibility patterns in neonatal sepsis.MethodsA hospital based observational study was conducted from April 2016 to May 2017 in Asella teaching and referral hospital (ATRH). A total of 303 neonates with clinical sepsis were included. Collected data were entered into EPI-INFO version 3.5.1 for cleanup; and then exported to SPSS version 21 for further analysis. Frequencies and proportion were used to describe the study population in relation to relevant variables.ResultsBacterial growth was detected in 88 (29.4%) of blood cultures. Predominantly isolated bacteria were coagulase negative staphylococci (CoNS) 22 (25%), Escherichia coli (E.Coli) 18 (20.5%) and Staphylococcus aureus 16 (18%). Resistance rates of S. aureus and CoNS against Ampicillin were 11 (69%) and 20 (91%) respectively. The resistance rate of E. coli against Ampicillin and Gentamycin were 12 (66.7%) and 10 (55.6%) while Klebsiella spp. resistance rate gets much higher against these two first line antibiotics [10 (91%) and 9 (82%) respectively]. Similarly, both Gram-positive and Gram-negative bacteria isolates were also highly resistant to third generation Cephalosporins, and 63 (72%) isolated bacteria showed multidrug-resistance. However; Gram-positive bacteria isolates had better susceptibility patterns to third line antibiotics like Clindamycin, Vancomycin and Ciprofloxacin while Gram-negative isolates had a higher susceptibility to Ciprofloxacin and Amikacin.ConclusionCoNS, S. aureus, E. coli and Klebsiella spp. were the leading bacterial causes of neonatal sepsis in our study. They were highly resistant to first- and second-line empiric antimicrobial treatment used at NICU (Neonatal intensive care unit), reducing the antimicrobial choices for management of neonatal sepsis. Fortunately, the mentioned isolated bacteria remained susceptible to third line antibiotics used to treat neonatal sepsis.
Highlights
Antimicrobial resistance is one of the major public health emergencies worldwide, and this trend didn’t spare developing countries like Ethiopia
A hospital-based observational study was conducted from April 2016 to May 2017at Asella teaching and referral hospital (ATRH) being a federal referral hospital located in Arsi zone, Oromia region, south east Ethiopia
When looking at bacteria isolates disaggregated to the age of neonates at presentation, 37 (42.4%) bacteria isolates were identified from Early onset sepsis (EONS) while 54 (61.2%) from Late onset sepsis (LONS) which is statistically significant (p = 0.001). neonates born to mother who took antibiotic during labor and delivery were having two-fold reduced risk of acquiring EONS compared to LONS [AOR 2.02
Summary
Antimicrobial resistance is one of the major public health emergencies worldwide, and this trend didn’t spare developing countries like Ethiopia. Neonatal mortality contributes significantly to the infant mortality rates in developing countries, various conditions are responsible for neonatal mortality among which neonatal sepsis accounts for variable figures ranging from 26 to 50% [1,2,3,4]. There is a significant geographical diversity of bacteria causing neonatal sepsis and the spectrum is constantly changing over time, even in the same place [5,6,7]. Reports of multidrug-resistant bacteria causing neonatal sepsis in developing countries are increasing, in intensive care units. The clinical signs and symptoms of neonatal sepsis are subtle and nonspecific, making early diagnosis difficult and leading to high rate of empiric antibiotic utilization which could contribute for the selection and spread of antimicrobial resistant strains of bacteria. Targeted antibiotic therapy plays a significant role in reduction of antimicrobial resistance [5, 6]
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