Neonatal Sepsis, Antibiotic Susceptibility Pattern, and Treatment Outcomes among Neonates Treated in Two Tertiary Care Hospitals of Yangon, Myanmar from 2017 to 2019.

Nan Aye Thida Oo,Prajjwal Pyakurel,Jeffrey K Edwards,Thae Maung Maung,Pruthu Thekkur,Hla Myat Nwe,Nant San San Aye

doi:10.3390/tropicalmed6020062

Abstract

Neonatal sepsis is a leading cause of morbidity and mortality in developing countries. This study aimed to assess the proportion of culture-confirmed sepsis, bacteriological pathogen profile, culture report turnaround times, antibiotic susceptibility patterns, and treatment outcomes of all with neonatal sepsis admitted in two tertiary care hospitals in Yangon, Myanmar, 2017–2019. This was a cross sectional study utilizing a standardized electronic database and paper-based records. Bacteriological profiles and associated factors were analyzed with descriptive statistics and Poisson Regression. Of those with suspected sepsis, 42% were bacteriologically confirmed and 74% of confirmed sepsis was resistant to at least first-line antibiotics. Neonates with late onset sepsis (LOS) (aPR: 1.2 (95% CI: 1.1–1.4, p = 0.008)) were more likely to have bacteriologically confirmed sepsis (45%) versus early onset sepsis (38%). Gram-negative organisms were most commonly isolated (63%), associated with multidrug-resistant organisms and with a high case-fatality rate (64%). These findings suggest that enhanced national guidance regarding infection control and prevention, antibiotic stewardship, and first-line antibiotic choices need to be provided. The link between LOS with infection and prevention protocols needs to be further explored in this context to decrease sepsis risk, neonatal mortality, and reduce further antimicrobial resistance.

Highlights

Neonatal sepsis is a leading cause of morbidity and mortality in the pediatric age group and, despite recent advances for neonatal care, there has been limited progress in mortality reduction [1]
There were 10,935 neonatal intensive care unit (NICU) admissions, of which 1705 (15.6%) were neonates with suspected neonatal sepsis admitted from January 2017 to December 2019 to either Yankin Children’s Hospital (YCH) or Central Women’s Hospital (CWH) and included in this study (Table 2)
The key findings from our study include: (1) 42% of neonates admitted for concern of sepsis were bacteriologically confirmed, (2) 74% of neonates with bacterial sepsis were resistant to first-line antibiotics, (3) the proportion of first-line antibiotic resistance progressed from 66% in the first year to 81% in the third year, (4) there was a higher proportion of neonates with antibiotic-resistant bacterial sepsis secondary to Gram-negative organisms (68%) than Gram-positive (37%), and (5) late onset sepsis (LOS) was more frequent (45%) than early onset sepsis (EOS) (38%)

Summary

Introduction

Neonatal sepsis is a leading cause of morbidity and mortality in the pediatric age group and, despite recent advances for neonatal care, there has been limited progress in mortality reduction [1]. Neonatal sepsis is the eighth leading cause of under-five mortality globally, accounting for more than one million deaths globally [2]. The World Health Organization (WHO) estimates that neonatal sepsis has an incidence of 7–38/1000 live births in Asia [2]. It remains one of the three most frequent causes of neonatal death in developing countries [3] and is a focus of the United Nations’ Sustainable Development Goal #3 [4]. There has been a decrease in the neonatal mortality rate (NMR) within Myanmar (from 41 in 1998 to 25 per 1000 live births in 2016). The Myanmar NMR remains one of the highest among Asian countries [5]

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