Abstract
BackgroundSepsis is the third most common cause of death among neonates, with about 225,000 newborns dying every year globally. Data concerning the microbial etiology of neonatal sepsis and antimicrobial resistance profiles of its causative agents are necessary to inform targeted and effective treatment and prevention strategies.ObjectiveTo determine the proportion of newborns with symptoms and signs of sepsis who had a positive blood culture, its bacterial etiology, the antimicrobial resistance patterns as well as the factors associated with culture-positivity and case fatality at Mulago national referral hospital in Uganda.MethodsWe conducted a cross-sectional study among 359 neonates with symptoms and signs of sepsis who presented to the pediatric emergency care unit of Mulago national referral hospital from mid-January to end of December 2018. We performed blood culture and antimicrobial susceptibility testing, and conducted polymerase chain reaction to identify methicillin-resistant Staphylococcus aureus (MRSA) isolates. We used multivariable logistic regression to estimate the association between potential risk factors and culture-positive neonatal sepsis.FindingsOf the 359 neonates recruited, 46 (12.8%; 95% CI 9.5%, 16.7%) had a positive blood culture. The predominant isolated bacteria were Staphylococcus aureus in 29 (63.0%), Escherichia coli in seven (15.2%), and Klebsiella pneumoniae in five (10.9%). Of the 46 pathogens, 73.9% were resistant to ampicillin, 23.9% to gentamicin and 8.7% to ceftriaxone. We isolated MRSA from the blood specimens of 19 (5.3%) of the 359 neonates, while 3 (0.8%) grew extended spectrum beta lactamase producers. The case fatality risk among neonates with neonatal sepsis was 9.5% (95% CI: 6.6%, 13.0%). Cesarean section delivery was strongly associated with culture-positive sepsis (adjusted odds ratio 3.45, 95% CI: 1.2, 10.1).ConclusionOne in eight neonates with clinical signs of sepsis grew a likely causative bacterial pathogen. S. aureus was the main pathogen isolated and a third of these isolates were MRSA. A significant proportion of the isolated bacterial pathogens were resistant to the first and second line antibiotics used for the treatment of neonatal sepsis. There is need to revisit the current treatment guidelines for neonatal sepsis.
Highlights
The mortality among children less than 5 years of age has declined considerably over the last two decades, but neonatal mortality remains high, accounting for 2.6 million annual deaths[1]
A significant proportion of the isolated bacterial pathogens were resistant to the first and second line antibiotics used for the treatment of neonatal sepsis
Early-onset sepsis usually results from an infection acquired in utero or during the birth process and group B Streptococcus(GBS) is the most common pathogen causing EOS in high income countries whereas Staphylococcus aureus, Klebsiella species and Escherichia coli are the most common causes in low and middle income-countries[7,8,9]
Summary
The mortality among children less than 5 years of age has declined considerably over the last two decades, but neonatal mortality remains high, accounting for 2.6 million annual deaths[1]. Early-onset sepsis usually results from an infection acquired in utero or during the birth process and group B Streptococcus(GBS) is the most common pathogen causing EOS in high income countries whereas Staphylococcus aureus, Klebsiella species and Escherichia coli are the most common causes in low and middle income-countries[7,8,9]. Surveillance of the etiology of neonatal sepsis and resistance patterns of the causative bacteria is critically important in informing the empirical treatment of neonatal sepsis and in guiding the development of preventive strategies, including the development and deployment of vaccines. This information is important in resource-limited settings where access to blood cultures is limited and if available, often unaffordable. Data concerning the microbial etiology of neonatal sepsis and antimicrobial resistance profiles of its causative agents are necessary to inform targeted and effective treatment and prevention strategies
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