Abstract
Background:Neonatal sepsis is a significant cause of neonatal mortality in developing countries. The aetiological agents and their antimicrobial susceptibility patterns are dynamic.Objectives: This study determined clinical features, aetiology, antimicrobial susceptibility and clinical outcome of neonatal sepsis in a Nigerian Tertiary Hospital.Methods: Neonates undergoing sepsis evaluation at a Nigerian Tertiary Hospital were included in the study. Demographic and clinical information were obtained using standard questionnaires. Blood samples were cultured on MacConkey, Blood and Chocolate agar. Isolated bacteria were identified based on morphology, Gram stain appearance and standard commercially prepared biochemical tests. Antimicrobial susceptibility testing was performed on Mueller-Hinton agar using the Kirby-Bauer method.Results: Eighty-five of the 180 neonates admitted during the study period were recruited. Fifty-five neonates presented with early-onset sepsis and 30 with late-onset sepsis. Culture-proven sepsis was detected in 19 (22.4%) neonates. The incidence of culture-proven sepsis in the hospital was 2.8/100 live-births. The most common clinical feature at presentation was respiratory distress. Gram-negative bacteria accounted for 78.9 percent of all isolates and were the only organisms encountered in earlyonset sepsis. Isolated pathogens were predominantly Klebsiella spp (31.6%), Enterobacter spp (21.1%) and coagulase-negative Staphylococci (15.8%). The isolates were most sensitive to ofloxacin. Gram-negative bacteria showed high resistance to cefuroxime and ampicillin. The case-fatality rate was 26%.Conclusion: Gram-negative bacilli, especially Klebsiella spp, was predominant. Neonatal sepsis persists as a cause of mortality in this region. Regular antimicrobial surveillance for empirical treatment remains an important component of neonatal care.
Highlights
Neonatal sepsis is a significant cause of neonatal mortality in developing countries
Gram-negative bacteria accounted for 78.9 percent of all isolates and were the only organisms encountered in earlyonset sepsis
The highest mortality rates for newborns are found in the poorest countries and a third of these deaths are attributed to infections acquired by the baby during labour and delivery or after birth.[1]
Summary
Neonatal sepsis is a significant cause of neonatal mortality in developing countries. Objectives: This study determined clinical features, aetiology, antimicrobial susceptibility and clinical outcome of neonatal sepsis in a Nigerian Tertiary Hospital. Gram-negative bacteria accounted for 78.9 percent of all isolates and were the only organisms encountered in earlyonset sepsis. About forty percent of under-five deaths occur in the neonatal period resulting in 2.9 million newborn deaths each year.[1] The highest mortality rates for newborns are found in the poorest countries and a third of these deaths are attributed to infections acquired by the baby during labour and delivery or after birth.[1] Nigeria accounts for the highest number of neonatal deaths in Africa and third in the world (after India and China) with sepsis responsible for about 30% to 50% of deaths.[2] In Nigeria, the prevalence of neonatal sepsis reported from previous hospital-based studies ranges between 7.04 and 22.9 per 1 000 live births.[3] mortality rates from neonatal sepsis have ranged from 26.7% in Abakaliki, to 32.2% in Sagamu and 33.3% in Ile-Ife, over the last two decades.[4]. Neonatal sepsis could be from early onset, within the first 72 h of life, and presumed to be acquired through prenatal and intrapartum maternal transmission, or late onset from the fourth day to fourth week of life.[5]
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