Neonatal sepsis in Sana\u2019a city, Yemen: a predominance of Burkholderia cepacia

Adeeb Salah,Fawaz Alobathani,Ola Alnadhari,Abdullah Almikhlafy,Talal Alwajeeh,Abdulhabib R Alqubaty,Waleed Farie,Ibrahim Al-Subol,Mohmmed A K Mahdy,Ali Alhaj,Dalal Sulieman,Ahmed Hudna

doi:10.1186/s12879-021-06808-y

Abstract

BackgroundNeonatal sepsis is a global concern with increasing morbidity and mortality. The burden of neonatal sepsis is highest in developing countries, especially in those lacking proper surveillance systems. The causative pathogens and their drug-resistance levels vary between countries with emergence of multidrug resistance organisms. Thus, accurate records on the recent trends of organisms causing neonatal sepsis will provide vital information for appropriate intervention. We aimed to investigate neonatal sepsis, identify its associated factors and causative pathogens and to assess the antibiotic susceptibility patterns in Sana’a city, Yemen.MethodsA cross-sectional study was conducted on neonates admitted to intensive care units of six hospitals in Sana’a city, Yemen, in the period from January 15, to March 30, 2020. Natal and prenatal medical data were collected using well-structured questionnaire. Neonates were subjected to sepsis work-up including blood culture, complete blood count and C-reactive protein. Organisms were identified by Gram staining and analyzed by the VITEK II system for bacterial bio-typing and antibiotic susceptibility testing.FindingsOf the 199-neonates with suspected neonatal sepsis, 154 (77.38%) had culture-proven sepsis. Early-onset neonatal sepsis (EOS) was higher (50.25%; 100/199) than late-onset neonatal sepsis (LOS) (27.13%; 54/199). Multivariable analysis identified vaginal delivery as an independent risk factor for neonatal sepsis p = 0.005. Majority of isolated bacteria (74.39%) were gram-negative with Burkholderia cepacia (39%) and Klebsiella oxytoca (13%) being the most common pathogens of EOS and LOS. The most common gram-positive pathogens were Staphylococcus haemolyticus (9.1%) and Staphylococcus epidermidis (7.1%). B. cepacia showed multidrug resistance except for cefepime. All Klebsiella species isolates (100%) and most Pantoea species (93%) were ESBL and carbapenemase positive. All Escherichia coli and Acinetobacter baumannii isolates were ESBL positive. A significant number of gram-positive bacteria showed resistance to vancomycin.ConclusionThe study findings show a high proportion of neonatal sepsis among neonates admitted to hospitals in Sana’a city with antibiotic-resistant B. cepacia being the single most common pathogen causing EOS and LOS. Findings also emphasize the emerging threat of multidrug-resistant bacteria in neonatal units and will help develop evidence-based management of neonatal sepsis in Yemen.

Highlights

Neonatal sepsis is a global concern with increasing morbidity and mortality
Staphylococcus species showed resistance to fluoroquinolones. In this multicentric cross-sectional study we report a high proportion of culture-confirmed neonatal sepsis, accounting for two-thirds (77.38%) of admitted neonates in the referral hospitals in Sana’a city in Yemen
Early-onset neonatal sepsis (EOS) was more common than late-onset neonatal sepsis (LOS) and B. cepacia emerged as the predominant causative organism of both EOS and LOS

Summary

Introduction

Neonatal sepsis is a global concern with increasing morbidity and mortality. Neonatal sepsis is a leading cause of neonatal morbidity and mortality worldwide. The global burden of neonatal sepsis and other neonatal infections was estimated. Neonatal sepsis is responsible for more than 50% of neonatal deaths. It includes EOS, which occurs within 72 h after birth and LOS [2]. B. cepacia, a bacterial pathogen that has intrinsic drug resistance and ability to live inside drug products [10, 11], has emerged as a significant pathogen causing neonatal sepsis [12,13,14,15,16]

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