Patterns in neonatal sepsis at the University Hospital of the West Indies

Abstract

Background: Neonatal sepsis is associated with significant morbidity and mortality especially in the resource limited setting. Although annual global estimates of neonatal sepsis approximate 3 million cases, the lack of standardized data from the developing nations affects these estimates of the burden of sepsis. This study seeks to give an update on current rates, associated factors, etiologies and resistance patterns associated with neonatal sepsis at the University Hospital of the West Indies, in Kingston Jamaica. Methods & Materials: Retrospective analysis of all results of blood, urine and cerebrospinal fluid cultures from neonates born and admitted to the institution between September 2015 and September 2018 was conducted. This was facilitated using data collected from the laboratory information system and physical docket review, which specifically examined antenatal conditions, perinatal factors, and management while on the nursery. All organisms resistant to at least one antibiotic from 3 or more classes was deemed multidrug resistance (MDR). Designation was also made for extended drug resistant (XDR) and pan drug resistant (PDR) organisms. Results: During the study period 2854 samples were received with a total of 190 positives (6.7%) of which 89 were from blood, 85 from urine and seven were from cerebrospinal fluid. These positive isolates were from a total of 145 patients. Male infants born at term contributed the majority of cases. The most commonly isolated organism was Coagulase negative Staphylococcus (23%) followed by Klebsiella pneumoniae (19%). Other organisms included E. coli (15%), Enterobacter spp. (7%) and Enterococcus spp. (7%). More than half (56%) of the isolates were regarded as sensitive, while another 31% were within the resistant spectrum. Caesarean section, rupture of membranes >18 h and Apgar score at one minute ≥7 was associated with higher incidence of early onset sepsis (most common form). Early onset sepsis also had a higher association with MDR organisms. Conclusion: It is important to recognize the trends of neonatal sepsis and create institutional management policies related to this and antibiogram data. Resistance is an increasing problem globally and is particularly unsettling in resource limited nations. The institution of an electronic hospital information system would greatly improve data collection opportunities for future surveillance and research.