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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 3  |  Page : 74-78

Bacteriological profile and antibiotic susceptibility pattern of neonatal sepsis at soba university hospital: A descriptive retrospective study


1 Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
2 Department of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
3 Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan

Date of Submission05-Jan-2020
Date of Decision14-May-2020
Date of Acceptance22-May-2020
Date of Web Publication14-Jul-2020

Correspondence Address:
Dr. Bashir Alsiddig Yousef
Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Al-Qasr Ave., Khartoum 11111
Sudan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MTSM.MTSM_12_20

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  Abstract 


Background: Neonatal sepsis is one of the most common causes of neonatal mortality and morbidity. Before getting the culture results, it is necessary to initiate empirical antibiotics based on the epidemiology of causative agents and antibiotic sensitivity patterns in the area. Our study aimed to determine the bacteriological profile of common etiologic agents of neonatal sepsis and their antibiotics-sensitivity pattern. Methodology: This study was a descriptive, cross-sectional, retrospective hospital-based survey of 250 neonates' reports with positive blood culture, which was carried out in the Department of Clinical Microbiology and Parasitology of Soba University hospital from January 1, 2017, to July 31, 2017. The data were collected by using a predesigned checklist and were analyzed by using the Statistical Package for the Social Sciences. Univariate, as well as multivariate analysis, were performed in this study to analyze the data. Results: Gram-negative bacteria were commonly isolated (56%). The most frequently isolated organism was Staphylococcus aureus(34.8%) followed by Pseudomonas species (33.6%) and Klebsiella species (15.2%). Moreover, overall sensitivity among Gram-negative isolates was to imipenem (87.1%), followed by ciprofloxacin (84.7%) and amikacin (75.9%), whereas Gram-positive isolates had a high sensitivity of (93.6%) to vancomycin. Conclusion: Among the studied samples, the most frequently isolated organism was S. aureus. The overall sensitivity among Gram-negative isolates was higher to imipenem ciprofloxacin and amikacin, whereas Gram-positive isolates had a high sensitivity to vancomycin.

Keywords: Antibacterial susceptibility, antimicrobial agents, bacteriological profile, blood culture, neonatal sepsis


How to cite this article:
Abdelsalam KB, Badi S, Yousef BA. Bacteriological profile and antibiotic susceptibility pattern of neonatal sepsis at soba university hospital: A descriptive retrospective study. Matrix Sci Med 2020;4:74-8

How to cite this URL:
Abdelsalam KB, Badi S, Yousef BA. Bacteriological profile and antibiotic susceptibility pattern of neonatal sepsis at soba university hospital: A descriptive retrospective study. Matrix Sci Med [serial online] 2020 [cited 2020 Dec 1];4:74-8. Available from: https://www.matrixscimed.org/text.asp?2020/4/3/74/289729




  Introduction Top


Neonatal sepsis is defined as a systemic inflammatory response to infection and/or isolation of the bacterial pathogen from blood in the first 28 days of life. The systemic inflammatory response also describes a clinical syndrome in which there are two or more of the following symptoms: Fever, hypothermia, tachycardia, tachypnea, and abnormal white blood cells in immature form.[1],[2] Neonatal sepsis is one of the most common causes of neonatal morbidity and mortality, and it is estimated to cause 26% of all neonatal deaths worldwide, three-quarters of these neonatal deaths occur in developing countries.[3],[4] Based on the neonate age, neonatal sepsis is categorized to early-onset or late-onset sepsis. Early-onset sepsis is highly allied to birth canal acquisition and maternal risk factors, whereas the late-onset sepsis is related to environment, and either acquired from the hospital or community.[5] The risk factors include prolonged rupture of membranes, preterm labor, maternal pyrexia, unhygienic intrapartum and postnatal care, and low-birth weight.[6],[7] The etiology of neonatal sepsis in developed and developing countries is varied that may reflect true variances in disease epidemiology.[8] Gram-negative organisms are more common and are mainly represented by Klebsiella, Escherichia coli, Pseudomonas, and Salmonella. Of the Gram-positive organisms, Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus pneumoniae, and Streptococcus pyogenes are most commonly isolated.[9],[10],[11],[12]

In neonates, early warning symptoms of neonatal sepsis are often slight, but the clinical course may be fulminant. Therefore, antimicrobial treatment of neonates with suspected sepsis must start without delay.[13] The selection of initial empirical antimicrobial depends on the spectrum of the antibiotics to cover the most likely pathogens in the given unit.[14],[15] In case of community-acquired infections that are mainly caused by sensitive strains, the combination of ampicillin or penicillin with gentamicin considered as the first-line therapy, whereas for hospital-acquired infections that due to resistant pathogens are mainly treated with a combination of newer generation of cephalosporins and aminoglycosides.[15] Nevertheless, due to the emergence of resistance, the preferable antibiotics have also changed to other antimicrobial agents or the use of different combination as empirical therapy. Therefore, the selection of suitable antibiotics is varied according to the institutional guidelines based on the epidemiology of causative microorganisms and antibiotic sensitivity patterns for these agents in the area.[16],[17]

Nowadays, neonatal sepsis becomes a potential clinical problem due to high neonatal morbidity and mortality, and the emergence of drug resistance of organisms causing neonatal sepsis. Notably, in the developing countries such as Sudan, because of the irrational prescribing of antibiotics, lack of legislation, and poor sanitary conditions.[18] Therefore, there is a need for surveillance to understand the trends in pathogens causing neonatal sepsis and the antibiotic susceptibility profile of those pathogens in a particular area. Thus, this study was conducted to determine the common bacterial agents associated with neonatal sepsis and their antibiotic susceptibility pattern in Soba University Hospital.


  Methodology Top


Study setting

This study was a retrospective, descriptive, cross-sectional hospital-based survey involving the review of patients' laboratory records and files. The study was conducted at the microbiology laboratory and records department of Soba University Hospital, Khartoum, Sudan. All neonates' reports with positive blood culture done between January 1, 2017 and July 31, 2017 were included in this study.

Inclusion and exclusion criteria

All neonates (0–28) days with positive blood culture, as well as all neonates, admitted to the Nursery Intensive Care Unit with positive blood culture, were included in the study. Neonates in the KWASH unit (Unit of Patients with Malnutrition), any reports with unknown age were also excluded from the study.

Data collection tool

A predesigned checklist was used to collect the data. It consisted of the isolated microorganisms, and the list of different antibiotics that tested against various microorganisms, and the results were sensitive or resistant to them.

Sampling method and sample size

The total coverage of all neonates' reports with positive blood culture during the study period was used. The sample size in this study was 250 neonates' records.

Data analysis

Data were analyzed by the international business machines (IBM). Statistical Package for the Social Sciences (SPSS) for Windows, version 24.0 software (Armonk, NY, USA: IBM Corp). Descriptive statistics (frequency tables) and bivariate analysis (Chi-square) were done. P ≤ 0.05 was considered statistically significant in comparative data.

Ethical consideration

The ethical clearance (FPEC-15-2018) was obtained from the Ethical Committee of the Faculty of Pharmacy, University of Khartoum. Additional approval was obtained from the Soba University Hospital. All collected data were coded with ensuring confidentiality throughout the study.


  Results Top


During the study period, a total of 250 culture results were recruited, as shown in [Table 1], 140 (56%) of the isolated organisms were gram-negative, while 110 (44%) were gram-positive. The most frequently isolated organism was S. aureus 87 (34.8%) followed by Pseudomonas species 84 (33.6%) and Klebsiella species 38 (15.2%).
Table 1: Distribution of different types of isolated microorganisms among the studied population (n=250)

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Regarding the sensitivity pattern of the isolated microorganisms to different antibiotics, S. aureus was highly sensitive to vancomycin and highly resistant to oxacillin and erythromycin. Whereas Pseudomonas species was highly sensitive to ciprofloxacin and imipenem, and highly resistance to ceftazidime and gentamycin. Moreover, Klebsiella species was highly sensitive to imipenem and amikacin, and highly resistant to ceftazidime and cefuroxime, and this may be due to the number of Klebsiella isolates tested against antibiotics is too small to warrant any reasonable conclusion. Enterococcus faecalis was highly sensitive to amoxicillin/clavulanic acid and vancomycin and highly resistant to co-trimoxazole. On the other hand, all isolated E. coli were sensitive to imipenem and amikacin, and highly resistant to cephalexin, ampicillin and cefuroxime, and this may be due to the number of E. coli isolates tested against antibiotics is too small to warrant any reasonable conclusion [Table 2].
Table 2: Sensitivity and resistance pattern of selected microorganisms

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When looking at the overall sensitivity of Gram-negative isolates, we found that 87.1%, 84.7%, 75.9%, and 57.6% of Gram-negative isolates were sensitive to imipenem and ciprofloxacin, amikacin and co-trimoxazole (P = 0.001,0.000, 0.000 and 0.000), respectively. Whereas, 86%, 85.4%, 83%, and 79.1% of Gram-negative isolates were resistant to cephalexin, ceftazidime, ceftriaxone, and ampicillin, respectively (P = 0.000). Furthermore, 93.6%, 70.4%, and 71.4% of Gram-positive isolates were sensitive to vancomycin, tetracycline, and amoxicillin/clavulanic acid, respectively (P values = 0.000). While 77.3% and 71.4% of Gram-negative isolates were resistant to oxacillin and erythromycin, respectively (P = 0.000) [Table 3].
Table 3: Susceptibility of different Gram-positive and Gram-negative isolated microorganisms to different antibiotics

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  Discussion Top


Neonatal sepsis is a life-threatening emergency, and the delay in diagnosis and treatment with appropriate antibiotics may have devastating consequences.[18] Therefore, a surveillance study is needed to identify the common pathogens of neonatal sepsis as well as the antibiotic susceptibility profile of the pathogens in a particular hospital. During the study period, 250 neonates with positive blood culture for sepsis were enrolled, Gram-negative bacteria was more common than Gram-positive bacteria, which is in agreement with the reports about the causing microorganism from Iran and Ethiopia.[19],[20] However, this finding is opposite to a previous report done in 2018 for neonatal sepsis culture from the same hospital.[21] The main reasons for this variation could be due to the different time for collecting the data, in addition to the variation in adherence to infection prevention and control measures.

Furthermore, S. aureus remains the main neonatal pathogen in developing countries, responsible for 8%–22% of bloodstream isolates in different regions, and the main source of spread of infection is the hands of health-care providers.[22] Similarly, we observed that S. aureus to be the predominant bacterial isolates, and this is similar to previous reports from Sudanese hospitals.[7],[21],[23] However, in the developed countries, Group B Streptococcus and coagulase-negative staphylococci are the predominant causes of sepsis.[24] The variation in the major isolate could be due to the differences in the study setting, study population, and adherence to hand hygiene practices.[10] Furthermore, the most common Gram-negative bacteria identified in this study were Pseudomonas (33.6%). It is also the second-most predominant cause of neonatal sepsis in our study next to S. aureus. Whereas, Klebsiella was the predominant identified Gram-negative bacteria in Omdurman maternity hospital.[23],[25] While, the lower incidence of E. faecalis and E. coli revealed in our study agrees with the report from Soba University Hospital.[21]

In the developing countries, community-acquired and hospital-acquired infections are characterized by high-rate antibiotic resistance, which may lead to continuous changes in the selection of empirical therapy.[18],[26] In the current study, different isolated microorganisms showed variations in susceptibility toward the commonly prescribed antibiotics [Table 2]. Furthermore, we observed that the overall sensitivity among the Gram-negative isolates was to imipenem (87.1%), and high resistance rate was observed to cephalexin. Whereas, among the Gram-positive isolates, the overall sensitivity was to vancomycin (93.6%), and overall resistance was to oxacillin (77.3%). These findings are in line with the previous study done in Soba hospital, and in contrast, to study from Egypt.[21],[27] Therefore, the high rate of antibiotic resistance lead physicians to prescribe broad-spectrum antibiotics to treat neonatal sepsis, like carbapenems and vancomycin as the first-line regimens.[28]

The limitations of the current study are, firstly the cross-sectional design in one hospital may not allow the generalization of the findings to all hospitals in Sudan. Second, the unavailability data about the sensitivity testing of cefotaxime against isolated organisms, even this drug, is regularly used as empirical therapy for neonatal sepsis. Despite these limitations, this surveillance is essential, as it provides the situation of the causative microorganisms, which will help a lot in constructing the proper hospital guidelines for treating neonatal sepsis. However, prospective studies are urgently needed in the Soba University Hospital to assess the risk factors for neonatal sepsis accurately.


  Conclusion Top


Among the studied samples, the most frequently isolated organism was S. aureus. The overall sensitivity among Gram-negative isolates was higher to imipenem ciprofloxacin and amikacin, whereas Gram-positive isolates had a high sensitivity to vancomycin the surveillance of antimicrobial resistance is necessary and antibiotic policy should be formulated in the hospital.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3]



 

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