Evaluation of culture-proven neonatal sepsis at a tertiary care hospital in South Africa
Date
2015
Authors
Lebea, Mamaila Martha
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Abstract
Background: Organisms causing neonatal sepsis differ in different regions and also
change with time in the same area. The antibiotic susceptibility of microorganisms also
changes with time, with emergence of multidrug resistant organisms. A periodic survey
of the causes of sepsis and their antibiotic sensitivity patterns is essential in the design of
effective infection control programs and in guiding empiric antibiotic therapy.
Aim: To evaluate the epidemiology of culture-proven neonatal sepsis and to describe the
clinical characteristics of patients with neonatal sepsis at a tertiary care hospital in South
Africa over a one year period.
Methods: This was a retrospective descriptive study conducted in the neonatal unit at
Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Clinical and laboratory
data of patients, admitted to the CMJAH neonatal unit between 1 January 2012 and 31
December 2012 with positive blood cultures were reviewed.
Results: During this time there were 196 patients with blood-culture proven neonatal
sepsis (NNS). This gave an incidence of 10.26 per 100 admissions. Late-onset sepsis
(LOS) accounted for 83.7% of cases of NNS. Of the 196 patients with NNS, 117 (59.39%)
were males. The median gestational age for patients with NNS was 30 weeks and the
median birth weight was 1300g. HIV exposure was present in 30.67 % of patients.
Predominant isolates were Klebsiella pneumioniae (32.20%), coagulase-negative
staphylococci (23.72%) and methicillin-resistant Staphylococcus aureus (13.13%). The
majority of the isolated K.pneumoniae were extended beta-lactamase-producing (ESBL)
with resistance to ampicillin and gentamicin.
Conclusion: Neonatal sepsis is an important cause of mortality at CMJAH neonatal unit.
Compared to previous audits in the unit, the incidence of NNS in the unit is on the increase
while mortality from NNS has remained relatively constant. LOS was more common than
EOS at CMJAH. A changing pattern of bacteria isolated has been observed. Gramnegative
microorganisms comprised the majority of the neonatal sepsis, with ESBL
Klebsiella pneumoniae and A. baumannii being the most prevalent. Coagulase negative
staphylococcus remains an important cause of NNS, and is the most prevalent grampositive
organism isolated. Resistance to the first-line antibiotic regimen for both EOS and
LOS is significant. Due to the changing pattern of bacteria isolated and changing patterns
in antibiotic sensitivity, recommendations are made regarding early empiric antibiotic
therapy.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree
of
Master of Medicine in the branch of Paediatrics.
Johannesburg, 2015.