ETD Collection

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Author: search.filters.author.Lebea, Mamaila MarthaSubject: search.filters.subject.Intensive Care, Neonatal

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    Evaluation of culture-proven neonatal sepsis at a tertiary care hospital in South Africa
    (2015) Lebea, Mamaila Martha
    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.