Epidemiology of culture-proven early-onset neonatal sepsis in a tertiary hospital in Johannesburg

Abstract

Background: Neonatal sepsis is poorly defined. The absence of a consensus neonatal-specific definition for sepsis results in variability in reporting early-onset neonatal sepsis and limitations with the comparison of current audits. There is limited research on the epidemiology of early-onset neonatal sepsis in low and middleincome countries.

Methods: To review the epidemiology of culture-proven early-onset neonatal sepsis over six years at Charlotte Maxeke Johannesburg Academic Hospital. This was a retrospective descriptive study of bloodstream culture-proven early-onset neonatal sepsis at Charlotte Maxeke Johannesburg Academic Hospital between 1 January 2013 and 31 December 2018.

Results: There were 100 episodes of early-onset bacterial bloodstream infections over the study period. The majority of infections were Gram-positive (73%). Mortality was significantly higher in Gram-negative sepsis 12/27 (44.4%) as compared with Grampositive sepsis 9/73 (12.3%) P < 0.001. Group B streptococcus culture predominated isolates 37/100 (37%) followed by Staphylococcus aureus (15%). Listeria Monocytogenes sepsis peaked in 2017, in keeping with the epidemic in South Africa.

Conclusion: Gram-positive organisms continue to be the majority of organisms cultured in newborns with early-onset neonatal sepsis, in the Charlotte Maxeke neonatal unit. Gram-negative sepsis was associated with significantly higher mortality in our study. In order to reach the Sustainable Development Goals and target a neonatal mortality rate below 12 per 1000 by 2030, early-onset neonatal sepsis needs to be addressed at a local and global level.