Antimicrobial resistance patterns in neonatal sepsis cases at Chris Hani Baragwanath Academic Hospital

Abstract

The purpose of this study was to describe the antimicrobial resistance (AMR) patterns of clinical isolates from neonatal sepsis cases admitted at Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2016 to December 2019. Globally, 214 000 – 690 000 neonatal deaths (death in first 28 days after birth) are associated with sepsis, 31% of the deaths are potentially attributed to AMR, with the highest burden experienced in sub-Saharan Africa. Methods This study used descriptive data analysis which involved a retrospective review of the neonatal hospital database, drug susceptibility test results, and neonatal sepsis discharge summary at CHBAH. Results Bacteria and fungi were the two organism types identified among neonatal sepsis cases at CHBAH. Gram-negative bacteria 317(52.93%) were the most predominant bacterial isolates among neonatal sepsis cases compared to gram-positive bacteria 282(47.08%), but the difference was not statistically significant (P=0.3961). The leading gram-negative bacteria causing AMR sepsis at CHBAH were Acinetobacter baumannii 194(28.4%), Klebsiella pneumoniae 96(14.69%), and Escherichia coli 6(0.88%). The most prevalent gram-positive bacteria were Staphylococcus aureus 109(16.0%), and Coagulase-negative staphylococci 106(15.5%). With regards to fungi, Candida parapsilosis 27(3.95%), Candida albicans 18(2.64%), and Candida tropicalis 1(0.15%) being the most common causes of candidemia. Acinetobacter baumannii was found to have very high resistance to amikacin (71.05%), meropenem (91.3%), and ceftazidime (82.46%). A high prevalence (73%) of extended spectrum beta-lactamase (ESBL) production was noted amongst the Klebsiella pneumoniae. A high prevalence of carbapenemase-producing Enterobacteriaceae(CPE)were noted amongthe Klebsiella pneumoniae as demonstrated by the 46.7% resistance to meropenem. Thirty five percent of the Staphylococcus aureus were resistant to methicillin Low susceptibility of the leading causes of AMR sepsis to the recommended empirical therapeutic options was noted. Overall, there was a 30% mortality rate among neonatal sepsis cases admitted.. Conclusion v Neonatal mortality associated with AMR sepsis remains significantly high at CHBAH and Acinetobacter baumannii was responsible for almost half the deaths. This was possibly attributed to poor therapeutic outcomes owing to the high resistance of the leading c auses of neonatal sepsis to empiric treatment and the recommended therapeutic choices