Bacterial etiology and risk factors among newborns suspected of sepsis at Hawassa, Ethiopia

Abstract

Neonatal sepsis is a systemic infection that occurs at an early age. Its etiology varies from one region to the other. The contribution of sepsis to neonatal mortality and morbidity is significant in resource-limited countries; however, there is limited information about the etiology of sepsis in Sidama Regional State, Ethiopia. The aim of this study was to determine the prevalence of bacterial caused newborn sepsis, associated factors, and the antimicrobial susceptibility profile of bacteria. A hospital-based prospective cross-sectional study was conducted among 392 sepsis suspected newborns admitted to the neonatal intensive care unit of Hawassa University Comprehensive Specialized Hospital from March 2021 to November 2021. Blood specimens were collected and bacteria were isolated using the standard culture method. The drug resistance profile of bacteria was evaluated using the disk diffusion method. The socio-demographic and clinical parameters of participants were gathered using a questionnaire. Binary logistic regression was used to determine the determinants of sepsis. A variable with a p < 0.05 was considered a significant determinant of neonatal sepsis with a 95% confidence level. The prevalence of sepsis caused by bacteria among newborns was 143 (36.5%); 95% CI (31.3–41.4). The predominant bacteria was Klebsiella species (n = 61; 42.65%), followed by non-lactose fermenting Gram-negative bacteria (n = 27; 18.88%) and Enterococcus species (n = 26; 18.18%). The overall proportions of antimicrobial resistance of Gram-negative bacteria range from 10.2 to 99.1%. All Klebsiella species were resistant to ceftriaxone. Ppremature rupture of membrane [AOR = 12.7 (95% CI 6.430–25.106)], absence of respiratory support [AOR = 3.53 (95% CI 1.840–6.759)], sex of newborns [AOR = 2.10 (1.214–3.560)] and reason for admission [AOR = 3.17 (95% CI 1.278–7.859)] were significantly associated with culture-confirmed neonatal sepsis. This study indicated the contribution of bacteria in causing sepsis among newborns; the majority of them were Gram-negative bacteria. Most recovered bacteria were resistant to commonly used antibiotics. Pre-term, mode of delivery and types of respiratory support were significantly associated with the occurrence of sepsis caused by bacteria.

Microbial Pattern of Neonatal Sepsis in the Neonatal Intensive Care Unit of dr. Ramelan Navy Central Hospital

“…Female newborns were predominant in this study compared to male newborns (52.7% vs. 47.3%). This result was in line with a study conducted by Worku et al, which showed that female newborns were the dominant population [ 26 ]. But it was contrary to studies conducted by Kurma et al, Agnche et al, and Guo et al (2019), which showed otherwise [ 19 , 24 , 27 ].…”

“…A retrospective study in South Africa also reported that 63.9% of their newborns were born via caesarean section [30]. In contrast, another study conducted in Ethiopia found that most of their study population was born via spontaneous vaginal delivery [26].…”

“…Govindaraju et al, Kurma et al, and Guo et al, through their studies, also reported that most of their study population were preterm newborns [ 18 , 19 , 27 ]. However, studies conducted by Agnche et al and Worku et al were dominated by full-term newborns [ 24 , 26 ]. This occurred because preterm babies had a limited capacity to increase neutrophil production in response to infection and neutrophil dysfunction [ 25 ].…”

“…Those results were in accordance with a study conducted by Hayun, in which 85.5% of their newborns were born with clear amniotic fluid [ 25 ]. Fecal contamination of amniotic fluid was found to have a correlation with the high prevalence of gram-negative bacteria infection in Ethiopia [ 26 ]. However, a study conducted by Lloyd et al found that 13.7% of their study population had patent ductus arteriosus (PDA) as their comorbid [ 30 ].…”

“…In this study, newborns infected with Klebsiella spp. could have gotten the bacteria from their mother either vertically (EOS) or horizontally (LOS) [ 26 ]. However, the high proportion of Klebsiella spp.…”