Neonatal sepsis in a tertiary unit in South Africa

Abstract

Background Antimicrobial resistance (AMR) has emerged as a global threat to healthcare resulting in an increase in morbidity and mortality. Neonatal sepsis is ranked as the third highest cause of neonatal demise globally, in which AMR accounted for 31.0% of deaths. AMR in neonates has been poorly characterised in Durban, South Africa. Thus, the resultant effect of AMR on empiric regimens for neonatal sepsis is uncertain in this setting. Therefore, this study analysed the aetiology and antimicrobial susceptibility patterns of bloodstream infections within the neonatal intensive care unit at a tertiary hospital in Durban, with the aim of establishing an effective empiric regimen for the unit. Methods A retrospective data review on positive blood cultures from the neonatal intensive care unit at Inkosi Albert Luthuli Central Hospital was conducted. Three time periods were analysed: 2014, 2016 and 2018. Culture data from neonates aged 0–30 days were included and repeat cultures were de-duplicated. The frequency of common organisms and their antimicrobial susceptibilities were analysed. Fischer’s exact test was used for subgroup analysis. Poisson and logistic regressions were used to assess significant trends in organisms and antimicrobial susceptibilities over time. Results Late-onset sepsis (86.8%) predominated over early-onset sepsis (13.2%). A preponderance of gram-positive organisms (68.7%) over gram-negatives (26.8%) and fungi (4.5%) was detected. Common pathogens included coagulase-negative staphylococci (53.5%), Klebsiella pneumoniae (11.6%), enterococci (9.3%), and Acinetobacter baumannii (7.7%). Despite the small contribution of fungi to the microbial profile, fluconazole-resistant Candida parapsilosis predominated within that group. High rates of resistance to first- and second-line antibiotics were also noted among gram-positive and gram-negative organisms. Multidrug resistant organisms included extended-spectrum beta-lactamase (ESBL) K. pneumoniae (7.6%) and extensively-drug resistant A. baumannii (7.0%). However, a statistically significant decrease in ESBL-producing organisms was documented during the entire study period (p = 0.005). Conclusions It was determined that first-line antimicrobials, advocated by the World Health Organization for treatment of neonatal sepsis, proved ineffective in this unit due to high levels of AMR. Therefore, this study advises that meropenem with or without vancomycin provides optimal empiric cover. Amphotericin B is advocated for empiric antifungal therapy. Ongoing surveillance is necessary.

Bacteriological profile, antibiotic susceptibility and factors associated with neonatal Septicaemia at Kilembe mines hospital, Kasese District Western Uganda

“…In our study, MRSA among S. aureus isolates was 79% (11/14) which was a high propotion as also reported in orther studies [48], which could have been due to transmission from the colonized maternal genital tract or from the labour ward after unhygienic obstetric practices. However this was relatively higher than what was reported by Eyob (72%), the difference could have been due to geographical differences ie variation in the frequency of the organisms within and between coutries, types of the specimen, laboratory procedures, study population, and study duration and differences in study design [49].…”

Early-Onset Neonatal Sepsis in Low- and Middle-Income Countries: Current Challenges and Future Opportunities

“…is elsewhere reported to be one of the dominant species in neonatal sepsis in LMICs. 1 , 72 , 74 Pillay et al in 2021 (South Africa), reported K. pneumoniae within the three leading causes of EOS, with coagulase-negative staphylococcus (CoNS) and A. baumannii . 74 Two years previously however, Velaphi et al (South Africa) in 2019 published data to the contrary revealing GBS and Ureaplasma spp.…”

“…Due to ease of access and simplicity to determine levels of AMR and classify the bacterial isolate as either sensitive (S) or resistant (R), many hospital laboratories use disc diffusion assays, 70 , 88 , 89 or E-tests. 66 , 90 Facilities with better resources in, other studies report minimum inhibitory concentration data interpreted from automated systems such as the VITEK, 74 or via agar dilution. 1 , 3 Moreover, different studies follow different reporting guidelines with both CLSI and EUCAST commonly used, amongst others, making data comparison difficult.…”

Neonatal Sepsis: The impact of Hypervirulent Klebsiella pneumonia in a Tertiary Care Hospital

“…An upsurge in ESBL-producing K. pneumoniae sepsis has been observed over the world, with the NICU accounting for the majority of cases. 31 Antimicrobial resistance in Klebsiella is mostly linked with the formation of ESBL. In 2017, the WHO included ESBL-producing Klebsiella as most dangerous superbugs along with Pseudomonas aeruginosa and Acinetobacter baumanni.…”