Neonatal sepsis in Sana’a city, Yemen: a predominance of Burkholderia cepacia

Abstract

Background Neonatal sepsis is a global concern with increasing morbidity and mortality. The burden of neonatal sepsis is highest in developing countries, especially in those lacking proper surveillance systems. The causative pathogens and their drug-resistance levels vary between countries with emergence of multidrug resistance organisms. Thus, accurate records on the recent trends of organisms causing neonatal sepsis will provide vital information for appropriate intervention. We aimed to investigate neonatal sepsis, identify its associated factors and causative pathogens and to assess the antibiotic susceptibility patterns in Sana’a city, Yemen. Methods A cross-sectional study was conducted on neonates admitted to intensive care units of six hospitals in Sana’a city, Yemen, in the period from January 15, to March 30, 2020. Natal and prenatal medical data were collected using well-structured questionnaire. Neonates were subjected to sepsis work-up including blood culture, complete blood count and C-reactive protein. Organisms were identified by Gram staining and analyzed by the VITEK II system for bacterial bio-typing and antibiotic susceptibility testing. Findings Of the 199-neonates with suspected neonatal sepsis, 154 (77.38%) had culture-proven sepsis. Early-onset neonatal sepsis (EOS) was higher (50.25%; 100/199) than late-onset neonatal sepsis (LOS) (27.13%; 54/199). Multivariable analysis identified vaginal delivery as an independent risk factor for neonatal sepsis p = 0.005. Majority of isolated bacteria (74.39%) were gram-negative with Burkholderia cepacia (39%) and Klebsiella oxytoca (13%) being the most common pathogens of EOS and LOS. The most common gram-positive pathogens were Staphylococcus haemolyticus (9.1%) and Staphylococcus epidermidis (7.1%). B. cepacia showed multidrug resistance except for cefepime. All Klebsiella species isolates (100%) and most Pantoea species (93%) were ESBL and carbapenemase positive. All Escherichia coli and Acinetobacter baumannii isolates were ESBL positive. A significant number of gram-positive bacteria showed resistance to vancomycin. Conclusion The study findings show a high proportion of neonatal sepsis among neonates admitted to hospitals in Sana’a city with antibiotic-resistant B. cepacia being the single most common pathogen causing EOS and LOS. Findings also emphasize the emerging threat of multidrug-resistant bacteria in neonatal units and will help develop evidence-based management of neonatal sepsis in Yemen.

Short Chain Fatty Acids Protect the Cognitive Function of Sepsis Associated Encephalopathy Mice via GPR43

“…The gut microbiota dysbiosis found in SAE mice was partly consistent with previous research, for example, more abundant Pseudomonas in SAE mice (35). Besides, Burkholderia also increased in the CLP group, which was reported to be associated with neonatal sepsis in a recent research (36). In contrast, Clostridium enriched in the CLP+SCFAs+GLPG0974 group exerts neuroprotective effect in traumatic brain injury via the gut-brain axis, according to another research (37).…”

Burkholderia cepacia Complex Infections in Urgently Referred Neonates from Syrian Border Regions to a Hospital in Turkey: A Cross-Border Cluster

“…In a multicentric cross-sectional study in Yemen, B. cepacia (37%) was the most common microorganism causing neonatal sepsis [ 7 ]. In a neonatal sepsis surveillance study covering the years 2017–2020 in India, Gram-negative non-fermentative bacilli accounted for 29% of all causative agents, among which the most common were A. baumannii (37.5%) and B. cepacia (33.3%) [ 11 ].…”

“…Our data, combined with previous studies, suggest that infants with an underlying risk factor are at greater risk for BCC infections, even if geography and possible sources of infection differ. The Yemen study also identified vaginal delivery as an independent risk factor for neonatal sepsis [ 7 ]. When evaluated in terms of nosocomial infections, the prolonged use of central lines in neonates was suggested as a significant risk factor in an outbreak of BCC septicemia in a NICU [ 5 ].…”

“…However, in studies, a significant relationship is not always seen. The Yemen study found no association between the culture-positive and culture-negative groups regarding leukocyte or platelet counts [ 7 ]. In the study of Chandrasekaran et al including 59 neonates, CRP elevation was found in 71% of the cases during bacteremia, and the median leukocyte count of the cases was 13,500 cells/mm 3 , and the platelet count was 20,000/mm 3 [ 19 ].…”

“…In neonates, BCC infections are usually reported as outbreaks in the neonatal intensive care unit (NICU). In addition to nosocomial infections, very few studies in the literature show that BCC is an important infectious agent group that can also cause community-acquired infections in areas with limited access to healthcare [ 7 , 8 ]. In this study, neonates referred to a NICU in Turkey from different centers, including the cross-border regions of Syria, shortly after birth and who were diagnosed with BCC bacteremia at admission were examined.…”