Predominance of Multi-Drug Resistant <i>Klebsiella pneumonia</i> and Other Gram Negative Bacteria in Neonatal Sepsis in Equatorial Guinea

Abstract

The study was conducted on new-born babies in whom septicemia was suspected, to determine the prevalence of bacterial strains isolated and their sensitivity to antimicrobial drugs. The study was carried out at La Paz Medical Center, Microbiology section, Malabo, Equatorial Guinea from August 2013 to October 2015. Out of 293 septicemia suspected cases, 29 (10%) blood cultures were positive, 28 with bacterial growth and 1 with growth of Candida sp. The mortality rate of neonates caused by Gram negative bacterial sepsis was 34.7%. Among the Gram negative bacteria (24 isolates), the most common types were Klebsiella pneumoniae (16 = 69.6%), followed by Escherichia coli (4 = 17.4%) and Acinetobacter species (4 = 17.4%). Four Gram positive bacteria were also isolated and identified all ascoagulase-negative staphylococci. All the Klebsiella pneumoniae isolates and Acinetobacter species demonstrated Multi Drug Resistance against different antibiotics with Extended-spectrum β-lactamase (ESBL) activity.The most frequent causative agent of bacterial sepsis in new-born children was Klebsiella pneumoniae. An alarming level of Multi Drug Resistance (MDR) Klebsiella pneumoniae strains to the first choice antibiotic treatment was observed.

Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines

“…Only few studies reported use of Etest 72,73,106,107 or microdilution 59 on all or some isolates. Several established guidelines for resistance interpretation were referenced: Clinical and Laboratory Standards Institute (CLSI; 36 stu dies), 24,31,36,56,59,63,70,72,73,84,[86][87][88]93,96,99,103,106,[108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125] EUCAST, 107 British Society for Antimicrobial Therapy, 60,61,71,97 and French Society of Microbiology. 91 Only 12 (15%) of 81 observational studies provided context by describing the pathway of neonatal presentation.…”

“…Only 13 (16%) of 81 studies listed pathogens excluded as contaminants. Although often reported as contaminants, several studies reported CoNS, 24,34,38,55,71,74,86-89,96,98,103,106,109,111-113,115-118,120,126-132 viridians streptococci, 61,85 Staphylococcus epidermidis, 84,99,125,133,134 Bacillus spp, 106,130 and Micrococcus spp 122 as neonatal pathogens. However, among the studies that reported CoNS as a pathogen, few provided a rationale for identifying the clinical significance of the infection.…”

“…22 studies 36,63,74,79,84,86,88,91,93,97,98,106,112,113,118,[123][124][125][126][127]132,135 reported resistance among Klebsiella spp (predominantly K pneumoniae, with few cases of Klebsiella oxytoca), documenting a non-susceptibility to gentamicin of 66% (95% CI 47-83), ceftriaxone of 49% , and cefotaxime of 78% . Reported resistance to amikacin, an alternative to gentamicin, was low (14%, 7-23).…”

“…Reported resistance to amikacin, an alternative to gentamicin, was low (14%, 7-23). 63,113,[124][125][126]132,135 High frequencies of extended spectrum β-lactamase (ESBL)-producing K pneumoniae were reported from South Africa, 24,126,131,132 Tanzania (49%; 24/50), 86 and Botswana (60%; 16/27). 135 In one South African study, 126 resistance to piperacillintazobactam, was higher among ESBL-producing K pneumoniae isolates (90%; 9/10) than in the non-ESBL producing isolates (43%; 3/7).…”

“…135 In one South African study, 126 resistance to piperacillintazobactam, was higher among ESBL-producing K pneumoniae isolates (90%; 9/10) than in the non-ESBL producing isolates (43%; 3/7). Non-susceptibility to carbapenems was reported in at least one country in each region, 63,86,88,91,106,125,126,132 with low resistance rates (4%, 95% CI 1-10).…”