Neonatal Sepsis Bacterial Etiologic Agents And Their Antibiotic Susceptibility Pattern In Tikur Anbessa University Hospital Addis Ababa Ethiopia

BACKGROUND: Neonatal sepsis is one of the most common reasons for admission tornneonatal units in developing countries. It is also a major cause of mortality in both developedrnand developing countries. The type and pattern organisms that cause neonatal sepsis changesrnover time and vary from one hospital to another hospital, even in the same country. Inrnaddition the causative organisms have developed increased drug resistance for the last tworndecades. Maternal, neonatal and environmental risk factors have contributed for therndevelopment of sepsis.rnOBJECTIVES: This study was undertaken to determine the pattern of bacterial agentsrncausing neonatal sepsis and to assess their susceptibility pattern to various antimicrobialrnagents in the Ethiopian setting. An attempt has been also made to identify the possiblernmaternal and neonatal risk factors responsible for neonatal septicemia.rnMETHODS: During the period of October 2006 and March 2007 a cross-sectionalrnprospective study was conducted at the Department of Pediatrics and Child Health, Ethio-rnSwedish Children’s Hospital, Addis Ababa, Ethiopia. Blood cultures were performed fromrnnewborn babies (n=302, age: 0-28 days) admitted to the hospital with a clinical diagnosis ofrnneonatal sepsis. Antimicrobial susceptibility testing was performed for all blood culturernisolates according to the criteria of the National Committee for Clinical Laboratory Standardsrnby disk diffusion method.rnRESULTS: Of the 302 patients, 46.4% were males and 53.6% were females (p >0.05)rnresulting in an overall male to female ratio of 0.8:1. The mean age of the neonates was 1.23 ±rn8.96 days and 70.2% of neonates were below age of 1 day. A total of 298 (98.7%) neonatesrnpresented with early-onset sepsis (EOS) and four (1.3%) presented with late-onset sepsisrn(LOS). Out of the 302 neonates, 57.3% were preterm and 62.7% had low birth weight. Thernmost prevalent clinical features of sepsis were hypothermia (84.8%), respiratory distressrn(72.8%), failure to feed (71.5%) and lethargy (30.1%). Among the 302 neonates admittedrnwith suspected cases of sepsis, 59 (19.5%) had abnormal white blood cell count (high andrnlow). Immature/total neutrophil ratio > 0.2 and 0.05). The most common isolated organismsrnwere Klebsiella spp. (39.2%) and Staphylococcus aureus (22.2%). Neonatal risk factors suchrnas prematurity, low birth weight, abnormal WBC count (high and low) and I:T ratio > 0.2rnwere strongly associated with culture proven neonatal sepsis. No maternal risk factors werernidentified. In general both gram positive and negative bacteria isolated from blood culturernshowed low resistance rates (80%) to ampicillin, ceftriaxone, cephalothin, chloramphenicol, and gentamicin.rnCiprofloxacin was the most effective drug against the tested gram-positive and gram-negativernbacteria. Multiple resistance (resistance to two or more drugs) was observed in 45.7% andrn84.2% gram positive and gram negative bacteria respectively (p 0.2 were strongly associated with blood culture proven neonatalrnsepsis. Gram-negative bacteria showed high level of resistance to commonly used antibiotics.rnCiprofloxacin was the most effective drug when compared to other drugs tested against therngram-positive and gram-negative bacteria. Multi-drug resistance detected in 67.4% isolates.rnThe detection of multi-drug resistant isolates may further limit therapeutic options. Routinernbacterial surveillance and the study of their resistance patterns must be an essentialrncomponent of neonatal care. A knowledge of these patterns is essential when local polices onrnthe uses of antibiotics are being devised.rnKey words: Neonatal sepsis, clinical features, bacterial pathogens, risk factors,rnantimicrobial susceptibility pattern, Ethiopia

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