Bacteriologic Profile, Antibiotic Regimen and Clinical Outcome of Neonatal Sepsis in a University Teaching Hospital in North Central Nigeria

Abstract

Background and Aims: Neonatal sepsis is an important cause of morbidity and mortality in Nigeria and in most parts of the world. Consequently, we determined the prevalence of the common bacterial pathogens of neonatal sepsis, their antibiotic susceptibility profiles, antibiotic regimen used in treatment and their clinical outcomes in a resource limited environment. Study Design: This was a prospective cross sectional study. Place and Duration of Study: Study was conducted in the Special Care Baby Unit (SCBU), Department of Paediatrics and the Department of Medical Microbiology of Jos University Teaching Hospital (JUTH), Jos, Nigeria between May to December 2011. Methodology: Biological samples were collected from 218 neonates suspected of sepsis (119 male, 99 female). The WHO and the Integrated Management of Childhood Illnesses (IMCI) criteria for suspicion of sepsis were used to select subjects into the study. Samples were processed and analyzed by standard methods in the microbiology laboratory. Antibiotic susceptibility testing was done. The antibiotic regimen used for therapy and subsequent clinical outcomes were documented. Results: Prevalence of culture proven sepsis was 34.4% (75/218). The common isolates were Klebsiella pneumoniae (32%), Staphylococcus aureus (30.7%) and Escherichia coli (10.7%). More than 60% of the K. pneumoniae isolates were resistant to the antibiotics tested. The E. coli and Enterobacter isolates were 100% sensitive to meropenem. The Gram positive isolates were most sensitive to ciprofloxacin (85%). Resistance of S. aureus was 6% to cefotaxime and 61% to ampicillin. A total of 173 (79.4%) neonates were discharged home, 15 (6.8%) were discharged against medical advice and 30 (13.8%) died on admission. The antibiotic regimen with the least mortality was a combination of ciprofloxacin and gentamicin. Conclusion: The cultures in this study showed variable antibiogram with complicated patterns of resistance. In all cases of suspected neonatal sepsis, we recommend culture and sensitivity tests to identify the causative pathogen and initiate specific antibiotic therapy. However, cefotaxime in combination with gentamicin is recommended as first line empirical therapy.