Common bacteria causes of neonatal sepsis and antimicrobial susceptibility at the university teaching hospital, Lusaka, Zambia?

Abstract

Background: Prescribing effective preventative antibiotics and treating infections in mothers, providing a clean birth environment, and delivering the baby within 24 hours of rupture of membranes, where possible, can all help lower the chance of neonatal sepsis. However, neonatal sepsis remains one of the leading causes of morbidity and mortality among neonates, responsible for 30- 50% of the total neonatal deaths in low-and middle-income countries. The incidence and mortality of neonatal sepsis in Zambia is quite high. In 2007, the neonatal mortality rate in Zambia was 38/1,000 live births. The present study sought to identify the common bacterial causes of neonatal sepsis and antimicrobial susceptibility at the University Teaching Hospital in Lusaka, Zambia. Methods: This was a descriptive cross sectional study with convenience sampling for a period of three months of 142 neonates at the University Teaching Hospital (UTH) Paediatric Department. Data was obtained from mothers with neonates clinically diagnosed with sepsis at the UTH from October 2013 to January, 2014. Data was collected by reviewing obstetric and neonatal files while laboratory studies done were HIV rapid test (for HIV exposure), random blood sugar, and full blood count and blood culture to establish common blood pathogens. All tests were done after consent from the mothers or a guardian for blood to be collected from neonates was obtained. There was a questionnaire administered for each patient for a more detailed antenatal and delivery history of the neonate. Results: Positive blood culture results were at 30% and most common bacteria isolated causing neonatal sepsis in A-block, UTH were gram positive staphylococcus aureus and coagulase negative staphylococcus, which together accounted to 85% of the positive blood culture tests. Staphylococcus aureus and coagulase negative staphylococcus were highly susceptible to Ciprofloxacin (100%), Chloramphenicol (84%), Cefotaxime (70%), Oxacillin (69%) and Gentamycin (70.6%). Penicillin (65%) showed high resistance to staphylococcus aureus and coagulase negative staphylococcus. The most common clinical presenting features were fever, irritability and poor feeding. Neonates born from the UTH had on average 4.5 increased odds for early onset sepsis compared to neonates born from other health centers (OR: 4.48, CI: 1.85 - 10.85, p < 0.01). v Conclusions: Gram positive staphylococcus aureus is the common cause neonatal sepsis in A-block UTH. The first line Penicillin treatment is highly resistance and careful consideration should be made by UTH management to introduce third generation cepholosporins and macrolides as first line to effectively improve treatment and prevent morbidity. Infection prevention in delivery and nursery wards should be held as highest priority to prevent loss of life. Key words: Neonate, early onset sepsis, late onset sepsis, University Teaching Hospital (UTH)