Etiology, antibiotic resistance and risk factors for neonatal sepsis in a large referral center in Zambia

Kabwe, Mwila and Tembo, John and Chilukutu, Lophina and Chilufya, Moses and Ngulube, Francis and Lukwesa, Chileshe and Kapasa, Monica and Enne, Virve and Wexner, Hannah and Mwananyanda, Lawrence and Hamer, Davidson H. and Sinyangwe, Sylvestor and Ahmed, Yusuf and Klein, Nigel and Maeurer, Markus and Zumla, Alimuddin and Bates, Matthew (2016) Etiology, antibiotic resistance and risk factors for neonatal sepsis in a large referral center in Zambia. Pediatric Infectious Disease Journal, 35 (7). E191-E198. ISSN 0891-3668

Documents
Kabwe et al 2016.pdf

Request a copy
[img] PDF
Kabwe et al 2016.pdf - Whole Document
Restricted to Repository staff only

471kB
Item Type:Article
Item Status:Live Archive

Abstract

Background: In sub-Saharan Africa, there is scanty data on the causes of neonatal sepsis and antimicrobial resistance among common invasive pathogens that might guide policy and practice. Methods: A cross-sectional observational prevalence and etiology study of neonates with suspected sepsis admitted to the neonatal intensive care unit, University Teaching Hospital, Lusaka, Zambia, between October 2013 and May 2014. Data from blood cultures and phenotypic antibiotic susceptibility testing were compared with multivariate analysis of risk factors for neonatal sepsis. Results: Of 313 neonates with suspected sepsis, 54% (170/313) were male; 20% (62/313) were born to HIV-positive mothers; 33% (103/313) had positive blood cultures, of which 85% (88/103) were early-onset sepsis. Klebsiella species was the most prevalent isolate, accounting for 75% (77/103) of cases, followed by coagulase-negative staphylococci 6% (7/103)], Staphylococcus aureus 6% (6/103)], Escherichia coli 5% (5/103)] and Candida species 5% (5/103)]. For Klebsiella species, antibiotic resistance ranged from 96%-99% for World Health Organizationrecommended first-line therapy (gentamicin and ampicillin/penicillin) to 94%-97% for third-generation cephalosporins. The prevalence of cultureconfirmed sepsis increased from 0 to 39% during the period December 2013 to March 2014, during which time mortality increased 29%-47%; 93% (14/15) of late-onset sepsis and 82% (37/45) of early-onset sepsis aged 4-7 days were admitted > 2 days before the onset of symptoms. Culture results for only 25% (26/103) of cases were available before discharge or death. Maternal HIV infection was associated with a reduced risk of neonatal sepsis odds ratio, 0.46 (0.23-0.93); P = 0.029]. Conclusions: Outbreaks of nosocomial multiantibiotic-resistant infections are an important cause of neonatal sepsis and associated mortality. Reduced risk of neonatal sepsis associated with maternal HIV infection is counterintuitive and requires further investigation.

Keywords:neonatal sepsi, Africa, HIV exposed, antimicrobial resistance, Klebsiella pneumoniae}
Subjects:A Medicine and Dentistry > A300 Clinical Medicine
C Biological Sciences > C521 Medical Microbiology
Divisions:College of Science > School of Life Sciences
ID Code:28350
Deposited On:06 Sep 2017 15:32

Repository Staff Only: item control page