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Niyoyita JC, Ndayisenga J, Omolo J, Niyompano H, Bimenyimana PC, Dzinamarira T, Nsekuye O, Chavez I, Hakizayezu F. Factors associated with neonatal sepsis among neonates admitted in Kibungo Referral Hospital, Rwanda. Sci Rep 2024; 14:15961. [PMID: 38987637 PMCID: PMC11236976 DOI: 10.1038/s41598-024-66818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024] Open
Abstract
More than one million neonatal deaths occur every year worldwide, of which 99% take place in low-income countries. In Rwanda, nearly 71% of neonatal deaths are preventable and among these, 10% are due to neonatal sepsis. Nevertheless, limited information exists on neonatal sepsis and its associated factors in Rwanda. The objectives of the study were to find prevalence and factors associated with neonatal sepsis among neonates admitted in Kibungo Referral Hospital, Ngoma District, Rwanda. We used a retrospective cross-sectional study design reviewing a subset of neonatal, maternal and laboratory records from Kibungo Hospital in 2017. Data were reviewed and collected from March to May, 2018. Logistic regression and odds ratios were calculated to identify the factors associated with neonatal sepsis at 95% CI, p < 0.05. Of the 972 total neonates' medical records from 2017, we randomly selected 422 of which 12.8% (n = 54) had neonatal sepsis. When blood cultures were positive, 62% grew Klebsiella pneumoniae. Among neonates with sepsis, 38 (70%) recovered while 16 (30%) died. Neonatal sepsis was strongly associated with neonatal age less than or equal to three days (aOR: 2.769, 95% CI 1.312-5.843; p = 0.008); and gestational age less than 37 weeks (aOR: 4.149; CI 1.1878-9.167; p ≤ 0.001). Increased use of blood cultures including sensitivity testing, routine surface cultures of the neonatology and maternity wards facilities, and systematic ward cleaning are all important approaches to prevent and treat neonatal infections in additional to regular neonatal sepsis evaluations.
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Affiliation(s)
- Jean Claude Niyoyita
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Biostatistics and Epidemiology, School of Public Health, University of Rwanda, P.O. Box 3286, Kigali, Rwanda.
- African Research and Community Health Initiative, Kigali, Rwanda.
| | - Jerome Ndayisenga
- African Research and Community Health Initiative, Kigali, Rwanda
- Rwanda Biomedical Centre, Kigali, Rwanda
| | - Jared Omolo
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Biostatistics and Epidemiology, School of Public Health, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
| | - Hosee Niyompano
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Biostatistics and Epidemiology, School of Public Health, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
- Rwanda Biomedical Centre, Kigali, Rwanda
| | - Pierre Celestin Bimenyimana
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Biostatistics and Epidemiology, School of Public Health, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
| | | | | | - Isabella Chavez
- University of California, Los Angeles (UCLA), Los Angeles, USA
| | - François Hakizayezu
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Biostatistics and Epidemiology, School of Public Health, University of Rwanda, P.O. Box 3286, Kigali, Rwanda
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Permana PBD, Widodo ADW, Setyaningtyas A, Wahyunitisari MR. Factors Associated With Culture-proven Neonatal Sepsis and Resistance to First-line Antibiotics in Indonesia. Pediatr Infect Dis J 2024; 43:56-62. [PMID: 37725828 DOI: 10.1097/inf.0000000000004108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Neonatal sepsis is one of the leading causes of neonatal morbidity and mortality in low- and middle-income countries. Blood culture positivity rates and antibiotic resistance pattern of neonatal sepsis differs across various regions. This study aims to identify clinical cofactors associated with blood culture-proven neonatal sepsis and in vitro resistance to first-line antibiotics (ampicillin and gentamicin) from cases originating in a tertiary healthcare center in Surabaya, Indonesia. METHODS A retrospective cohort study was conducted from January 2020 to August 2022 by utilizing secondary data collected from standardized electronic medical records. Microbiologic characteristics and associated factors were statistically analyzed using multivariable logistic regression. RESULTS Across 266 neonatal sepsis cases, 46.9% were culture-proven and 79.2% of confirmed sepsis were resistant to first-line antibiotics. The most common isolated pathogen is Klebsiella pneumoniae , followed by coagulase-negative Staphylococci , Acinetobacter baumannii and Enterobacter cloacae . Extremely preterm delivery [adjusted odds ratio (aOR): 5.813; 95% confidence interval (CI): 1.70-19.91] and late-onset sepsis (aOR: 9.165; 95% CI: 5.12-16.40) were associated with culture-proven neonatal sepsis. Increased odds of resistance to first-line antibiotics were identified in extremely preterm (<28 weeks) or very-preterm delivery (28 to <32 weeks) (aOR: 50.80; 95% CI: 1.66-1554.21 and aOR: 45.679; 95% CI: 3.22-647.46, respectively), cesarean section (aOR: 4.149; 95% CI: 1.04-16.53) and an absence of antenatal corticosteroid use (aOR: 0.233; 95% CI: 0.07-0.76). CONCLUSIONS The association between clinical cofactors with culture-proven sepsis and antibiotic resistance emphasizes the importance for clinicians to adjust empirical antibiotic regimens based on the local antibiogram and resource availability.
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Affiliation(s)
| | - Agung Dwi Wahyu Widodo
- Integrated Medical Laboratory, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Clinical Microbiology, Dr. Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Arina Setyaningtyas
- Division of Pediatrics Emergency and Intensive Care, Department of Pediatrics, Dr. Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Manik Retno Wahyunitisari
- Department of Clinical Microbiology, Dr. Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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Baharin NS, Duan M, Loe MWC, Goh GL, Thoon KC, Rajadurai VS, Yeo KT. Burden of antibiotic resistance in infections among very-low-birthweight infants in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:561-569. [PMID: 38920145 DOI: 10.47102/annals-acadmedsg.2023190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Recent reports have described the increasing predominance of Gram-negative organisms among invasive bacterial infections affecting preterm infants. This changing pattern of infections is concerning due to the spread of antibiotic resistance among Gram-negatives. Method We conducted a single-centre, retrospective cohort study involving very-low-birthweight (VLBW) (<1500 grams) infants born <32 weeks gestation, with culture-proven infections (blood, urine, cerebrospinal fluid [CSF]) in the neonatal intensive care unit from 1 January 2005 to 31 October 2017. Results A total of 278 out of 2431 (11.4%) VLBW infants born <32 weeks gestation developed 334 infections, i.e. 52 (15.6%) early-onset infections (EOIs) and 282 (84.4%) late-onset infections (LOIs). The overall incidence decreased from 247 to 68 infections per 1000 infants over the study period, corresponding to reductions in LOI (211 to 62 infections per 1000 infants). A total of 378 bacteria were isolated, i.e. Gram-negatives accounted for 70.9% (45 of 59 [76.3%] EOI; 223 of 319 [69.9%] LOI). Specific resistant organisms were noted, i.e. Methicillin-resistant Staphylococcus aureus (8 of 21 S. aureus infections [38.1%]); Cephalosporin-resistant Klebsiella (18 of 62 isolates [29.0%]) and multidrug-resistant [MDR] Acinetobacter (10 of 27 isolates [37.0%]). MDR organisms accounted for 85 of 195 (43.6%) Gram-negative infections from the bloodstream and CSF. Based on laboratory susceptibility testing, only 63.5% and 49.3% of infecting bacteria isolated in blood were susceptible to empiric antibiotic regimens used for suspected EOI and LOI, respectively. Conclusion Gram-negative bacteria are the predominant causative organisms for EOI and LOI and are frequently MDR. Understanding the pattern of antimicrobial resistance is important in providing appropriate empiric coverage for neonatal infections.
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MESH Headings
- Humans
- Singapore/epidemiology
- Infant, Newborn
- Retrospective Studies
- Infant, Very Low Birth Weight
- Female
- Male
- Intensive Care Units, Neonatal/statistics & numerical data
- Anti-Bacterial Agents/therapeutic use
- Anti-Bacterial Agents/pharmacology
- Gram-Negative Bacterial Infections/epidemiology
- Gram-Negative Bacterial Infections/drug therapy
- Gram-Negative Bacterial Infections/microbiology
- Incidence
- Gram-Negative Bacteria/drug effects
- Gram-Negative Bacteria/isolation & purification
- Infant, Premature
- Drug Resistance, Bacterial
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/microbiology
- Infant, Premature, Diseases/drug therapy
- Methicillin-Resistant Staphylococcus aureus/isolation & purification
- Methicillin-Resistant Staphylococcus aureus/drug effects
- Microbial Sensitivity Tests
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Affiliation(s)
| | - Menghao Duan
- Department of Neonatology, KK Women's & Children's Hospital, Singapore
| | - Marcus Wing Choy Loe
- Department of Neonatology, KK Women's & Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Guan Lin Goh
- Department of Neonatology, KK Women's & Children's Hospital, Singapore
| | - Koh Cheng Thoon
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Infectious Disease Service, KK Women's & Children's Hospital, Singapore
| | - Victor Samuel Rajadurai
- Department of Neonatology, KK Women's & Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's & Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Sherif M, Abera D, Desta K. Prevalence and antibiotic resistance pattern of bacteria from sepsis suspected neonates at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. BMC Pediatr 2023; 23:575. [PMID: 37980512 PMCID: PMC10656775 DOI: 10.1186/s12887-023-04399-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Neonatal sepsis is the major cause of neonatal mortality and morbidity, especially in low and middle-income countries. Continuous monitoring of pathogens and their antibiotic resistance pattern is crucial for managing neonatal sepsis. This study aimed to determine neonatal sepsis due to bacteria, antibiotic resistance patterns, associated risk factors and patient outcomes at St. Paul's Hospital Millennium Medical College. METHOD An institutional-based cross-sectional study was conducted on 400 neonates suspected of sepsis at St. Paul's Hospital Millennium Medical College from March 2020 to July 2020. A questionnaire was used to collect socio-demographic information, clinical parameters and potential risk factors from study participants. About 2ml of blood was drawn aseptically and inoculated into Tryptone Soya Broth at the patient's bedside. Bacterial identification was performed by using standard microbiological techniques. The disk diffusion method was used to determine the antibiotic susceptibility patterns of each isolated bacteria. Data entry and analysis were done using Statistical Package for Social Sciences (SPSS) version 20 software. Bivariate and multivariable logistic regressions were used to assess associated risk factors of neonatal sepsis. A p-value less than 0.05 was considered statically significant with a 95% confidence interval. RESULTS The overall prevalence of neonatal septicemia was 21% (84/400). Of these, 67 (79.8%) and 17 (20.2%) were gram-negative and gram-positive bacteria, respectively. Klebsiella spp, 37 (44%), E. coli 19 (21.6%) and Coagulase negative Staphylococci 13 (15.47%) were the leading cause of neonatal sepsis. Ciprofloxacin and amikacin were the most effective antibiotics for gram-negative and gram-positive bacteria. Multidrug resistance was observed in 84% of the bacterial isolates. Low birth weight and preterm were associated with neonatal septicemia (AOR = 49.90, 95% CI = 15.14-123.081, P = 0.002) and (AOR = 18.20, 95% CI = 6.835-27.541, P = 0.004) respectively. CONCLUSION Klebsiella spp and E. coli were frequently isolated bacteria in our study. The proportion of multidrug-resistance was significantly high. Most isolated bacteria were resistant to ampicillin, ceftazidime, cefotaxime and gentamycin, which indicates the necessity of continuous evaluation of antibiotic resistance rate.
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Affiliation(s)
- Merema Sherif
- St Paul hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dessie Abera
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Kassu Desta
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Pataskar A, Chandel A, Chauhan V, Jain M. Gram-negative Late Onset Neonatal Sepsis in a Tertiary Care Center From Central India: A Retrospective Analysis. Clin Med Insights Pediatr 2023; 17:11795565231189595. [PMID: 37545480 PMCID: PMC10403979 DOI: 10.1177/11795565231189595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Background Neonatal sepsis has been a major cause of neonatal mortality and morbidity globally. Late onset sepsis is on the rise mostly due to better health care services and improved survival of premature neonates. Gram-negative sepsis has emerged as a major public health problem constituting significant morbidity and mortality. There is limited data on gram-negative late onset sepsis from the central part of India, therefore this study was conducted at a tertiary care center from rural part of India. Objectives To determine the clinical profile and outcome among neonates with gram-negative late onset sepsis. Design It is a retrospective analysis conducted among neonates with gram-negative late onset sepsis at a tertiary care center from central India. Methods All neonates below 28 days of age suspected to have late onset sepsis were enrolled in the study. The data for the period of January 2019 to December 2021 was collected and analyzed using software SPSS version 29. The outcome variables studied were discharge (good outcome) and death (poor outcome). Results In the present study, overall prevalence of gram-negative late onset sepsis was 4.8%. Respiratory distress (52.2%), seizure (18.9%), jaundice (15.6%), and lethargy (15.6%) were common clinical symptoms among neonates with sepsis. The most common organism isolated was Klebsiella spp. (36.7%) followed by Acinetobacter spp. (31.1%) and E. coli (17.8%). Low gestational age (n = 20 vs n = 7, P = .002) and low birth weight (n = 33 vs n = 4, P = .02) were associated with poor outcomes in neonates with gram negative LOS. The overall mortality rate was found to be 30% among neonates with gram negative sepsis. Conclusion The prevalence of gram-negative sepsis was found to be 4.8%. Factors associated with poor outcome in gram-negative sepsis were low birth weight, and prematurity. Klebsiella spp. was found to be a common cause of gram-negative LOS, therefore, the empiric antibiotic policy must provide coverage against these micro-organisms.
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Affiliation(s)
| | | | - Varsha Chauhan
- Department of Pediatrics, MGIMS, Sevagram, Maharashtra, India
| | - Manish Jain
- Department of Pediatrics, MGIMS, Sevagram, Maharashtra, India
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Prasetyo DS, Karyanti MR, Yuniar I, Saharman YR, Holiwono L. Application of a sepsis flow chip (SFC) assay for the molecular diagnosis of paediatric sepsis. Access Microbiol 2023; 5:000474.v4. [PMID: 37223064 PMCID: PMC10202402 DOI: 10.1099/acmi.0.000474.v4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/06/2023] [Indexed: 05/25/2023] Open
Abstract
A delay in detecting sepsis pathogens is a problematic issue for determining definitive antibiotic therapy for the causative pathogens. The gold standard method for sepsis is blood culture but this requires 3 days to detect the definitive pathogen. Molecular methods offer rapid identification of pathogens. We evaluated the use of sepsis flow chip (SFC) assay for identifying pathogens from children with sepsis. Blood samples from children with sepsis were collected and incubated in a culture device. Positive samples were subjected to amplification-hybridization using SFC assay and culture. A total of 94 samples from 47 patients were recovered, from which 25 isolates were recovered, including Klebsiella pneumoniae (11) and Staphylococcus epidermidis (6). From 25 positive blood culture bottles subjected to SFC assay, 24 genus/species and 18 resistance genes were detected. The sensitivity, specificity and conformity was 80, 94.2 and 94.68 % respectively. SFC assay offers promise to identify pathogens from positive blood culture in paediatric patients with sepsis and may support the antimicrobial stewardship programme in hospitals.
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Affiliation(s)
- Dimas Seto Prasetyo
- Clinical Microbiology Medical Staff, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Department of Microbiology Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mulya Rahma Karyanti
- Pediatric Child Health Medical Staff, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Department of Child Health Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Irene Yuniar
- Pediatric Child Health Medical Staff, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Department of Child Health Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yulia Rosa Saharman
- Clinical Microbiology Medical Staff, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Department of Microbiology Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Livya Holiwono
- Clinical Microbiology Medical Staff, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Department of Microbiology Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Muacevic A, Adler JR. The Role of C-reactive Protein Estimation in Determining the Duration of Antibiotic Therapy in Neonatal Sepsis. Cureus 2022; 14:e30211. [PMID: 36246087 PMCID: PMC9554835 DOI: 10.7759/cureus.30211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Septicemia is globally considered the most important cause of neonatal morbidity and fatality. Serum C-Reactive Protein (CRP) is an acute phase reactant, which is brought out in response to the inflammatory reaction. It is prophesied to drop down speedily after the coherent weeding out of microbial incitation due to the short half-life of CRP. CRP levels reflect the individual's association between microbial infection and defensive mechanisms. Methods: This hospital-based cross-sectional study included 150 admitted patients with suspected sepsis in the Department of Pediatrics, Rajendra Institute Medical Sciences (RIMS), Ranchi, India, over a study period of one year (2020 to 2021). CRP was estimated on the day of admission and repeated after 72 hours, on the fifth day, and on the seventh day for serial values of CRP, and the findings were compared by making three groups. Further, the research participants were designated to three different groups according to the CRP estimation levels. RESULTS Out of the 150 assumed neonatal septicemia patients, antibiotics were paused in 42 neonates (28%) within 72 hours. In group 2, 8% of neonates' antibiotics were stopped in five days, and a total of 102 neonates (68%) could be discharged on the seventh day of antibiotic therapy as their CRPs became negative on the third day and seventh day consecutively, along with negative blood culture reports. In group 3, antibiotics of 48 neonates (32%) were continued beyond seven days. CONCLUSION CRP has a skyscraping specificity and negative predictive values (NPV); thus, by estimating serial CRPs, the antibiotic therapy duration can be determined, which further helps determine the period of hospitalization.
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Tetteh FKM, Fatchu R, Ackah K, Philips TJ, Shewade HD, Fenny AP, Timire C, Edwards JK, Parbie EA. Sepsis among Neonates in a Ghanaian Tertiary Military Hospital: Culture Results and Turnaround Times. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11659. [PMID: 36141932 PMCID: PMC9517560 DOI: 10.3390/ijerph191811659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
In this study, we described the bacterial profile, antibiotic resistance pattern, and laboratory result turnaround time (TAT) in neonates with suspected sepsis from a tertiary-level, military hospital in Accra, Ghana (2017-2020). This was a cross-sectional study using secondary data from electronic medical records. Of 471 neonates clinically diagnosed with suspected sepsis in whom blood samples were collected, the median TAT from culture request to report was three days for neonates who were culture-positive and five days for neonates who were culture-negative. There were 241 (51%) neonates discharged before the receipt of culture reports, and of them, 37 (15%) were culture-positive. Of 471 neonates, twenty-nine percent (n = 139) were bacteriologically confirmed, of whom 61% (n = 85) had late-onset sepsis. Gram-positive bacterial infection (89%, n = 124) was the most common cause of culture-positive neonatal sepsis. The most frequent Gram-positive pathogen was coagulase-negative Staphylococcus (55%, n = 68) followed by Staphylococcus aureus (36%, n = 45), of which one in two were multidrug resistant. The reasons for large numbers being discharged before the receipt of culture reports need to be further explored. There is a need for improved infection prevention and control, along with ongoing local antimicrobial resistance surveillance and antibiotic stewardship to guide future empirical treatment.
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Affiliation(s)
| | - Raymond Fatchu
- Pathology Division, 37 Military Hospital, Neghelli Barracks, Accra GA 01, Ghana
| | - Kingsley Ackah
- Pathology Division, 37 Military Hospital, Neghelli Barracks, Accra GA 01, Ghana
| | - Trudy Janice Philips
- Clinical Pathology Department, Noguchi Memorial Institute for Medical Research, P.O. Box LG 581, Accra GA 01, Ghana
| | - Hemant Deepak Shewade
- Division of Health System Research, ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai 600077, India
| | - Ama Pokuaa Fenny
- Institute of Statistical, Social and Economic Research, University of Ghana, P.O. Box LG 1181, Accra GA 01, Ghana
| | - Collins Timire
- International Union against Tuberculosis and Lung Disease (The Union), 75006 Paris, France
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Sands K, Spiller OB, Thomson K, Portal EAR, Iregbu KC, Walsh TR. Early-Onset Neonatal Sepsis in Low- and Middle-Income Countries: Current Challenges and Future Opportunities. Infect Drug Resist 2022; 15:933-946. [PMID: 35299860 PMCID: PMC8921667 DOI: 10.2147/idr.s294156] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/17/2022] [Indexed: 12/18/2022] Open
Abstract
Neonatal sepsis is defined as a systemic infection within the first 28 days of life, with early-onset sepsis (EOS) occurring within the first 72h, although the definition of EOS varies in literature. Whilst the global incidence has dramatically reduced over the last decade, neonatal sepsis remains an important cause of neonatal mortality, highest in low- and middle-income countries (LMICs). Symptoms at the onset of neonatal sepsis can be subtle, and therefore EOS is often difficult to diagnose from clinical presentation and laboratory testing and blood cultures are not always conclusive or accessible, especially in resource limited countries. Although the World Health Organisation (WHO) currently advocates a ß-lactam, and gentamicin for first line treatment, availability and cost influence the empirical antibiotic therapy administered. Antibiotic treatment of neonatal sepsis in LMICs is highly variable, partially caused by factors such as cost of antibiotics (and who pays for them) and access to certain antibiotics. Antimicrobial resistance (AMR) has increased considerably over the past decade and this review discusses current microbiology data available in the context of the diagnosis, and treatment for EOS. Importantly, this review highlights a large variability in data availability, methodology, availability of diagnostics, and aetiology of sepsis pathogens.
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Affiliation(s)
- Kirsty Sands
- Ineos Institute of Antimicrobial Research, Department of Zoology, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Owen B Spiller
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Kathryn Thomson
- Ineos Institute of Antimicrobial Research, Department of Zoology, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | | | | | - Timothy R Walsh
- Ineos Institute of Antimicrobial Research, Department of Zoology, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
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San T, Aung MS, San N, Aung MMZ, Mon WLY, Thazin TE, Kobayashi N. Bacterial Species and Antimicrobial Resistance of Clinical Isolates from Pediatric Patients in Yangon, Myanmar, 2020. Infect Dis Rep 2022; 14:26-32. [PMID: 35076535 PMCID: PMC8788269 DOI: 10.3390/idr14010004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 02/04/2023] Open
Abstract
Antimicrobial resistance (AMR) is a concern in medical care for children who have high burden of infectious diseases. We investigated the prevalence of bacterial species and their susceptibility to antimicrobials of 1019 clinical isolates from pediatric patients in a tertiary-care hospital in Yangon, Myanmar for one-year period (2020). The most frequently recovered species was Escherichia coli, followed by Klebsiella pneumoniae and Staphylococcus aureus, all of which accounted for 43% of clinical isolates, while 25% of isolates comprised non-fermenter, including Pseudomonas sp. and Acinetobacter sp. Phenotypically determined ESBL (extended-spectrum beta-lactamase)-positive rates in E. coli, K. pneumoniae, and Enterobacter sp. were 82%, 88%, and 65%, respectively. High rates of multiple drug resistance were noted for E. coli (84%), K. pneumoniae (81%), and Acinetobacter sp. (65%), associated with carbapenem resistance in 48%, 42%, and 59% of isolates, respectively. In contrast, S. aureus isolates exhibited low resistance rates (<30%) to most of antimicrobials, with 22% being resistant to oxacillin/cefoxitin. Fluoroquinolone resistance was found in most of bacterial species with different prevalence rates. The present study revealed the current status on prevalence of bacterial species causing infections in pediatric patients in Myanmar, highlighting the significance to monitor AMR among children.
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Affiliation(s)
- Thida San
- Department of Clinical Laboratory, Yangon Children’s Hospital, Yangon 11191, Myanmar; (T.S.); (T.E.T.)
| | - Meiji Soe Aung
- Department of Hygiene, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan;
| | - Nilar San
- Department of Microbiology, University of Medicine 2, Yangon 11031, Myanmar;
| | - Myat Myint Zu Aung
- Department of Microbiology, University of Medicine 1, Yangon 11131, Myanmar;
| | - Win Lei Yi Mon
- Department of Clinical Laboratory, Yangon General Hospital, Yangon 11131, Myanmar;
| | - Thin Ei Thazin
- Department of Clinical Laboratory, Yangon Children’s Hospital, Yangon 11191, Myanmar; (T.S.); (T.E.T.)
| | - Nobumichi Kobayashi
- Department of Hygiene, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan;
- Correspondence: ; Tel.: +81-11-611-2111
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