Causative organisms, antibiotic sensitivity patterns and risk factors associated with neonatal sepsis at Moi Teaching and Referral Hospital, Kenya

Abstract

Background: Neonatal sepsis is a clinical syndrome characterized by systemic signs of infection which can be confirmed by blood culture testing. Previous studies have reported high incidences of hospital associated sepsis; antimicrobial resistance coupled with increased mortality especially in the developing economies. There are limited local studies regarding antibiotic sensitivity patterns and its associated risk factors of neonatal sepsis. This limits empirical antibiotic therapy and local infection control strategies. Objectives: To determine the causative organisms, antibiotic sensitivity patterns and risk factors associated with neonatal sepsis at Moi Teaching and Referral Hospital (MTRH) newborn unit. Methodology: A cross-sectional study among 141 neonates with confirmed sepsis receiving care at MTRH new-born unit between September 2017 and July 2018. The participants were sampled consecutively until the desired sample size was achieved. Neonatal clinical characteristics were obtained from the participants’ medical records while blood culture samples were collected for antimicrobial susceptibility testing. Data on maternal characteristics were obtained using an interviewer administered questionnaire. Descriptive statistics, Pearson chi-square test of association and odds ratios were conducted using statistical package for social sciences (SPSS) version 24. Results: Females accounted for 57.4% of the 141 neonates enrolled. The median gestational age and birth weight were 37 (IQR: 22-45) weeks and 2400g (IQR: 800 - 4700) respectively; 78% (n=110) of the neonates were born via spontaneous vertex delivery. A total of 151 bacterial isolates were identified, majority (46.4%; n=70) being Klebsiella pneumoniae. followed by Coagulate negative staphylococcus aureus (CoNS) 27.8% (n=42). Klebsiella pneumoniae was sensitive to meropenem (OR=3.298; 95% CI: 2.219-4.902; p<0.001) and amikacin (OR=1.116; 95% CI: 0.920, 1.354; p=0.270). but resistant to vancomycin (OR=2.455; 95% CI:1.888- 3.192; p<0.001), CoNS was sensitive to vancomycin (OR=5.710; 3.478-9.374; p<0.001) but resistant to the rest. Both the neonatal (mode delivery, place of birth, prematurity and 5-minute APGAR score) and maternal (parity, intrapartum pyrexia, age, level of education and urinary tract infection during pregnancy) risk factors showed no significant associations with the occurrence of neonatal sepsis. Conclusion: The main bacterial causes of neonatal sepsis were Klebsiella pneumoniae and CoNS. Both the gram positive and gram-negative bacteria had good sensitivity to meropenem and amikacin. The risk factors evaluated were not associated with the occurrence of neonatal sepsis. Recommendations: Klebsiella pneumoniae being one of the known nosocomial infections, improvement in infection control in the unit is recommended. There is need for evidence-based review of empirical antibiotic therapy regimen containing penicillin, gentamicin, and ceftriaxone due to the prevailing high resistance levels. Future larger studies designed to identify other risk factors for neonatal sepsis should be conducted.