Bacterial Pathogens and Antibiotic Susceptibility Patterns Among Neonates With Sepsis at Kenyatta National Hospital, Newborn Unit

Abstract

Background Neonatal sepsis is a major cause of morbidity and mortality among neonates more so in low- and middle-income countries. There is variability of causative pathogens in neonatal sepsis between as well as within countries and this changes from time to time. Antimicrobial resistance is globally on the rise and Africa shares this trend. However, there are major gaps in routine antimicrobial surveillance reported in the region. Objectives The study aimed to describe the bacterial pathogens and antibiotic susceptibility of neonates with sepsis from the Newborn unit at Kenyatta National Hospital within a six months period. This study also determined some clinical characteristics of cases with culture positive sepsis to further put the matter into perspective. Methods A retrospective cross-sectional study design was used. Cases with blood culture positive results from the newborn unit were identified from January to June 2019. These details were used to trace patient files from the records department of KNH. Data management and analysis Case record forms were used for data collection then transferred to Microsoft EXCEL spread sheets on a password protected computer. Data verification, cleaning and coding was done before transfer to STATA version 13 for analysis. Results A total of 357 blood culture samples were analyzed from the NBU, of which 158 were positive (44.2%). More than half (54%) of the cases had late onset sepsis. Gram negative isolates were predominant at 58% and associated with poor outcome with mortality rate of 56.3% (p=0.007). Klebsiella pneumoniae was the leading isolate at 28.9%. High resistance rates above 95% were noted to cephalosporins. Vancomycin and amikacin had high sensitivities of 90% and 88% respectively, that of ciprofloxacin and meropenem was 87%. Majority of patients were discharged home alive, 53% although they had stayed longer in hospital with 25 days median duration of stay (p=0.0069). Conclusion Gram-negative sepsis predominated by K. pneumoniae accounts for majority of neonatal sepsis cases and is associated with high mortality and morbidity in our setting. Many isolates demonstrated high sensitivity to vancomycin, amikacin, ciprofloxacin and meropenem whereas very high resistance rates to commonly used antibiotics particularly, cephalosporins and benzylpenicillin were noted