Multi-drug resistance in early and late onset neonatal sepsis in a tertiary hospital in Nigeria
Accepted: July 31, 2019
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Neonatal sepsis is a clinical syndrome characterized by systemic signs of infection, and accompanied by bacteremia in the first month of life and is responsible for 30-50% of total neonatal deaths, each year in developing countries. This study investigated multi-drug resistant organisms associated with early and late onset neonatal sepsis in the University of Ilorin Teaching Hospital (UITH). It was a descriptive cross-sectional study. One hundred and sixty-two blood samples from neonates admitted into the neonatal intensive care unit of UITH with clinical diagnosis of sepsis were obtained. One milliliter of blood was taken per neonate and cultured aerobically in brain heart infusion broth and sub cultured onto blood and MacConkey agar plates. Identification of the isolates was carried out by colonial morphology, Gram stain microscopy and several biochemical tests. Antibiotic susceptibility test was done using the modified Kirby-Bauer method, screening for methicillin resistance Staphylococcus aureus (MRSA) and extended spectrum beta lactamase (ESBL) was done by the cefoxiin- based methods and double disc synergy test respectively. Data analysis was carried out using Microsoft excel version 2007 and Epi-info version 2012. Sepsis was confirmed bacteriologically in 22.2% of the samples. The prevalence of multidrug resistant isolate was 29.0%. The prevalence of MRSA was found to be 37% while that of ESBL producing Enterobacteria was 44.4% with ESBL producing Klebsiella pneumoniae and Escherichia coli prevalence of 50% and 25% respectively. This study shows a high prevalence of Methicillin Resistant Staphylococcus Aureus and Extended Spectrum Beta Lactamase producing Klebsiella pneumoniae and Escherichia coli causing neonatal sepsis in UITH Ilorin.
Kale A, Jaybhaye D, Bonde V. ‘Neonatal Sepsis: An update’ Iranian Journal of Neonatology , 2013, 4: 39-51.
Vergnano S, Sharland M, Kazembe P et al., ‘Neonatal sepsis: An international perspective’ www.archdischild.com 2005 DOI: 10.1186/s13756-017-0225-9. DOI: https://doi.org/10.1186/s13756-017-0225-9
Iregbu, KC, Elegba, OY, Babaniyi, IB, ,'Bacteriological profile of neonatal septicaemia in a tertiary hospital in Nigeria' African Health Sciences 2006; 6: 151-154.
Mokuolu, AO, Jiya, N and Adesiyun, OO, Neonatal Septicaemia in Ilorin: Bacterial Pathogens and Antibiotic Sensitivity Pattern', Afr. J. Med. Sci.2002; 31,127-30.
Bhat, S, kavita, and Rao S, 'Bacteriology of Neonatal Septicaemia', JRRMS, 2011;vol.1,no 1,pp18-21
Shalini, A, Niranjan, T, Balaji, V, Atanu, KJ, ' Prevalence of Extended- spectrum B-lactamase Producing Escherichia coli and Klebsiella spp in a Neonatal Intensive Care Unit', Indian Pediatr 2009;46: 1106-1107.
Baddour, M.M., Abuelkheir, M.M., and Fatani, A.J. Trends in antibiotic susceptibility patterns and epidemiology of MRSA isolates from several hospitals in Riyadh, Saudi Arabia. Annals of Clin. Microbio. and Antimicrob 2006;5:30
David, ZM, and Robert SD, 'Community- Associated Methicillin- Resistant Staphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic'. Clinical Microbiology Reviews, 2010; 23: 616-687. DOI: https://doi.org/10.1128/CMR.00081-09
Kaufman, D, and Fairchild, DK, 'Clinical Microbiology of Bacterial and Fungal sepsis in Very- Low-Birth- Weight infants', Clinical Microbiology Reviews, 2004; 17: 638-680. DOI: https://doi.org/10.1128/CMR.17.3.638-680.2004
Kenneth, ST, ' Controversies about Extended-Spectrum and AmpC beta-lactamases', Emerging infectious Diseases 2001; 7:333-335. DOI: https://doi.org/10.3201/eid0702.010238
Ankur Goyal, KN. Prasad, AP, Sapna Gupta, U G, Archana, A. 'Extended spectrum beta-lactamase in Escherichia coli and Klebsiella pneumoniae &associated risk factors', Indian J Med Res 2008;129: 695-700.
Jonathan, N, 'Screening for Extended -Spectrum Beta- lactamase- producing pathogenic Enterobacteria in District General Hospitals', Journal of clinical microbiology, 2005;43: 31488-31490. DOI: https://doi.org/10.1128/JCM.43.3.1488-1490.2005
Cheesbrough, M, Culturing Blood. District Laboratory practice in Tropical Countries. United Kindom, University Press, Cambridge. 2000, ;124-30.
Forbes, BA, Sahm, DF, and Weissfeld, AS, Bloodstream Infections. Bailey and Scott’s Diagnostic Microbiology, 12th Edition. Mosby Elsevier, China, 2007; 789 – 797.
CLSI 'Performance standards for Antimicrobial disk susceptibility tests; Approved Standard, M02-A11, Clinical and laboratory Standard Institute 2012; vol.32, no.1, pp9-13.
Vemula, S and Vadde R, 2011,'Prevalence of ESBL- producing Klebsiella pneumoniae isolates in tertiary care hospital', ISRN microbiology, vol 2011, p5. DOI: https://doi.org/10.5402/2011/318348
Yelda, AL, Álvarez-Nemegyei J, Velázquez R J, et al. ,'Risk factors and prognosis for neonatal sepsis in southern mexico: analysis of a four- year historic cohort follow-up', BMC pregnancy and child health, 2012; 12:48 DOI: https://doi.org/10.1186/1471-2393-12-48
Zhiling L, Zhijun X, Zhiping L, Qiao Z et al. ‘116 cases of neonatal early-onset or late-onset sepsis: A single center retrospective analysis on pathogenic bacteria species distribution and antimicrobial susceptibility. Int J Clin Exp Med 2013; 6(8): 693-99.
Ghandi, S, Ranjan, K, Sapre, N, and Massani, M, 'Incidence of neonatal sepsis in tertiary care hospital: An overview, Int J Med Sci Public Health, 2013; 2:162-475. DOI: https://doi.org/10.5455/ijmsph.2013.090320131
Prabhu, K, Bhat, S, and Rao, S, 'Bacteriologic profile and antibiogram of blood culture isolates in a pediatric care unit', J Lab Physicians 2010; 2: 85-88. DOI: https://doi.org/10.4103/0974-2727.72156
Singh S, Kumar S, Kumari P. ‘Isolation of methicillin- resistant Staphylococcus aureus from neonatal sepsis at a tertiary care hospital. Int. J Sci. Stud. 2019;6(10): 25-28
Karthikeyan, G, and Premkumar K, 'Neonatal Sepsis: Staphylococcus aureus as the predominant pathogen, The Indian Journal of Pediatrics 2001;68(8):715-717. DOI: https://doi.org/10.1007/BF02752407
Hannan, A, Qamar, MU, Usman, M, Ahmed, K, Waheed, I, and Rauf, K, 'Multidrug resistant microrganisms causing neonatal septicaemia: In a tertiary hospital Lahore, Pakistan', African Journal of Microbiology Reseach2013;.7:1896-1902. DOI: https://doi.org/10.5897/AJMR2012.2307
Dangre-Mudey, G, Neelima, S. Tankhiwale, and Fule, RP, ' Multidrug Resistance and Extended Spectrum Beta Lactamase Production in Klebsiella Species Isolated From Cases of Neonatal Septicaemia', J Life Sci, 2012; 4: 59-62. DOI: https://doi.org/10.1080/09751270.2012.11885196
Jain, A, and Mondal, R,' Prevalence & antimicrobial resistance pattern of extended spectrum beta-lactamase producing Klebsiella spp isolated from cases of neonatal septicaemia', Indian J Med Res.Jan, 2007;125(1):89-94
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