Microbiological Profile of Neonatal Sepsis at a Maternity Hospital in Omdurman, Sudan
Background: Neonatal sepsis is a clinical syndrome characterized by systemic signs of infection and accompanied by bacteremia in the first month of life. It is a major cause of morbidity and mortality in neonatal period. The study was conducted to determine microbiological profile and antibiogram of neonatal sepsis at Omdurman Maternity Hospital.
Methods: This was a cross-sectional hospital-based study involving 202 neonatal blood cultures at Omdurman Maternity Hospital during the period from April 2017 to April 2018. Specimens were cultured in Brain Heart Infusion broth followed by subculture of isolates on blood agar, MacConkey agar, and Chocolate agar and incubated aerobically at 37ºC for 24 h. The isolates were tested for their susceptibility to antimicrobial agents using the Kirby Bauer disc diffusion method.
Results: Of 202 positive blood cultures, 130 cases (64.4%) were early onset and 72 cases (35.6%) were recorded for late onset sepsis. Gram-negative pathogens approaching (123, 60.9%). Staphylococcus aureus was the most common organism in both groups of neonatal sepsis being isolated from (71, 35.7%), followed by Klebsiella pneumoniae (43, 21.2%). Gram-negative organisms were sensitive to Imepenem (97.3%) and Meropenem (80.5%) and resistant to third-generation Cephalosporins (65.3%) and Amoxicillin/Clavulanic acid (91.4%). Gram-positive organisms were resistant to Cefotaxime (75%), Amoxicillin/Clavulanic acid (65.4%), and Clindamycin (68.2%); 91.6% of gram-positive isolates were sensitive to Vancomycin.
Conclusion: Gram-negative pathogens took the major spectrum of isolates. Klebsiella pneumoniae (21.2%) was the most frequent gram-negative organism. Methicillinresistant Staphylococcus aureus (MRSA) (33.7%) was the most common isolate. Most of the isolates were multidrug resistant. The best choice for treatment is Vancomycin (8.4%) and Imepenem (2.7%) for gram-positive and gram-negative, respectively. Adherence to antibiotic policy, antimicrobial surveillance, and policy updating is necessary.
 Camacho-Gonzalez, A., Spearman, P. W., and Stoll, B. J. (2013). Neonatal infectious diseases: evaluation of neonatal sepsis. Pediatric Clinics of North America, vol. 60, pp. 367–389.
 Verani, J. R., McGee, L., Schrag S. J. (November 19, 2010). Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. MMWR Recommendations and Reports, vol. 59, pp. 1–32.
 Brye, J, Boschi, Pinto, C., et al. (2005). WHO estimate of the causes of death in children. Lancet, vol. 365, p. 1147.
 NBS, S., Menezes, R. P., Brito, M. O., et al. (2017). Sepsis neonatal: epidemiology, etiology and risk factors. Advances in Biotechnology and Microbiology, vol. 4, no. 2, pp. 7–8.
 Le Doare, K. and Heath, P. T. (2013). An overview of global GBS epidemiology. Vaccine, vol. 31S, pp. D7–12.2.
 Weston, E. J., Pondo, T., Lewis, M. M., et al. (November 2011). The burden of invasive early-onset neonatal sepsis in the United States, 2005-2008. The Pediatric Infectious Disease Journal, vol. 30, no. 11, pp. 937–941.
 Simonsen, K. A., Anderson-Berry, A. L., Delair, S. F., et al. ( January 1, 2014). Earlyonset neonatal sepsis. Clinical Microbiology Reviews, vol. 27, no. 1, pp. 21–47.
 World Health Organiation. (2011). Neonatal Sepsis - A Major Killer to be Tackled in Communities. WHO.
 Kheir, A. E. M. and Khair, R. A. (2014). Neonatal sepsis: Prevalence and outcome in a tertiary neonatal unit in Sudan. Time Journals of Medical Sciences Report and Research, vol. 2, no. 1, pp. 21–25.
 Clinical & Laboratory Standards Institute. (2011). Performance Standards for Antimicrobial Susceptibility Testing: Twenty-First Informational Supplement. CLSI document M100-S21. Wayne, PA: Clinical and Laboratory Standards Institute.
 Verma, P., Berwal, P. K., Nagaraj, N., et al. (2015). Neonatal sepsis: Epidemiology, clinical spectrum, recent antimicrobial agents and their antibiotic susceptibility pattern. International Journal of Contemporary Padiatrics, vol. 2, no. 5, pp. 176– 180.
 Jyothi, P., Basavaraj, M. C., and Basavaraj, P. V. (2013). Bacteriological profile of neonatal septicemia and antibiotic susceptibility pattern of the isolates. Journal of Natural Science, Biology and Medicine, vol. 4, no. 2, pp. 306–309.
 Vergnano, S., Sharland, M., Kazembe, P., et al. (2005). Neonatal sepsis: An international perspective. Archives of Disease in Childhood - Fetal and Neonatal Edition, vol. 90, pp. F220–F224.
 Ibrahim, S. A. and Rahma, S. (2012). Microbiological profile of neonatal septicemia. The Iraqi Postgraduate Medical Journal, vol. 11, no. 1.
 Kayange, N., Kamugisha, E., Mwizamholya, D. L., et al. (2010). Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza- Tanzania. BMC Pediatrics, pp. 1471–2431.
 Lamba, M., Sharma, R., Sharma, D., et al. (2016). Bacteriological spectrum and antimicrobial susceptibility pattern of neonatal septicaemia in a tertiary care hospital of North India. Journal of Maternal-Fetal and Neonatal Medicine, vol. 29, pp. 3993– 3998.
 Agnihotri, N., Kaistha, N., and Gupta, V. (December 2004). Antimicrobial susceptibility of isolates from neonatal septicemia. Japanese Journal of Infectious Diseases, vol. 57, pp. 273–275.
 Zaidi, A. K., Thaver, D., Ali, S. A., et al. (2009). Pathogens associated with sepsis in newborns and young infants in developing countries. The Pediatric Infectious Disease Journal, vol. 28, pp. s10–s18.
 Babiker, W., Ahmed, A., Babiker, T., et al. (2018). Prevalence and causes of neonatal sepsis in Soba University Hospital, Sudan. Medical Microbiology Reports, vol. 1, 2.