Early Onset and Late Onset of Neonatal Sepsis in a Tertiary Hospital, South-South, Nigeria

Main Article Content

A. A. Adedokun
E. O. Onosakponome
C. U. Nyenke

Abstract

Aims: The study was carried out to determine organisms present during early onset of neonatal sepsis (EONNS), late onset of neonatal sepsis (LONNS) and their antimicrobial susceptibility pattern.

Methodology: This study is a retrospective evaluation of 453 neonatal blood cultures. Two (2) ml of blood from these neonates was cultured in thioglycollate broth and tryptone soya broth. This was carried out in the Department of Microbiology and Parasitology of the University of Port Harcourt Teaching Hospital, Nigeria between January-December 2007.

Results: Out of 453, 272(60.0%) neonates showed negative blood cultures, while 181(40.0%) neonates had positive bacterial cultures and 2 neonates (0.4%) were positive for Candida albicans. Overall, Klebsiella spp. was the most common pathogen, accounting for (37.8%) of the total isolates. Others were as follows; Staphylococcus aureus (28.4%), Escherichia coli (11.8%), unclassified coliforms 8.3%, Pseudomonas spp. 4.9%, Enterococcus spp. (2.9%), coagulase-negative Staphylococcus (CONS) (2.5%) and Proteus spp. (3.4%). Early onset neonatal sepsis (EONNS) and late onset neonatal sepsis (LONNS) had Klebsiella spp and Staphylococcus aureus as their common causes of neonatal sepsis respectively. Klebsiella spp. was susceptible to spafloxacin (87.0%) followed by ofloxacin (82.0%), amoxycillin-clavulanic acid (79.0%) and ceftazidime (65.0%) among the Gram-negative organisms. In the category of Gram-positive organisms, Staphylococcus aureus is highly sensitive to ofloxacin (81.0%) followed by spafloxacin (79.0%) and amoxicillin-clavulanic acid (71.0%).

Conclusion: A viable antibiotic susceptibility surveillance programme coupled with good infection control practices and rational antibiotics use will reduce infection rate, ensure better therapeutic success and prolong the efficacy of available antimicrobials.

Keywords:
Early onset, late onset, neonatal sepsis, blood culture, Klebsiella spp, Staphylococcus aureus, antimicrobial agents.

Article Details

How to Cite
Adedokun, A. A., Onosakponome, E. O., & Nyenke, C. U. (2020). Early Onset and Late Onset of Neonatal Sepsis in a Tertiary Hospital, South-South, Nigeria. Journal of Advances in Microbiology, 20(6), 19-29. https://doi.org/10.9734/jamb/2020/v20i630249
Section
Original Research Article

References

WHO. Handbook IMCI: Integrated Management of Childhood Illnesses. WHO/FCH/CAH/00.12 Geneva; 2000.

Weber MW, Carlin JB, Gatchalian S, Lehmann D, Muhe L, Mulholland EK, et al. Predictors of neonatal sepsis in developing countries. Pediatr Infect Dis J. 2003;22(8): 711-717.

Gray J. Which factors predict hospital-acquired late-onset neonatal sepsis. Pediatr Health. 2008;2(4):477-484.

Misallati A, El-Bargathy S, Shembesh N. Blood-culture-proven neonatal septicemia: A review of 36 cases. E Mediterr Health J. 2000;6(2-3):483-486.

Bode-Thomas F, Ikeh EI, Pam SD, Ejellogu EU. Current aetiology of neonatal sepsis in Jos University Teaching Hospital. Nigerian J. Med. 2004;13(2):130-135.

Mahapatra A, Ghosh SK, Mishra S, Pattnaik D, Pattnaik K, Mohanty SK. Enterobacter cloacae: A predominant pathogen in neonatal septicemia. Indian J Med Microbiol. 2000;20(2):110-112.

Stoll BJ. Infections of the neonatal infant. In: Berhman RE, Kliegman RM, Jenson HB (editors). Nelson Textbook of Pediatrics, 17th Edition. India, WB Saunders Company. 2004;623-639.

Black E, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Global, regional, and national causes of child mortality in 2008: A systematic analysis. Lancet. 2010;375(9730):1969-1987.

Holland BJ, Demer D, Brook I, Windle ML, Schleiss MR, Tolan RW, Jr, et al. Bacteremia. Pediatr Infect Dis. 2005;1-11. (Retrieved 15 March 2005).

Stoll BJ. Early-Onset Neonatal Sepsis: A Continuing Problem in Need of Novel Prevention Strategies. Pediatric. 2016; 138(6):e20163038.

Ohlin A, Bjorkqvist M, Montgomery SM, Schollin J. Clinical signs and CRP values associated with blood culture results in neonates evaluated for suspected sepsis. Acta Pediatr. 2010;99(11):1635-1640.

Iroh TPI, Bendel CM. Diagnostics for neonatal sepsis: Current approaches and future directions. Pediatric 2017;82(4):574-583.

Coggins SA, Weitkamp JH, Grunwald L, Stark AR, Reese J, Walsh W, et al. Heart rate characteristic index monitoring for bloodstream infection in an NICU: A 3-year experience. Arch Dis Child Fetal Neonatal Ed. 2016;101(4):F329-332.

American Academy of Pediatrics. Red Book 2003: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: Am Acad Pediatr. 2003;117-123,237-43,561-73,584-91.

American Academy of Pediatrics. Red Book 2018-2021: Report of the Committee on Infectious Diseases. 31st Ed. Elk Grove Village, IL: Am Acad Pediatr; 2018.

American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee opinion no. 485: Prevention of early-onset group B streptococcal disease in newborns (reaffirmed in 2016). Obstet Gynecol. 2011;117(4):1019-1027.

Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep. 2002;51(RR-11):1-22.

Tsai MH, Lien R, Wang JW, Huang HR, Chiang CC, Chu SM, et al. Complication rates with percutaneously central venous catheters inserted at femoral and non-femoral sites in very low birth weight infants. Pediatr Infect Dis J. 2009;28(11): 9663-970.

Tsai MH, Chu SM, Lee CW, Hsu JF, Huang HR, Chiang MC, et al. Recurrent late-onset sepsis in the neonatal intensive care unit: Incidence, clinical characteristics, and risk factors. Clin Microbiol Infect. 2014;20(11):0928-0935.

Tsai MH, Chu SM, Hsu JF, Lien R, Huang HR, Chiang MC, et al. Risk factors and outcomes for multidrug-resistant gram-negative bacteremia in the NICU. Pediatric. 2014;133(2):e322-329.

Edwards MS, Baker CJ. Sepsis in the newborn, p 545–561. In Gershon AA, Hotez PJ, Katz SL (Ed.), Krugman’s infectious diseases of children, 11th ed. Mosby, Philadelphia, PA; 2004.

Schuchat A. Neonatal group B streptococcal disease—screening and prevention. N Engl J Med. 2000;343(3): 209-10.

Available:http://dx.doi.org/10.1056/NEJM200007203430310

Cheesbrough M. Microbiological tests. In: District Laboratory Practice in Tropical Countries. Cambridge Low-Price Editions, University Press. Cambridge. 2006;2:1-7.

Hudzicki J. Kirby-Bauer disk diffusion susceptibility protocol. American Society for Microbiology; 2018.

Clinical and Laboratory Standard Institute, author. 11th edition document M02-A11. Wayne: Clinical and Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests. Approved standard. 2012;12–27.

Chako B, Sohi I. Early Onset Neonatal Sepsis. Indian J Pediatr. 2005;72(1):23-26.

Rasul CH, Hassan MA, Habibullah M. Neonatal Sepsis and Use of Antibiotics in a Tertiary Care Hospital. Pakistan J Med Sci. 2007;23(1):78-81.

West BA, Tabansi PN. Clinico-bacteriological profile of early and late onset sepsis in a tertiary institution in Nigeria. J Med Med Sci. 2012;3(2):107-111.

Peterside O, Pondei K, Akinbami FO. Bacteriological profile and antibiotic susceptibility pattern of neonatal sepsis at a teaching hospital in Bayelsa State, Nigeria. Trop Med Health. 2015;43(3):183-190.

Kurma VR, Raju MS, Manchu T, Manchu K. Neonatal sepsis: Clinical spectrum, bacteriological profile and antibiotic sensitivity patterns in neonatal intensive care unit in a tertiary care Hospital. Int J Contemp Med Res. 2019;6(6):F1-F48.

Mokuolu AO, Jiya N, Adesiyun OO. Neonatal septicemia in Ilorin: Bacterial pathogens and antibiotic sensitivity pattern. African J Med Sci. 2002;31(2):127-130.

Meremikwu MM, Nwachukwu CE, Asuquo AE, Okebe JU, Utsalo SJ. Bacterial isolates from blood cultures of children with suspected septicemia in Calabar, Nigeria. BMC Infect Dis. 2005;5:110.

Onyedibe KI, Okolo MO, Toma B, Afolaranmi T. The necessity of full sepsis screen in neonatal sepsis: Experience in a resource limited setting. Sahel Med J. 2016;19(2):89-93.

Ekwochi U, Ifediora C, Osuorah CD. A 4-Year prospective study of clinico-bacterial profile and antibiogram of neonatal bacterial sepsis at a tertiary health facility in a resource-limited setting. J Clin Neonatol. 2018;7(2):80-88.

Musoke RN, Revathi G. Emergence of multidrug resistant Gram-negative organisms in a neonatal unit and the therapeutic implications. J Trop Pediatr. 2000;46(2):86-91.

Tallur SS, Kasturi AV, Nadgir SD, Krishna BV. Clinico-bacteriological study of neonatal septicemia in Hubli. Indian J Pediatr. 2000;67(3):169-174.

Khante SV, Raut SS. Clinical and bacteriological study of neonatal septicemia in a tertiary care hospital. Int J Res Med Sci. 2017;5(10):4455-4462.

Sathyamurthi B, Leela KV, Narayanababu R, Padmanaban S, Sreedevi S, Sujatha, et al. Clinical and bacteriological profile of neonatal sepsis in a tertiary care hospital. Int J Sci Stud. 2016;4(8):57-60.

Galhotra S, Gupta V, Bains HS, Chhina D. Clinico-bacteriological profile of neonatal septicemia in a tertiary care hospital. J Mahatma Gandhi Inst Med Sci. 2015;20(2): 148-152.

Ogundare E, Akintayo A, Aladekomo T, Adeyemi L, Ogunlesi T, Oyelami O. Presentation and outcomes of early and late onset neonatal sepsis in a Nigerian Hospital. African Health Sci. 2019;19(3): 2390-2399.

Rashmi P, Praveen BK. Clinico-bacteriological profile of neonatal sepsis. International J Contemp Pediatr. 2019; 6(2):796-802.

Komolafe AO, Adegoke AA. Incidence of bacterial septicemia in Ile-Ife Metropolis, Nigeria. Malaysian J Microbiol. 2008;4(2): 51-61.

Arowosegbe AO, Ojo DA, Dedeke IO, Shittu OB, Akingbade OA. Neonatal sepsis in a Nigerian Tertiary Hospital: Clinical features, clinical outcome, aetiology and antibiotic susceptibility pattern. Southern African J Infect Dis. 2017;32(4):127-131.

Yusuf MA, Haziyamin T, Hamid ATA. Isolation and identification of bacteria associated with neonatal septicemia at the Specialist Hospital Bauchi. IOSR J Pharm Biol Sci. 2012;2(6):47-50.

Dagnew M, Yismaw G, Gizachew M, Gadisa A, Abebe T, Tadesse T, et al. B. Bacterial profile and antimicrobial susceptibility pattern in septicemia suspected patients attending Gondar University Hospital, Northwest Ethiopia. BMC Res Notes. 2013;6:283.

Ansari S, Nepal HP, Gautam R, Shrestha S, Neopane P, Chapagain ML. Neonatal Septicemia in Nepal: Early-Onset versus Late-Onset. Int J Pediatrics. 2015;2015: Article ID 379806,6 page.

Aletayeb SM, Khosravi AD, Dehdashtian M, Kompani F, Mortazavi SM, Aramesh MR. Identification of bacterial agents and antimicrobial susceptibility of neonatal sepsis: A 54-month study in a tertiary hospital. African J Microbiol Res. 2011; 5(5):528-531.

Mugalu J, Nakakeeto MK, Kiguli S, Kaddu-Mulindwa DH. Aetiology, risks and immediate outcome of bacteriologically confirmed neonatal septicemia in Mugalo hospital, Uganda. African Health Sci. 2006; 6(2):120-126.

Vergnano S, Sharland M, Kazembe P, Mwansambo C, Heath PT. Neonatal sepsis: an international perspective. Arch Dis Child Fetal Neonatal Ed. 2005;90(3): F220-224.

Ghotaslou R, Ghorashi Z, Nahaei MR. Klebsiella pneumoniae in neonatal sepsis: A 3-year study in the pediatric hospital of Tabriz, Iran. Japanese J Infect Dis. 2007; 60(2-3):126-128.

Husada D, Chanthavanich P, Chotigeat U, Sunttarattiwong P, Sirivichayakul C, Pengsaa K, Chokejindachai W, Kaewkungwal J. Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand. BMC Infect Dis. 2020;0:151.

Fadero FF, Aboderin AO, Onigbinde MO, Ako-Nai AK. Bacteria Pathogens and Antibiotics Sensitivity in Neonatal Septicemia at the Ladoke Akintola University Teaching Hospital (LTH), Osogbo, Southwestern Nigeria. Int J Trop Med. 2007;2(1):21-24.

Auranqzeb B, Hameed A. Neonatal sepsis in hospital-born babies: bacterial isolates and antibiotic susceptibility patterns. J Coll Physicians Surg Pak. 2003;13(11):629-632.

Roy I, Jain A, Kumar M, Agarwal SK. Bacteriology of neonatal septicemia in a tertiary care hospital of northern India. Indian J Med Microbiol. 2002;20(3):156-159.

Rao S, Ali U. Systemic fungal infections in neonates. J Postgraduate Med. 2005; 51(Suppl 1):S27-S29.

Chen J, Jiang Y, Wei B, Ding Y, Xu S, Qin P, Fu P. Epidemiology of and risk factors for neonatal candidemia at a tertiary care hospital in western China. BMC Infect Dis. 2016;16:700.

Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: Analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39(3):309-317.

Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group B Streptococcal disease. MMWR Morb Mortal Wkly Rep. 2002;51(RR-11):1-22.

Neu N, Malik M, Lunding A, Whittier S, Alba L, Kubin C, et al. Epidemiology of candidemia at a Children’s hospital, 2002 to 2006. Pediatr Infect Dis J. 2009;28(9): 806-809.

Wirsching S, Michel S, Morschhauser J. Targeted gene disruption in Candida albicans wild-type strains: The role of the MDR1 gene in fluconazole resistance of clinical Candida albicans isolates. Mol Microbiol. 2000;36(4):856-865.

Saiman L, Ludington E, Dawson JD, Patterson JE, Rangel-Frausto S, Wiblin RT, Blumberg HM, Pfaller M, Rinaldi M, Edwards JE, Wenzel RP, Jarvis W. Risk factors for Candida species colonization of neonatal intensive care unit patients. Pediatr Infect Dis J. 2000;19(4):319-324.

Karlowicz MG, Giannone PJ, Pestian J, Morrow, AL, Shults J. Does candidemia predict threshold retinopathy of prematurity in extremely low birth weight (≤1000 g) neonates? Pediatrics. 2000;105(5):1036-1040.

Fairchild KD, Tomkoria S, Sharp EC, Mena FV. Neonatal Candida glabrata sepsis: clinical and laboratory features compared with other Candida species. Pediatr Infect Dis J. 2002;21(1):39-43.

Ali GY, Algohary EH, Rashed KA, Almoghanum M, Khalifa AA. Prevalence of Candida colonization in preterm newborns and VLBW in neonatal intensive care unit: Role of maternal colonization as a risk factor in transmission of disease. J Matern Fetal Neonatal Med. 2012;25(6):789-795.

Bliss JM, Basavegowda KP, Watson WJ, Sheikh AU, Ryan RM. Vertical and horizontal transmission of Candida albicans in very low birth weight infants using DNA fingerprinting techniques. Pediatr Infect Dis J. 2008;27(3):231-235.

Adejuyigbe EA, Adeodu OO. Ako-Nai K A, Taiwo O, Owa JA. Septicemia in high risk neonates at a teaching hospital in Ile-Ife, Nigeria. East African Med J. 2001;78(10): 540-543.

Noel GJ, Bradley JS, Kauffman RE, Duffy CM, Gerbino PG, Arguedas A, et al. Comparative safety profile of levofloxacin in 2523 children with a focus on four specific musculoskeletal disorders. Pediatr Infect Dis J. 2007;26(10):879-891.