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Bacterial Etiology of Neonatal Sepsis, Antimicrobial Susceptibility Profile, and Risk Factors among Sepsis Suspected Newborns admitted at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia

Author(s) : Endale Worku

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Issue Date : 2022-07-13T06:52:59Z
Abstract :
Background: Neonatal sepsis is a systemic infection occurring in infants at an early age and it can be classified as early or late-onset sepsis. The contribution of sepsis to neonatal mortality and morbidity is significant in resource-limited countries. Objective: This study was undertaken to determine the bacterial etiology of neonatal sepsis, its associated risk factors among sepsis suspected newborns, and the anti-microbial susceptibility profile of bacteria. Materials and Methods: A Hospital-based cross-sectional study was conducted among 392 sepsis suspected newborns admitted to the neonatal intensive care unit of Hawassa University Comprehensive Specialized Hospital from March to November; 2021. Blood was aseptically obtained using a butterfly needle and dispensed into a sterilized universal bottle containing 20 ml of tryptone soybean broth. Bacteria were isolated using the standard culture method. Antibacterial susceptibility testing was performed according to the criteria of the Clinical and Laboratory Standards Institute guidelines. Clinical and socio-demographic data were collected using a structured questionnaire. Data were analyzed using a statistical package for social science, version 25. Bivariate and multivariate regression analysis was applied to determine the association between independent variables and dependent variables. Bivariate logistic regression was carried out then variables with p <0.25 were further analyzed by multivariate logistic regressions, p-value <0.05 were accepted as statistically significant. Results: The overall prevalence of bacteria among sepsis suspected newborns was 143 (36.5%; 95% CI: 31.3-41.4). The predominant bacteria were Klebsiella species. (n=61; 42.65%), followed by, non-lactose fermenting Gram-negative bacteria (n= 27; 18.88%) and Enterococcus species (n=26; 18.18%). Most isolates were resistant to the commonly used antimicrobial agents. Most Klebsiella species showed resistance to commonly used antibiotics such as ; amoxicillin-clavuclic acid ( 100%), trimethoprim-sulphamethoxazole (93.4%), amikacin (29.5%), and ceftriaxone (100%). multiple drug resistance (resistance to three or more drugs categories) was observed in 112 of 143 (78.3 %). In multivariate analysis premature rupture of membrane (AOR=12.70(95% CI: 6.430-25.106)), absence of respiratory support (AOR= 3.53 (95% CI: 1.840-6.759)), way of delivery; Instrumental vaginal delivery (AOR= 0.38(95% CI:(0.192-0.782)) and (Cesarean section) (AOR= 0.42 (95% CI: 0.217-0.803)), Sex of newborns (female ) (AOR=2.10 (1.214-3.560)) and reason for admission to VIII NICU such as, low birth weight with (AOR=3.17(95% CI 1.278-7.859)) were significantly associated with culture-proven neonatal sepsis. Conclusions: It is evident from this study that Gram-negative bacteria such as Klebsiella species and non-lactose fermenters were the leading cause of neonatal sepsis. Most of the bacteria recovered were resistant to multiple antibiotics. Premature rupture of membrane, way of delivery, sex of newborns, the reason for admission to NICU, and types of respiratory support were significantly associated with the occurrence of neonatal sepsis caused by bacteria.
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