Abstract:

Neonatal sepsis has been identified by World Health Organisation (WHO) as one of the major causes of high morbidity and mortality in neonates [1]. It is a clinical syndrome characterised by systemic signs of circulatory compromise which is usually as a result of the invasion of the blood stream by bacteria during the first month of life [2], [3]. In Ghana where most people are in the middle or low-income range and cannot afford the cost of a blood culture investigation and considering the fact that it takes a minimum of five days for one to receive a blood culture report, there is usually the approach of empirical management of most cases of neonatal sepsis in the hospital. A request is made for blood cultures usually after treatment failure. The incidence of neonatal sepsis in the Korle-Bu Teaching Hospital is very high and this is likely due to the occurrence of predisposing factors and lack of essential facilities for optimal hygiene in most of the primary health facilities from where the patients are referred.

OBJECTIVE: The aim of this study was to evaluate the empirical management of neonatal sepsis at the Children’s Department of Korle –Bu Teaching Hospital (KBTH).

METHODOLOGY: A prospective cohort study method was used. Patients diagnosed with Neonatal sepsis were identified from the admissions and discharge records. All neonates admitted to the pediatric ward with sepsis during the period was selected and followed up over the study period (15th November, 2015 – 15th December, 2015. There was no intervention made to the management approach to the subjects during the study. All the necessary data was taken from the patients’ folders and the care givers (Clinical staff and parents of the patient) where possible. The data was collected using a specially designed data collection tool which captured data on the following; Patient characteristics, Septic screen, Case fatality, Sensitivity patterns and Pattern of antibiotic usage . The results were analysed using SPSS for Microsoft version 20 and Excel spreadsheet and presented as bar charts, pie charts and percentages.

FINDINGS: A total of 271 neonates were admitted at the study site during the period. A third of all neonatal admissions during the period were diagnosed with neonatal sepsis. 55.4% of the cases were males and the rest females. More than half of the neonates diagnosed with neonatal sepsis had septic screen conducted on them. Most of the cases (58.33%) were screened for C - reactive protein whilst less than half (40.2%) of the septic screen was for organism culture. Over half of the samples sent for organism culture yielded no growth. 48.27% yielded growth out of which only 35.71% were micro - organisms. Most of the cousative organisms were gram-negative micro-organisms. The case fatality rate of neonatal sepsis for the period was 4.17%. E-coli infection was confirmed as a cause of more than a third of death from Neonatal Sepsis. Almost all (95.83%) of the neonates diagnosed with neonatal sepsis were given empirical antibiotics. Only 4.17% of the cases had their antibiotics changed in accordance with their culture and sensitivity results.

CONCLUSION: Neonatal sepsis diagnosis at the department was usually of early onset and empirical treatment used for its management appeared effective. Most of the subjects did not have septic screen done making it impossible for microbial sensitivity and resistance patterns to be studied.

Keywords: Neonatal Sepsis, Septic Screen, Empirical Antibiotics, Culture and Sensitivity

References:

[1.]   Al-Shamahy, H.A., Sabrah, A.A., Al-Robasi, A.B. & Naser, S.M. Types of bacteria associated with neonatal sepsis in Al-Thawra University Hospital, Sena’a

[2.]   Anderson-Berry, A. L., Bellig, L. L., & Ohning, B. L. (2006). Neonatal sepsis. University of Nebraska Medical Center, Omaha

[3.]   Aurangzeb, B., & Hameed, A. Neonatal sepsis in hospital-born babies: bacterial isolates and antibiotic susceptibility patterns. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP, (2003)13(11), 629-632

[4.]   Bahl, R., Martines, J., Ali, N., BHAN, M.K., Carlo, W., Chan, K.Y., & Rudan I. Research priorities to reduce global mortality from newborn infections by 2015. The Paediatric infectious disease journal (2009). 28(1) S43 –S48

[5.]   Baltimore, R. S., Huie, S. M., Meek, J. I., Schuchat, A., & O'Brien, K. L. (2001). Early-onset neonatal sepsis in the era of group B streptococcal prevention. Pediatrics, 108(5), 1094-1098.

[6.]   Baltimore, R. S. (2003). Neonatal sepsis. Pediatric drugs, 5(11), 723-740.

[7.]   Benitz, W. E., Han, M. Y., Madan, A., & Ramachandra, P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics, (1998)102(4), e41-e41.

[8.]   Benjamin, D. K., Miller, W., Garges, H., McKinney, R. E., Cotton, M., Fisher, R. G., & Alexander, K. A. Bacteremia, central catheters, and neonates: when to pull the line. Pediatrics, (2001) 107(6), 1272-1276

[9.]   Bizzarro, M. J., Dembry, L. M., Baltimore, R. S., & Gallagher, P. G. (2008). Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics, 121(4), 689-696.

[10.]      Bryce, J. Boschi- Pinto, C., Shibuya, K., Black, R.E, WHO child health Epidermiology reference Group. WHO estimates of the causes of death in children. The Lancet (2005), 365(9465) 1147-1152

[11.]      Calfee, D. P., & Farr, B. M. Comparison of four antiseptic preparations for skin in the prevention of contamination of percutaneously drawn blood cultures: a randomized trial. Journal of clinical microbiology (2002),40(5), 1660-1665

[12.]      Darmstadt, G.L. Bhutta, Z.A, Causes, S., Adam, T., Walker, N de Bemis, L., & Lancet Neonatal Survival Steering Team. Evidence- based, cost effective interventions: how many newborn babies can we save? The Lancet (2005)365 (9463), 977-988.

[13.]      Edmond, K. & Zaidi, A. New approaches to preventing, diagnosing and treating neonatal sepsis PLOS medicine, (2010) 7(3) 283

[14.]      Enguix, A., Rey, C., Concha, A., Medina, A., Coto, D., & Diéguez, M. A. (2001). Comparison of procalcitonin with C-reactive protein and serum amyloid for the early diagnosis of bacterial sepsis in critically ill neonates and children. Intensive care medicine, 27(1), 211-215.

[15.]      Hengst, J. M. (2003). The role of C-reactive protein in the evaluation and management of infants with suspected sepsis. Advances in Neonatal Care,3(1), 3-13.

[16.]      Iregbu, K.C, Elegba, O.Y ., & Babaninyi, I.B, Bacteriological profile of Neonatal septicaemia in a tertiary hospital in Nigeria, African health sciences (2006) 6(3), 151-154

[17.]      Klein, J. O. (1990). Bacteriology of neonatal sepsis. Pediatr Infect Dis J, 9(10), 778.

[18.]      Krediet, T., Gerards, L., Fleer, A., & van Stekelenburg, G. (1992). The predictive value of CRP and I/T-ratio in neonatal infection. Journal of Perinatal Medicine-Official Journal of the WAPM, 20(6), 479-485.

[19.]      Kumhar, G.D., Ramachandran, V.G.& Gupta, P Bacteriological analysis of blood culture isolates from neonates in a tertiary care hospital in India, Journal of Health, Population and Nutrition (2002), 343-347

[20.]      Lanari, M, Lazzararotto, T., Pignatelli, S., Guerra, B., &Serra, L. Epidemiology of Neonatal infections. Journal of chemotherapy (Florence, Haly) (2007) 19,20-23.

[21.]      Lawn J.E. Cousens, S. Zupan., J., & Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why? The Lancet (2005)365(9462), 891-900

[22.]      Mokoulu, O.A., Jiya N., & Adesiyun, O.O Neonatal Septicaemia in Ilorin: bacterial pathogens and antibiotic sensitivity pattern. Africa Journal of medicine and medical sciences (2002), 31(2)127-130

[23.]      Nizet, V., & Klein, J. O. (2011). Bacterial sepsis and meningitis. Infectious diseases of the fetus and newborn.

[24.]      Rahman, S., Hameed, A., Roghani, M. T., & Ullah, Z. Multidrug resistant neonatal sepsis in Peshawar, Pakistan. Archives of Disease in Childhood-Fetal and Neonatal Edition, (2002) 87(1), F52-F54

[25.]      Rodrigo, I. (2009). Changing patterns of neonatal sepsis. Sri Lanka journal of child health, 31(1).

[26.]      Seale, A. C., Blencowe, H., Manu, A. A., Nair, H., Bahl, R., Qazi, S. A., ... & Lawn, J. E. (2014). Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis. The Lancet infectious diseases, 14(8), 731-741.

[27.]      Simon, L., Gauvin, F., Amre, D. K., Saint-Louis, P., & Lacroix, J. (2004). Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clinical Infectious Diseases, 39(2), 206-217.

[28.]      Simonsen, K. A., Anderson-Berry, A. L., Delair, S. F., & Davies, H. D. (2014). Early-onset neonatal sepsis. Clinical microbiology reviews, 27(1), 21-47.

[29.]      Sivanandan, S., Soraisham, A. S., & Swarnam, K. (2011). Choice and duration of antimicrobial therapy for neonatal sepsis and meningitis. International journal of pediatrics, 2011.

[30.]      Stoll B.Y., The global impact of neonatal infection. Clinics in perinatology (1997), 24(1), 1-21

[31.]      Tarlow, M.J, Epidemiology of Neonatal Infections Journal of Antimicrobial chemotherapy .(1994)34(suppl. A)43-52

[32.]   Thaver, D.,& Zaidi, A.K. Burden of neonatal infections in developing countries: a review of evidence from community –based studies. The paediatric Infectious disease journal (2009), 28(1), S3-S9

[33.]   Vergnano, S., Sharland, M., Kazembe, P., Mwansambo, C., & Heath, P. T. (2005). Neonatal sepsis: an international perspective. Archives of Disease in Childhood-Fetal and Neonatal Edition, 90(3), F220-FF224.

[34.]   Yemen and their antimicrobial profile, Sultan Qaboos University medical journal, (2012) 12(1),48

[35.]   Zaidi, A. K., Thaver, D., Ali, S. A., & Khan, T. A. (2009). Pathogens associated with sepsis in newborns and young infants in developing countries. The Pediatric infectious disease journal, 28(1), S10-S18.