Centre for Intervention Science for Maternal and Child Health (CISMAC), Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Department of Medical Microbiology, Makerere University, Kampala, Uganda.
PLoS One. 2020 Aug 10;15(8):e0237085. doi: 10.1371/journal.pone.0237085. eCollection 2020.
Sepsis is the third most common cause of death among neonates, with about 225,000 newborns dying every year globally. Data concerning the microbial etiology of neonatal sepsis and antimicrobial resistance profiles of its causative agents are necessary to inform targeted and effective treatment and prevention strategies.
To determine the proportion of newborns with symptoms and signs of sepsis who had a positive blood culture, its bacterial etiology, the antimicrobial resistance patterns as well as the factors associated with culture-positivity and case fatality at Mulago national referral hospital in Uganda.
We conducted a cross-sectional study among 359 neonates with symptoms and signs of sepsis who presented to the pediatric emergency care unit of Mulago national referral hospital from mid-January to end of December 2018. We performed blood culture and antimicrobial susceptibility testing, and conducted polymerase chain reaction to identify methicillin-resistant Staphylococcus aureus (MRSA) isolates. We used multivariable logistic regression to estimate the association between potential risk factors and culture-positive neonatal sepsis.
Of the 359 neonates recruited, 46 (12.8%; 95% CI 9.5%, 16.7%) had a positive blood culture. The predominant isolated bacteria were Staphylococcus aureus in 29 (63.0%), Escherichia coli in seven (15.2%), and Klebsiella pneumoniae in five (10.9%). Of the 46 pathogens, 73.9% were resistant to ampicillin, 23.9% to gentamicin and 8.7% to ceftriaxone. We isolated MRSA from the blood specimens of 19 (5.3%) of the 359 neonates, while 3 (0.8%) grew extended spectrum beta lactamase producers. The case fatality risk among neonates with neonatal sepsis was 9.5% (95% CI: 6.6%, 13.0%). Cesarean section delivery was strongly associated with culture-positive sepsis (adjusted odds ratio 3.45, 95% CI: 1.2, 10.1).
One in eight neonates with clinical signs of sepsis grew a likely causative bacterial pathogen. S. aureus was the main pathogen isolated and a third of these isolates were MRSA. A significant proportion of the isolated bacterial pathogens were resistant to the first and second line antibiotics used for the treatment of neonatal sepsis. There is need to revisit the current treatment guidelines for neonatal sepsis.
败血症是全球每年导致 22.5 万名新生儿死亡的第三大致死原因。了解新生儿败血症的微生物病因学和病原体的抗生素耐药情况，对于制定有针对性和有效的治疗和预防策略至关重要。
确定乌干达穆拉戈国家转诊医院出现败血症症状和体征的新生儿中血培养阳性的比例、其细菌病因、抗生素耐药模式，以及与培养阳性和病死率相关的因素。
我们对 2018 年 1 月中旬至 12 月底期间在穆拉戈国家转诊医院儿科急诊就诊的 359 名有败血症症状和体征的新生儿进行了一项横断面研究。我们进行了血培养和抗生素药敏试验，并通过聚合酶链反应鉴定耐甲氧西林金黄色葡萄球菌（MRSA）分离株。我们使用多变量逻辑回归来估计潜在风险因素与培养阳性新生儿败血症之间的关联。
在纳入的 359 名新生儿中，46 名（12.8%；95%置信区间 9.5%，16.7%）血培养阳性。主要分离细菌为 29 株金黄色葡萄球菌（63.0%）、7 株大肠埃希菌（15.2%）和 5 株肺炎克雷伯菌（10.9%）。在 46 种病原体中，73.9%对氨苄西林耐药，23.9%对庆大霉素耐药，8.7%对头孢曲松耐药。我们从 359 名新生儿的血样中分离出 19 株（5.3%）MRSA，3 株（0.8%）产生超广谱β-内酰胺酶。败血症新生儿的病死率为 9.5%（95%置信区间：6.6%，13.0%）。剖宫产分娩与培养阳性败血症密切相关（调整优势比 3.45，95%置信区间：1.2，10.1）。
每 8 名有败血症临床症状的新生儿中就有 1 名可能有致病细菌病原体生长。金黄色葡萄球菌是主要分离病原体，其中三分之一为 MRSA。相当一部分分离的细菌病原体对治疗新生儿败血症的一线和二线抗生素耐药。有必要重新审查目前的新生儿败血症治疗指南。
