Rajshahi Medical College, Rajshahi, Bangladesh.
Medical Centre, University of Rajshahi, Rajshahi, Bangladesh.
PLoS One. 2020 Nov 13;15(11):e0242275. doi: 10.1371/journal.pone.0242275. eCollection 2020.
Sepsis is one of the major causes of neonatal death worldwide as well as in Bangladesh. The objective of the present study was to identify the risk factors and causative organisms of neonatal sepsis after delivery in a tertiary care hospital, Bangladesh.
This was a case-control study conducted in the neonatal ward of Rajshahi Medical College Hospital (RMCH), a 1000-bed tertiary hospital situated in Rajshahi, Bangladesh. Neonates diagnosed as neonatal sepsis by clinical and laboratory parameters were included as cases in this study. Admitted neonates unsuspected or undiagnosed for sepsis were considered as controls. Maternal and neonatal information and their laboratory reports were collected and analyzed. Both bivariate and multiple logistic regression models were used to identify the risk factors of neonatal sepsis.
A total of 91 cases and 193 controls were included in the study. Maternal history of urinary tract infection (UTI) during the third trimester of pregnancy (aOR 2.75, 95% CI: 1.04-7.23, p <0.05), premature birth (aOR 2.77, 95% CI: 1.08-7.13, p <0.05) and APGAR score <7 at five minutes (aOR 2.58, 95% CI: 1.04-6.39, p <0.05) were associated with onset of neonatal sepsis in multiple logistic regression model. All these factors were also associated with developing early-onset neonatal sepsis, while maternal UTI and male sex of neonates were associated with developing late-onset neonatal sepsis. Escherichia coli (40.7%), Staphylococcus aureus (27.5%), and Klebsiella pneumoniae (18.7%) were the commonly isolated organisms causing neonatal sepsis. All these organisms were highly resistant to common antibiotics like amoxicillin, cephalosporins, aminoglycosides and quinolones. Carbapenemase group of drugs along with amikacin, nitrofurantoin and linezolid were the most sensitive drugs.
Strengthening the existing facility for antenatal screening for early diagnosis and treatment of maternal infection during pregnancy as well as identifying high-risk pregnancy for adequate perinatal management is necessary to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics according to local epidemiology and culture and sensitivity reports may minimize the increasing hazards of antibiotic resistance.
败血症是全球以及孟加拉国新生儿死亡的主要原因之一。本研究的目的是确定孟加拉国一家三级保健医院分娩后新生儿败血症的危险因素和病原体。
这是一项在拉杰沙希医科大学医院（RMCH）新生儿病房进行的病例对照研究。RMCH 是一家位于拉杰沙希的 1000 张床位的三级医院。本研究将通过临床和实验室参数诊断为败血症的新生儿纳入病例。将疑似或未诊断为败血症的入院新生儿视为对照。收集并分析了母婴信息及其实验室报告。使用单变量和多变量逻辑回归模型来确定新生儿败血症的危险因素。
本研究共纳入 91 例病例和 193 例对照。母亲在妊娠晚期（第三 trimester）有尿路感染史（aOR 2.75，95%CI：1.04-7.23，p<0.05）、早产（aOR 2.77，95%CI：1.08-7.13，p<0.05）和 5 分钟时 APGAR 评分<7（aOR 2.58，95%CI：1.04-6.39，p<0.05）与新生儿败血症的发生相关。在多变量逻辑回归模型中，这些因素也与早发型新生儿败血症的发生相关，而母亲尿路感染和新生儿男性性别与晚发型新生儿败血症的发生相关。引起新生儿败血症的常见病原体包括大肠杆菌（40.7%）、金黄色葡萄球菌（27.5%）和肺炎克雷伯菌（18.7%）。所有这些病原体对常见抗生素如阿莫西林、头孢菌素、氨基糖苷类和喹诺酮类高度耐药。碳青霉烯类药物联合阿米卡星、呋喃妥因和利奈唑胺是最敏感的药物。
加强现有的产前筛查设施，以便早期诊断和治疗孕妇感染，并对高危妊娠进行充分的围产期管理，是预防与新生儿败血症相关的发病率和死亡率所必需的。根据当地的流行病学和培养及药敏报告合理使用抗生素，可能会最大限度地减少抗生素耐药性不断增加的危害。
