Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan.
Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Balochistan, Pakistan.
PLoS One. 2021 Jan 13;16(1):e0244866. doi: 10.1371/journal.pone.0244866. eCollection 2021.
Sepsis is one of the major causes of neonatal mortality in Pakistan. This study aimed to investigate the treatment outcomes, antibiotic use and its resistance pattern among neonatal sepsis patients attending a tertiary care hospital in Pakistan. We also aimed to identify the factors affecting mortality in neonatal sepsis patients.
A descriptive, cross-sectional study was conducted in the pediatric wards of the Bahawal Victoria Hospital, Bahawalpur, Pakistan. All eligible neonatal sepsis patients who were registered at the study site from January 1, 2019 to June 30, 2019 were included in the study. The data collection form included information on patient's characteristics, antibiotic use and its sensitivity pattern, laboratory and microbiological data, and final treatment outcomes. Treatment outcomes included, discharged (with treatment success), leave against medical advice (LAMA), discharged on request (DOR) and death. Multivariable binary logistic regression analysis was used to find the independent factors associated with death. A p-value of less than 0.05 was considered statistically significant.
Among the total 586 patients, 398 (67.9%) were male, 328 (56%) were preterm, 415 (70.8%) were diagnosed with early onset sepsis, 299 (51%) were born with low birth weight. Most of the patients (n = 484, 82.6%) were treated with amikacin+cefotaxime at the start of treatment. Culture was positive in 52 (8.9%) patients and the most commonly identified bacteria included, Klebsiella species (n = 19, 36.5%) followed by E. coli (n = 15, 28.5%) and Staphylococcus aureus (n = 8, 15.4%). The identified bacterial isolates showed high level of resistance against the antibiotics initiated at the start of the treatment, while resistance against piperacillin+tazobactam, imipenem, vancomycin and linezolid was very low. Just under half of the patients (n = 280, 47.8%) successfully completed the treatment (i.e., discharged with treatment success), while 123 (21%) patients died during treatment. In multivariable binary logistic regression, the factors which still remained significantly associated with neonatal death included, preterm delivery (AOR 9.59; 95% CI 4.41, 20.84), sub-optimal birth weight (AOR 5.13; 95% CI 2.19, 12.04), early onset sepsis (AOR 2.99; 95% CI 1.39, 6.41) and length of hospital stay (AOR 0.76; 95% CI 0.67, 0.88).
The mortality rate associated with sepsis was high in our study cohort. The bacterial isolates showed high level of resistance against the antibiotics started as the empiric therapy. Rational use of antibiotics can decrease the adverse outcomes in neonatal sepsis patients.
败血症是导致巴基斯坦新生儿死亡的主要原因之一。本研究旨在调查巴基斯坦一家三级护理医院新生儿败血症患者的治疗结果、抗生素使用情况及其耐药模式。我们还旨在确定影响新生儿败血症患者死亡率的因素。
这是一项在巴基斯坦巴哈瓦尔布尔的 Bahawal Victoria 医院儿科病房进行的描述性、横断面研究。所有符合条件的于 2019 年 1 月 1 日至 2019 年 6 月 30 日在研究地点登记的新生儿败血症患者均被纳入研究。数据收集表包括患者特征、抗生素使用及其敏感性模式、实验室和微生物学数据以及最终治疗结果的信息。治疗结果包括，出院（治疗成功）、未经医嘱出院（LAMA）、要求出院（DOR）和死亡。多变量二元逻辑回归分析用于寻找与死亡相关的独立因素。p 值小于 0.05 被认为具有统计学意义。
在总共 586 名患者中，398 名（67.9%）为男性，328 名（56%）为早产儿，415 名（70.8%）为早发型败血症，299 名（51%）出生体重低。大多数患者（n = 484，82.6%）在开始治疗时使用阿米卡星+头孢噻肟进行治疗。52 名患者的培养呈阳性，最常见的细菌包括克雷伯氏菌属（n = 19，36.5%），其次是大肠杆菌（n = 15，28.5%）和金黄色葡萄球菌（n = 8，15.4%）。鉴定出的细菌分离株对开始治疗时使用的抗生素表现出高水平的耐药性，而对哌拉西林+他唑巴坦、亚胺培南、万古霉素和利奈唑胺的耐药性非常低。近一半的患者（n = 280，47.8%）成功完成治疗（即治疗成功出院），而 123 名（21%）患者在治疗期间死亡。在多变量二元逻辑回归中，仍与新生儿死亡显著相关的因素包括早产（AOR 9.59；95%CI 4.41，20.84）、出生体重不足（AOR 5.13；95%CI 2.19，12.04）、早发型败血症（AOR 2.99；95%CI 1.39，6.41）和住院时间（AOR 0.76；95%CI 0.67，0.88）。
本研究队列中，败血症相关死亡率较高。细菌分离株对作为经验性治疗开始的抗生素表现出高水平的耐药性。合理使用抗生素可以降低新生儿败血症患者的不良结局。
