Department of Pathology, Faculty of Medicine and Health Sciences, University of Science and Technology, Sanaa, Yemen.
Department of Microbiology, Faculty of Medicine and Health Sciences, University of Science and Technology, Sanaa, Yemen.
BMC Infect Dis. 2021 Oct 27;21(1):1108. doi: 10.1186/s12879-021-06808-y.
Neonatal sepsis is a global concern with increasing morbidity and mortality. The burden of neonatal sepsis is highest in developing countries, especially in those lacking proper surveillance systems. The causative pathogens and their drug-resistance levels vary between countries with emergence of multidrug resistance organisms. Thus, accurate records on the recent trends of organisms causing neonatal sepsis will provide vital information for appropriate intervention. We aimed to investigate neonatal sepsis, identify its associated factors and causative pathogens and to assess the antibiotic susceptibility patterns in Sana'a city, Yemen.
A cross-sectional study was conducted on neonates admitted to intensive care units of six hospitals in Sana'a city, Yemen, in the period from January 15, to March 30, 2020. Natal and prenatal medical data were collected using well-structured questionnaire. Neonates were subjected to sepsis work-up including blood culture, complete blood count and C-reactive protein. Organisms were identified by Gram staining and analyzed by the VITEK II system for bacterial bio-typing and antibiotic susceptibility testing.
Of the 199-neonates with suspected neonatal sepsis, 154 (77.38%) had culture-proven sepsis. Early-onset neonatal sepsis (EOS) was higher (50.25%; 100/199) than late-onset neonatal sepsis (LOS) (27.13%; 54/199). Multivariable analysis identified vaginal delivery as an independent risk factor for neonatal sepsis p = 0.005. Majority of isolated bacteria (74.39%) were gram-negative with Burkholderia cepacia (39%) and Klebsiella oxytoca (13%) being the most common pathogens of EOS and LOS. The most common gram-positive pathogens were Staphylococcus haemolyticus (9.1%) and Staphylococcus epidermidis (7.1%). B. cepacia showed multidrug resistance except for cefepime. All Klebsiella species isolates (100%) and most Pantoea species (93%) were ESBL and carbapenemase positive. All Escherichia coli and Acinetobacter baumannii isolates were ESBL positive. A significant number of gram-positive bacteria showed resistance to vancomycin.
The study findings show a high proportion of neonatal sepsis among neonates admitted to hospitals in Sana'a city with antibiotic-resistant B. cepacia being the single most common pathogen causing EOS and LOS. Findings also emphasize the emerging threat of multidrug-resistant bacteria in neonatal units and will help develop evidence-based management of neonatal sepsis in Yemen.
新生儿败血症是一个全球性问题，其发病率和死亡率不断上升。在发展中国家，新生儿败血症的负担最高，特别是在那些缺乏适当监测系统的国家。引起败血症的病原体及其耐药水平因国家而异，出现了多种耐药菌。因此，准确记录导致新生儿败血症的病原体近期趋势将为适当干预提供重要信息。我们旨在调查也门萨那市新生儿败血症的情况，确定其相关因素和病原体，并评估其抗生素敏感性模式。
本研究采用横断面研究，于 2020 年 1 月 15 日至 3 月 30 日期间，对也门萨那市 6 家医院重症监护病房的新生儿进行调查。使用结构化问卷收集新生儿的出生和产前医疗数据。对新生儿进行败血症检查，包括血培养、全血细胞计数和 C 反应蛋白检测。通过革兰氏染色和 VITEK II 系统进行细菌生物分型和抗生素敏感性试验鉴定病原体。
在 199 例疑似新生儿败血症的新生儿中，154 例（77.38%）经培养证实为败血症。早发型新生儿败血症（EOS）（50.25%，100/199）高于晚发型新生儿败血症（LOS）（27.13%，54/199）。多变量分析发现阴道分娩是新生儿败血症的独立危险因素（p=0.005）。分离的细菌主要为革兰氏阴性菌（74.39%），其中洋葱伯克霍尔德菌（39%）和产酸克雷伯菌（13%）是 EOS 和 LOS 的最常见病原体。最常见的革兰氏阳性病原体是溶血葡萄球菌（9.1%）和表皮葡萄球菌（7.1%）。洋葱伯克霍尔德菌除头孢吡肟外，对其他抗生素均表现出耐药性。所有产酸克雷伯菌属（100%）和大部分泛菌属（93%）分离株均为 ESBL 和碳青霉烯酶阳性。所有大肠埃希菌和鲍曼不动杆菌分离株均为 ESBL 阳性。相当数量的革兰氏阳性菌对万古霉素耐药。
研究结果表明，也门萨那市医院收治的新生儿中，新生儿败血症的比例较高，对单一最常见病原体洋葱伯克霍尔德菌的抗生素耐药性是导致 EOS 和 LOS 的主要原因。研究结果还强调了新生儿病房中出现多种耐药菌的威胁，并将有助于在也门制定新生儿败血症的循证管理策略。
