Neonatal Sepsis: Etiology, Antimicrobial Susceptibility, and Treatment Outcomes in a Tertiary Hospital in Jos, Nigeria

Abstract

Sepsis is a leading cause of neonatal mortality. Current knowledge of etiology, antimicrobial susceptibility, and outcomes provides evidence for judicious antimicrobial use. The aim for the present study was to identify etiologic organisms, antimicrobial susceptibility, and treatment outcomes at a tertiary hospital in Jos, Nigeria. A retrospective case review of neonates hospitalized for sepsis was conducted between August 25, 2017 and December 31, 2020. Clinical and laboratory data were collected from 1,984 neonates admitted, of whom 516 (26%) were diagnosed with neonatal sepsis (NNS). The clinical and blood culture data were available for 380 (74%) neonates, of whom 226 (60%) were male. The majority (63%) were diagnosed with early-onset sepsis, of whom 146 (38%) had severe sepsis. The mean age of the mothers was 29.5 ± 5.5 years. Of the 207 cultures obtained, 87 (43%) yielded pure isolates, with 50 (58%) of these being Gram-positive. For neonates born outside the study hospital, 6/36 (17%) were methicillin-sensitive, compared with 6/44 (14%) neonates born at the study hospital. Gram-negative isolates, predominantly Klebsiella pneumoniae, grew in 36 (41%) of all positive cultures (27/87; 31%). More organisms were sensitive to piperacillin-tazobactam (19/19; 100%), gentamicin (21/27; 78%), imipenem (4/8; 50%), and ceftazidime (17/28; 61%) than to the other antibiotics tested. Mortality in all patients with proven or presumed NNS was 31/380 (8%), with increased mortality in those without cultures (8/71; 11% versus 39/71; 55%). Neonatal sepsis-related mortality is high in the study center in Jos, Nigeria. Additional work is needed to mitigate NNS mortality and the rising problem of antimicrobial resistance.