Aetiology, antibiotic resistance and risk factors for neonatal sepsis at the University Teaching Hospital in Lusaka, Zambia

Although neonatal sepsis occurs in approximately 15% of neonatal admissions in Sub-Saharan Africa, there is minimal data on its causes and antimicrobial resistance (AMR) that might guide policy and practice. Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Group B streptococcus (GBS) and other gram negative bacteria are the most common causes. These organisms especially the Enterobacteriaceae have AMR rates higher than 50%, for both first (Ampicillin and Gentamycin) and second line (Cephalosporins) drugs. Data on prevalence, aetiology, AMR patterns and risk factors for neonatal sepsis at the University Teaching Hospital (UTH) in Zambia has not been collected systematically making it difficult to utilize such information on patient management. Thus, this cross sectional study conducted in the Neonatal Intensive care Unit at UTH was aimed at providing baseline data that can be used to formulate guidelines for neonatal sepsis management. Among 313 neonates with clinically suspected sepsis, the prevalence of culture-confirmed sepsis was 33% with early onset sepsis (EOS) accounting for 85% of the cases. K. pneumoniae was the most prevalent pathogen accounting for 75% of the cases, followed by S. aureus and E. coli at 6% and 5%, respectively. During the study, it was observed that an increase in prevalence of neonatal sepsis due to K. pneumonia correlated with a high mortality rate, implying a potential outbreak. For WHO-recommended first line and second line therapy, AMR ranged from 96-99% and 94-97%, respectively. Bacterial culture diagnosis had minimal impact on treatment and outcome as only 25% of the neonates had received results for culture and drug sensitivity before discharge/death. Increasing neonatal age in days, and parity were associated with a significant increase in the odds of culture-confirmed neonatal sepsis, whereas irritability and pallor were negatively associated. Maternal human immunodeficiency virus infection was also associated with a significant reduction in the odds of culture-confirmed neonatal sepsis. These data, therefore, indicate a high burden of neonatal sepsis that needs immediate intervention. This could be done through implementation of simple and scalable infection control strategies that can reduce the frequency and rate of transmission of these infections