Antimicrobial susceptibility patterns among neonates admitted with Neonat al Septicemia at Mulago Hospital Acute Care Unit

Abstract

Background: Neonatal septicemia is an emergency; globally, In Mulago there is an increase in microbial resistance to the commonly used drugs. This is associated with increased morbidity and mortality which can be prevented if the appropriate drugs are used. The drugs used to treat neonatal septicemia need to be reviewed regularly. A study to review the burden of antimicrobial resistance and the associated factors had been long overdue to be conducted at Mulago hospital. Study Objective: To determine the prevalence of antimicrobial resistance, antimicrobial susceptibility patterns, factors associated with antimicrobial resistance and the immediate outcome among neonates admitted for neonatal septicemia to Acute Care Unit (ACU) of Mulago Hospital. Methodology: This was a prospective cross sectional analytical study conducted at Mulago Hospital from July 2014 to October 2014. Blood and cerebral spinal fluid cultures were done and analyzed for the antimicrobial susceptibility patterns. Data was analyzed using proportions and percentages to determine prevalence and susceptibility patterns and logistic regression was used to determine factors associated with antibacterial resistance. Results: A total of 260 neonates with clinical septicemia aged 0-28 days were enrolled in the study. The male to female ratio was 1.1:1 with a median age of 8.5 days (SD 9.34). Resistance to ampicillin and gentamicin was at 88.5% and 14.5% respectively. Most prevalent organisms cultured from the blood were S. aureus, E. coli and S. pyogenes at 61.3%, 16.3% and 7.5% respectively. Prevalence of blood culture positive neonatal septicemia was 31%, resistance of S. aureus to ampicillin was 89%, and resistance of E.coli to gentamicin was 8% with ESBL at 8% for ceftriaxone and 15% for cefotaxime. Male sex was significantly associated with antimicrobial resistance (p= 0.006) and refusal to breast feed was significantly associated with neonatal septicemia (p= 0.032). Mortality was 16/260 (6.15%) with 7/80 (8.75%) in those with positive blood cultures. Conclusions: The prevalence of antimicrobial resistance to atleast one drug was 64% with ampicillin exhibiting the highest resistance at 88.5%, gentamicin at 14.5%. The susceptibility patterns per organism show that gram negative organisms still have a good susceptibility to gentamicin and the third generation cephalosporins and S. aureus has a good sensitivity to gentamicin. Male sex was the only factor significantly associated with antimicrobial resistance and majority of the vital signs returned to normal by 1.5 days although most of the deaths occurred among the neonates with culture positive septicemia. Recommendation: we still have a good sensitivity of the microorganisms to gentamicin however due to the high resistance of the microorganisms to ampicillin; we recommend the use of cefotaxime and gentamicin as the drug combination for treatment of neonatal septicemia. There is need for a randomized comparative study that will determine the best drug combination and show the outcome of neonates with neonatal septicemia on the various drug combinations such as amikacin/cefotaxime, cefotaxime/gentamicin, and ampicillin/cefotaxime