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. 2023 Oct 1;42(10):921-926.
doi: 10.1097/INF.0000000000004008. Epub 2023 Jun 26.

Etiology of Bacterial Sepsis and Isolate Resistance Patterns in Hospitalized Neonates in Zambia

Franklyn N Egbe  1 , Carter Cowden  2 , Lawrence Mwananyanda  3   4 , Cassandra Pierre  5 , James Mwansa  6   7 , Chileshe Lukwesa Musyani  6 , Angela Lyondo  6 , Monica L Kapasa  8 , Sylvia Machona  8 , Moses M Chilufya  3 , Gertrude Munanjala  3 , Susan E Coffin  2 , Davidson H Hamer  4   5 , Matthew A Bates  1
Affiliations

Etiology of Bacterial Sepsis and Isolate Resistance Patterns in Hospitalized Neonates in Zambia

Franklyn N Egbe et al. Pediatr Infect Dis J. .

Abstract

Background: The Sepsis Prevention in Neonates in Zambia study is a prospective cohort study that evaluated an infection prevention and control (IPC) bundle in the University Teaching Hospital neonatal intensive care unit (NICU) in Lusaka, Zambia. We present here the etiologies, antimicrobial resistance profiles, and associated mortality of bloodstream infections (BSI) in this cohort.

Methods: Venous blood was collected from neonates with clinically suspected sepsis and cultured with an automated blood culture system. Organism identification and susceptibility testing were done using the Vitek II system. We used the CDC National Health Safety Network criteria to define pathogens and commensals.

Results: There were 1120 blood cultures performed for 1060 neonates with suspected sepsis. Overall, 38% (424/1120) of cultures were positive of which 72% (306/424) grew pathogens. Blood cultures obtained after, as compared to before, 2 days of hospitalization were more likely to yield a pathogen (77% vs. 65%; P < 0.001). Klebsiella pneumoniae was the most prevalent organism, accounting for 74% (225/306) of all pathogens . K. pneumoniae isolates were highly resistant: 98% (221/225) were extended-spectrum beta-lactamase (ESBL)-positive, while 81% were resistant to gentamicin (182/225) and fluoroquinolones (177/219). Only one isolate was carbapenem resistant. Observed mortality rate was 32% (122/380); 61% (75/122) of the deaths was related to Klebsiella BSI.

Conclusions: Multidrug-resistant ESBL-producing Klebsiella species were the main organisms responsible for BSI and were associated with increased mortality. BSI risk increased with prolonged hospitalization, underscoring the importance of IPC measures in the NICU.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

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