Bacterial profile, antibiotic susceptibility patterns and associated factors among neonates suspected of omphalitis in Arba Minch, Southern Ethiopia

Abstract

Neonatal omphalitis is a true medical emergency that can rapidly progress to sepsis and even death if not promptly diagnosed and treated appropriately. Empirical therapy is widely practised in this case, too, in low-income countries like Ethiopia, paving the way for severe drug resistance and posing serious challenges. To determine the magnitude, bacterial profile, antibiotic susceptibility patterns, and associated factors of omphalitis among clinically suspected neonates attending four government health institutions in Arba Minch, southern Ethiopia, during the second half of 2023. A facility-based multi-centred cross-sectional study was conducted among 379 clinically suspected neonates who attended the inpatient/outpatient departments and intensive care units of four government health institutes of Arba Minch from June 1 to December 28, 2023. Study participants were consecutively recruited, and their demographic and clinical data were collected using a pre-tested questionnaire. Samples were aseptically collected and inoculated onto a series of bacterial culture media, namely MacConkey agar, mannitol salt agar, chocolate, and blood agar, and different species were identified by means of several biochemical tests. Antibiotic susceptibility tests were performed through the Kirby-Bauer disc diffusion technique. Bivariable and multivariable logistic regression models (SPSS version 25) were utilized to analyze the association between dependent and independent variables; P-values ≤ 0.05 were considered statistically significant. The overall number of clinically suspected and culture-confirmed cases of omphalitis, respectively, were 379 and 130 per 1000 live births. Gram-positive (GPB) and Gram-negative bacteria (GNB) were detected in 50.4% (n = 71) and 49.6% (n = 70) of cases, respectively. The often isolated bacteria were S. aureus, 53.5% (n = 38), and E. coli, 47.1% (n = 33); GNB were highly resistant (> 60%) to tetracycline, sulfamethoxazole-trimethoprim, and ampicillin. The overall multi-drug resistance was 34.7% (n = 49); methicillin-resistant S. aureus was 34.1% (n = 14). The GNB isolates comprised extended-spectrum beta-lactamase, 15.7% (n = 11), and carbapenemase, 10% (n = 7) producers. The lack of hand washing practices [AOR = 2.08, (95% CI 1.26-3.41), P value = 0.004] and lower gestation period (< 37 weeks) [AOR = 2.3, (95% CI 1.33-3.93), P value = 0.003] were statistically associated. The overall prevalence of omphalitis was higher; WHO-prioritised drug-resistant bacterial pathogens were also detected. This study underscores the importance of factors such as maternal/caregiver hand hygiene and antenatal care. Thus, a more comprehensive approach towards the management of omphalitis employing precise diagnostic tools and an antimicrobial stewardship program is essential in all the four study settings.

Keywords: Associated factors; Bacterial profile; Drug resistance; Magnitude; Neonates; Omphalitis; Southern Ethiopia.

Fig. 1

Percentage of clinical manifestations of bacterial omphalitis.