Library Dissertation Showcase

Changing aetiology of neonatal sepsis and increased antibiotic resistance: how convincing is the evidence?

  • Year of Publication:
  • 2020

Although the global incidence of neonatal sepsis is well-documented, aetiology surveillance is lacking, which is important for sepsis management. Neonatal sepsis results in death for 40% of those affected even with prompt antibiotic therapy, with up to 70% observed in some developing countries. Additionally, hospital-based studies in developing countries suggest troubling levels of resistance to WHO-recommended first-line antibiotics for treating neonatal infections. Therefore, the study’s aim was to investigate the aetiology of neonatal sepsis in developing countries and ascertain patterns of antibiotic resistance in the population. A PubMed search restricted to 2008-2019, and reference lists of suitable studies found 28 relevant studies. Data on aetiology were extracted, tabulated, and analysed along with data on incidence rates, and antimicrobial resistance. The estimated culture-positive rate of neonatal sepsis was 27.4%. Gram-positive organisms accounted for 44% of sepsis cases in the studies, whereas Gram-negative accounted for 56%. The distribution of important pathogens were Klebsiella species 25.1% (95% CI 16.8-33.5), S. aureus 23.8% (95% CI 15.5-32.1) and E. coli 14.0% (95% CI 5.9-22.1). The distribution of S. aureus appears to be similar in East-Asia and Africa regions, but both Klebsiella species and E. coli had a greater presence in the African region. Klebsiella had the highest rates of resistance: 93%, 66%, and 68% to penicillin/ampicillin, gentamicin, and third-generation cephalosporins, respectively. Several of the studies reported low resistance (0-20%) to imipenem and meropenem and should, therefore, be considered as target antibiotic therapy in neonatal sepsis management. This study indicates that antibiotic resistance in neonatal sepsis cases is a cause for concern. Limited data presents a challenge in duly assessing antibiotic resistance patterns and time trends in developing country regions, as further studies are needed. A further study with more focus on the burden of antibiotic resistance in the neonatal population is also recommended.

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