TITLE:
Neonatal and Young Infant Sepsis in a Regional Hospital in Ghana
AUTHORS:
Innocent Afeke, Misa Hirose, Kokou Hefoume Amegan-Aho, Christoph Haertel, Mareike Becker, Ahmed Moustafa, Paul Schilf, Mohamed Tarek Badr, Graceful Lord Mensah, Hintermann Kobina Mbroh, Jan Rupp, Saleh Ibrahim
KEYWORDS:
Neonatal Sepsis, Neonatal Mortality, Healthcare-Associated Infections, Neonatal Intensive Care Unit, Ho Teaching Hospital of Ghana
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.11 No.2,
June
22,
2021
ABSTRACT: Background: Neonatal sepsis is a global health problem that
mainly affects low- and middle-income countries. We have previously shown that
early neonatal mortality is high at the Ho Teaching Hospital (HTH) of Ghana. We
sought to determine the prevalence of neonatal sepsis, sepsis-related
mortality, and bacterial species patterns in neonatal and young infant sepsis
in this hospital. Methods: A hospital-based study was conducted in the
hospital’s neonatal intensive care unit (NICU) from March to June 2018. Blood
samples from 96 babies clinically diagnosed with or at risk of sepsis were
cultured using the BACTEC 9050®machine. Clinical data including gravida,
parity and antibiotic medication before delivery of mother and delivery type,
gestation, birth weight and antibiotic medication status were collected for
analysis. MALDI-TOF MS identified bacterial isolates, and their identities were
confirmed via tuf gene sequence typing. The data were analyzed using
GraphPad Prism 8.0.2. Results: Blood cultures were positive in 28 of the babies,
with 14 and 12 representing early-onset and late-onset neonatal sepsis,
respectively, and two cases of unknown sepsis type. Of the bacterial species
that caused sepsis in the babies, coagulase-negative staphylococcus (CoNS) was
the most prevalent isolate in 22 cases, followed by Klebsiella pneumoniae in two and Staphylococcus aureus, Streptococcus agalactiae, the Acinetobacter species, and Escherichia coli in the rest (one each). Of
the CoNS, S. haemolyticus and S. epidermidis were the most
prevalent species, found in eight and six cases, respectively. Thirteen
neonates died, of whom seven had positive blood cultures, and two were
referred. A case fatality rate of 7/26 was estimated. Neonatal mortality caused
by Gram-negative bacterial infection was higher than that caused by
Gram-positive bacteria. Conclusions: These data suggest a significant burden of sepsis among neonates and
young infants and are associated with substantial morbidity and mortality at
the HTH. There is a need to investigate risk factors associated with the
increased sepsis rate in this hospital to inform measures to reduce the neonatal
sepsis rate.