BACTERIAL AETIOLOGY, CLINICAL MANIFESTATIONS AND FACTORS ASSOCIATED WITH NEONATAL SEPSIS AT AMINU KANO TEACHING HOSPITAL, KANO, NIGERIA

Abstract

Neonatal sepsis is among the leading causes of morbidity and mortality, particularly in the
developing countries where the risk factors for the development of the disease are prevalent. The
bacterial agents responsible for neonatal sepsis and their susceptibilities to antibiotics vary from
time to time and from place to place hence the need for frequent update.
This was a hospital-based descriptive cross-sectional study aimed at determining the prevalence
of blood culture positive bacterial neonatal sepsis, the clinical features, bacterial isolates and their
antibiotic sensitivity pattern as well as factors associated with neonatal sepsis at the Special Care
Baby Unit (SCBU), Aminu Kano Teaching Hospital (AKTH), Kano. The study was carried out
between September 2015 and August 2016. Three hundred and forty neonates with suspected
sepsis were studied. Socio-demographic characteristics and clinical features of the neonates were
obtained using a standard proforma. Blood culture was done on admission using the automated
blood culture system (BACTEC) and bacterial isolates were identified using standard procedures.
Antibiotic susceptibility testing was done using disc diffusion methods.
The prevalence of blood culture positive neonatal sepsis was 28.8 per 1000 live birth. The
infection rate was higher among the out-born (34.4%) than the in-born (27.0%) babies. The most
frequent presenting complaints among the subjects were fever, difficulty with breathing and
inability to suck. The symptoms significantly associated with sepsis were fever, difficulty with
breathing, preterm birth and abdominal swelling (p < 0.05). The most frequent signs elicited among
the subjects were pyrexia, respiratory distress, tachypnoea and tachycardia. The signs significantly
associated with sepsis were pyrexia, hypothermia, pallor, hypotonia, apnoea, tachypnoea and
abdominal distention (p < 0.05). Gram-negative bacteria (66.3%) were the major causes of
neonatal sepsis in the study. The predominant bacterial isolates were Klebsiella pneumoniae
(21.3%), Staphylococcus aureus (16.8%) and Escherichia coli (13.5%). A high prevalence of
resistance to the commonly used antibiotics, especially the beta-lactams and cephalosporins, was
observed. The most sensitive antibiotics were ciprofloxacin and gentamycin.
Factors significantly associated with blood culture positive neonatal sepsis in this study include
home delivery, delivery by cesarean section, preterm delivery, multiple gestations, pre-labour
rupture of membranes, prolonged rupture of membranes and uvulectomy (p < 0.05). Multivariate
logistic regression analysis of the factors found to be significantly associated with positive blood
culture neonatal sepsis revealed that all the factors were independent risk factors for neonatal
sepsis.
In conclusion the prevalence of blood culture positive neonatal sepsis is high with the bacterial
isolates showing high antibiotic resistance hence, the need to frequently review the pattern of the
isolates and their susceptibility to antibiotics. There is need to provide health education to the
populace on the importance of antenatal care, to promote good hygienic practices surrounding
delivery, care of the newborn and to stop the harmful traditional practices on newborn babies.

BACTERIAL AETIOLOGY, CLINICAL MANIFESTATIONS AND FACTORS ASSOCIATED WITH NEONATAL SEPSIS AT AMINU KANO TEACHING HOSPITAL, KANO, NIGERIA