Abstract:

Background: Neonatal period contributes more than 40% of all mortality in children under 5 years of age. In Lower- and Middle-Income Country (LMIC) the major causes of neonatal death include birth asphyxia, prematurity and neonatal sepsis. Neonatal sepsis accounts for about 22% of annual neonatal deaths globally. WHO recommends the use of either ampicillin or benzylpenicillin and gentamicin as the first line treatment for neonatal and pediatric sepsis, with ceftriaxone as second line therapy. However there has been a growing challenge of antimicrobial resistance (AMR) in neonatal intensive care units (NICUs), especially with resistant Gram-negative bacteria (GNB). In LMICs, approximately 60% of cases of neonatal sepsis are caused by GNB. Resistance of GNB causing neonatal sepsis have been documented to resist WHO first line antimicrobial drugs by 90% ampicillin and 40% gentamicin, threatening the effectiveness of management of neonatal sepsis with associated high mortality.

Method: The study was a retrospective study conducted at the neonatal unit of the Bugando medical Center (BMC). BMC is a tertiary zonal referral hospital and a teaching hospital for the Catholic University of Health and Allied Sciences (CUHAS). The study extracted data from April 2024 to April 2022 of all neonates who were admitted at BMC neonatal unit with clinical signs and symptoms of neonatal sepsis and the sample size used was 250 participants.

Results: From a total of 250 patients, occurrence of neonatal sepsis was among 79 (31.60%) proven to be culture positive with presence of gram positive and gram-negative bacteria. On the other hand, the prevalence of gram-negative sepsis among those who were culture positive was 65(82.28%) whereby EOS and LOS occurred in 62(95.38%) and 3(4.62%). Isolated Gram-Negative Bacteria resisted WHO first line drug ampicillin by 88.37%, and gentamicin by 76.92%. and second line by 88.14% (ceftriaxone). Factors associated and statistically significant with neonatal sepsis among the study participants was maternal infection during pregnancy (3.652 [1.014- 13.149], P=0.047).

Conclusion: In the current study, we recorded that one third of neonates had laboratory confirmed neonatal sepsis of which GNB contributed to 82.3%. The predominant bacteria causing neonatal sepsis was k. pneumoniae. Resistance towards WHO first line and second line drugs was high. Maternal infection was significantly associated with neonatal sepsis.