TY  - BOOK
AU  - Rehema Irene Marando
AU  - Stephen Mshana
AU  - Neema Kayange 
AU  - Festo Manyama
TI  - Prevalence and Predictors of Extended Spectrum Betalactamases Producing Enterobactericeae Neonatal Sepsis at the Bugando Medical Centre Mwanza, Tanzania
PY  - 2017///
CY  - Mwanza, Tanzania:  
PB  - Catholic University of Health and Allied Sciences [CUHAS – Bugando]
KW  -  
N2  - ABSTRACT

Background: Neonatal sepsis is a worldwide problem and accounts for 2 million deaths of the newborns every year. In the developing countries, neonatal sepsis accounts for 30-50% of the neonatal deaths. Neonatal sepsis due to extended-spectrum-beta lactamases producing enterobactericeae (ESBL-PE) is on the increase and has been found to be associated with significant morbidity and mortality. Here we report the magnitude of ESBL neonatal sepsis and factors associated to it.

Methods: This was a hospital based cross-sectional study conducted at the Bugando Medical Centre (BMC) neonatal units between July 2016 and December 2016. Neonates and their mothers/guardians were enrolled and screened for ESBL-PE colonization. In addition, blood culture was done to all neonates. Demographic and clinical data were collected using standard structured data collection tool. The isolates were confirmed to be ESBL-PE by disk approximation method. Step wise logistic regression analysis was done to determine predictors for ESBL-PE neonatal sepsis, ESBL-PE colonization and mortality using STATA-11 software.

Results: A total of 304 neonates with median age of 6 days (IQR 3-9) were enrolled between July 2016 and December 2016. Out of 304 neonates, 166(54.6%; 95%CI: 49-60.1) were found to be colonized by ESBL-PE. Neonatal ESBL-PE sepsis was detected in 32 (10.5%, 95%CI: 7.1- 13.9) of neonates. Factors found to predict neonatal ESBL-PE sepsis were; admission at neonatal Intensive Care Unit (NICU) (OR: 3.02, 95%CI; 1.19-7.69, P=0.021), positive mother ESBL-PE colonization (OR: 2.8, 95% CI; 1.29-6.3, P=0.009) and positive neonate ESBL-PE colonization (OR: 3.1, 95% CI; 1.19-7.99, P=0.021). Positive ESBL-PE colonization of the mother (OR: 2.19, 95%CI 1.3-3.8, P=0.005) and history of neonatal antibiotic use (OR:1.73, 95%CI 1-2.9, P=0.048) were found to predict neonatal ESBL-PE colonization. Deaths occurred in 55(18.1%, 95% CI 13.4-22.4) of the neonates. Predictors of death were being admitted at NICU (OR 2.7, 95%CI 1.2-6, p=0.015), referral from other centres (OR 2.9, 95%CI 1.4-6.1, P=0.004) and positive ESBL-PE neonatal sepsis (OR 3.2, 95%CI 1.3-7.7, p=0.011). Out of 60 laboratory confirmed neonatal sepsis, 45(75%) were due to gram negative enteric bacteria of which 32/45(71%) were due ESBL-PE. Klebsiella pneumoniae isolates were predominantly found to infect and colonize neonates.

Conclusion: Majority of the neonates at BMC neonatal units were infected with ESBL producing Klebsiella pneumoniae. Maternal and neonatal ESBL-PE colonization and being admitted at NICU were important risk factors for ESBL-PE neonatal sepsis. Neonates referred from other centres, infected with ESBL-PE and admitted at NICU had significantly high mortality rate. There is a need to do blood culture to every child with signs and symptoms of sepsis for early detection of ESBL-PE sepsis and early intervention to reduce its prevalence and hence mortality

ER  -