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Etiology, Antibiotic Resistance and Risk Factors for Neonatal Sepsis in a Large Referral Center in Zambia

Kabwe, Mwila MSc; Tembo, John MSc; Chilukutu, Lophina MSc; Chilufya, Moses MSc; Ngulube, Francis BSc; Lukwesa, Chileshe MB ChB; Kapasa, Monica MB ChB; Enne, Virve PhD; Wexner, Hannah; Mwananyanda, Lawrence MD; Hamer, Davidson H. MD; Sinyangwe, Sylvestor MB ChB; Ahmed, Yusuf FRCOG; Klein, Nigel FRCPath; Maeurer, Markus FRCP; Zumla, Alimuddin FRCP; Bates, Matthew PhD

The Pediatric Infectious Disease Journal: July 2016 - Volume 35 - Issue 7 - p e191–e198
doi: 10.1097/INF.0000000000001154
Original Studies

Background: In sub-Saharan Africa, there is scanty data on the causes of neonatal sepsis and antimicrobial resistance among common invasive pathogens that might guide policy and practice.

Methods: A cross-sectional observational prevalence and etiology study of neonates with suspected sepsis admitted to the neonatal intensive care unit, University Teaching Hospital, Lusaka, Zambia, between October 2013 and May 2014. Data from blood cultures and phenotypic antibiotic susceptibility testing were compared with multivariate analysis of risk factors for neonatal sepsis.

Results: Of 313 neonates with suspected sepsis, 54% (170/313) were male; 20% (62/313) were born to HIV-positive mothers; 33% (103/313) had positive blood cultures, of which 85% (88/103) were early-onset sepsis. Klebsiella species was the most prevalent isolate, accounting for 75% (77/103) of cases, followed by coagulase-negative staphylococci [6% (7/103)], Staphylococcus aureus [6% (6/103)], Escherichia coli [5% (5/103)] and Candida species [5% (5/103)]. For Klebsiella species, antibiotic resistance ranged from 96%–99% for World Health Organization-recommended first-line therapy (gentamicin and ampicillin/penicillin) to 94%–97% for third-generation cephalosporins. The prevalence of culture-confirmed sepsis increased from 0 to 39% during the period December 2013 to March 2014, during which time mortality increased 29%–47%; 93% (14/15) of late-onset sepsis and 82% (37/45) of early-onset sepsis aged 4–7 days were admitted >2 days before the onset of symptoms. Culture results for only 25% (26/103) of cases were available before discharge or death. Maternal HIV infection was associated with a reduced risk of neonatal sepsis [odds ratio, 0.46 (0.23–0.93); P = 0.029].

Conclusions: Outbreaks of nosocomial multiantibiotic-resistant infections are an important cause of neonatal sepsis and associated mortality. Reduced risk of neonatal sepsis associated with maternal HIV infection is counterintuitive and requires further investigation.

From the *UNZA-UCLMS Research and Training Programme, University Teaching Hospital, Lusaka, Zambia; HerpeZ, Department of Pathology and Microbiology, and §Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia; Division of Infection and Immunity, University College London, United Kingdom; Harvard Medical School, Boston, Massachusetts; **Zambia Centre for Applied Health Research and Development, Boston, Massachusetts; ††Center for Global Health and Development, Boston University School of Public Health (BUSPH), Boston, Massachusetts; ‡‡Department of Global Health, Boston, Massachusetts; §§Department of Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia; ¶¶Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London and Great Ormond Street Hospital, London, United Kingdom; ‖‖Therapeutic Immunology, Departments of Laboratory Medicine and Microbiology, Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden; and ***Department of Infection, Immunity and Inflammation, NIHR Biomedical Research Centre, University College London Hospitals, London, United Kingdom.

Accepted for publication December 9, 2015.

M.K., J.T., A.Z. and M.B. contributed equally.

“ Kid’s Here and There” (Columbus, OH), the UBS Optimus Foundation and the European and Developing Countries Clinical Trials Partnership.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Matthew Bates, PhD, UNZA-UCLMS Research and Training Programme, D-Block Research Office, Department of Paediatrics and Child Health, University Teaching Hospital, Nationalist Road, Lusaka, Zambia. E-mail: matthew.bates@ucl.ac.uk.

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