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Resistance of Bacterial Isolates from Neonates with Suspected Sepsis to Recommended First-Line Antibiotics in Fiji

Kumar, Shaneel; Graham, Stephen M.; Varman, Sumantla; Kado, Joseph; Viney, Kerri

The Pediatric Infectious Disease Journal: August 2015 - Volume 34 - Issue 8 - p 915–916
doi: 10.1097/INF.0000000000000764
Letters to the Editor
Free

Department of Health Sciences, College of Medicine, Nursing & Health Sciences, Fiji National University, Fiji

Department of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne, Australia, Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia, International Union Against Tuberculosis and Lung Disease, Paris, France

Department of Health Economics, College of Engineering, Science & Technology, Fiji National University, Fiji

Paediatrics Department, Colonial War Memorial Hospital, Ministry of Health, Fiji

Secretariat of the Pacific Community, Noumea, New Caledonia, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia

Funding for the course was provided by the Global Fund to fight AIDS, TB and Malaria, with cofunding by The Union; the Special Programme for Research and Training in Tropical Diseases (TDR); Public Health Division of the Secretariat of the Pacific Community, New Caledonia; Centre for International Child Health, the University of Melbourne, Australia; School of Population Health, University of Queensland, Australia.

The authors have no conflicts of interest to disclose.

Address for correspondence: Shaneel Kumar, Grad-DipClinPharm; E-mail: shaneel.kumar@fnu.ac.fj.

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To the Editors:

We performed a retrospective descriptive study involving a review of the Infection Control Unit register and the patient folders in the neonatal intensive care unit (NICU) at the Colonial War Memorial Hospital, Fiji’s largest public hospital. Our study population was all neonates admitted to the Colonial War Memorial Hospital’s NICU during a 1-year period (January 1 to December 31, 2012) who had clinically suspected sepsis and a positive bacteriologic culture result from a sample obtained screening for sepsis. Ethics approval was provided by the Ethics Advisory Group of the International Union Against Tuberculosis and Lung Disease and the Fiji National Health Research Committee.

Of the 418 newborns admitted to the NICU ward, 103 neonates with a positive bacteriologic culture were identified from the register during the study period. The commonest reason for admission to the NICU was respiratory abnormalities occurring in 47% (48 of 103). The majority, 92% (95 of 103) had early-onset sepsis, that is, <7 days after birth.

Bacteria were cultured from a range of specimens including rectal swabs (n = 49), endotracheal tube tips (n = 32), urine (n = 12) and blood (n = 6). Gram-negative organisms accounted for the majority of bacteria isolated with the commonest of these being Escherichia coli (n = 24), Klebsiella pneumoniae (n = 20) and Acinetobacter baumannii (n = 15). Coagulase negative staphylococcus was the commonest Gram-positive organism isolated (n = 23) followed by Streptococcus species (n = 3). Table 1 shows in vitro resistance data to the 5 commonly used antibiotics. Inpatient mortality for the 103 neonates with clinical suspected sepsis and a bacterial isolate was 19% (n = 20). Mortality was highest in those that had bacteria isolated from blood (2 of 6 or 33% died) or from an endotracheal tube (14 of 32 or 44% died).

TABLE 1

TABLE 1

Our study provides original data from Fiji on bacteria isolated in the NICU from neonates with a diagnosis of suspected sepsis. Gram-negative bacteria were the commonest isolates identified, and mortality of neonates was high. These findings are consistent with previous studies of neonatal sepsis in developing countries and resource limited settings.1–3 The data indicate high rates of resistance to ampicillin and gentamicin, the first-line antimicrobial agents recommended by WHO for treatment of serious infections in young infants,4 as well as emerging resistance to the commonly used second-line drugs, ceftriaxone and ciprofloxacin.

Our study has important limitations that include its retrospective design and low numbers of neonates with microbiologically confirmed invasive sepsis. A prospective study is required to provide more comprehensive data regarding the causes of invasive neonatal sepsis in Fiji to inform appropriate antibiotic guidelines for management. In the meantime, there must be ongoing attention to practices known to reduce the risk of hospital-acquired sepsis, such as the promotion of hand hygiene and antibiotic stewardship.5

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ACKNOWLEDGMENT

This research was conducted through the Structured Operational Research and Training Initiative (SORT IT). The training was run in Fiji by the College of Medicine, Nursing and Health Sciences, Fiji National University, Fiji and The Union.

Additional support for running the course was provided by the Public Health Division of the Secretariat of the Pacific Community, New Caledonia; Centre for International Child Health, the University of Melbourne, Australia; School of Population Health, University of Queensland, Australia; Regional Public Health, Hutt Valley District Health Board, New Zealand and the National TB Programme, Fiji Ministry of Health, Fiji.

Shaneel Kumar

Department of Health Sciences

College of Medicine, Nursing & Health

Sciences

Fiji National University

Fiji

Stephen M. Graham

Department of Paediatrics

Centre for International Child Health

University of Melbourne

Melbourne, Australia

Murdoch Childrens Research Institute

Royal Children’s Hospital

Melbourne, Australia

International Union Against Tuberculosis

and Lung Disease

Paris, France

Sumantla Varman

Department of Health Economics

College of Engineering, Science &

Technology

Fiji National University

Fiji

Joseph Kado

Paediatrics Department

Colonial War Memorial Hospital

Ministry of Health

Fiji

Kerri Viney

Secretariat of the Pacific Community

Noumea, New Caledonia

National Centre for Epidemiology and

Population Health

Australian National University

Canberra, Australia

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REFERENCES

1. Downie L, Armiento R, Subhi R, et al. Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO’s currently recommended antibiotics–systematic review and meta-analysis. Arch Dis Child. 2013;98:146–154
2. Kohli-Kochhar R, Omuse G, Revathi G.. A ten-year review of neonatal bloodstream infections in a tertiary private hospital in Kenya. J Infect Dev Ctries. 2011;5:799–803
3. Zaidi AK, Huskins WC, Thaver D, et al. Hospital-acquired neonatal infections in developing countries. Lancet. 2005;365:1175–1188
4. Thaver D, Ali SA, Zaidi AK.. Antimicrobial resistance among neonatal pathogens in developing countries. Pediatr Infect Dis J. 2009;28(1 Suppl):S19–S21
5. Murni IK, Duke T, Kinney S, et al. Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study. Arch Dis Child. 2015;100:454–459
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