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).
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
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.
Department of Health Sciences
College of Medicine, Nursing & Health
Fiji National University
Stephen M. Graham
Department of Paediatrics
Centre for International Child Health
University of Melbourne
Murdoch Childrens Research Institute
Royal Children’s Hospital
International Union Against Tuberculosis
and Lung Disease
Department of Health Economics
College of Engineering, Science &
Fiji National University
Colonial War Memorial Hospital
Ministry of Health
Secretariat of the Pacific Community
Noumea, New Caledonia
National Centre for Epidemiology and
Australian National University
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