Neonatal sepsis in Pakistan. Presentation and pathogens

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Hospital Epidemiology

Background:

• Neonatal sepsis is a significant cause of morbidity and mortality in newborns.
• Understanding the causative organisms and risk factors is crucial for effective management.
• Hospital-acquired infections (nosocomial sepsis) pose a particular challenge in neonatal units.

Purpose of the Study:

• To analyze the patterns of neonatal sepsis, including non-nosocomial (NNC) and nosocomial (NC) infections.
• To identify the common etiological agents responsible for neonatal sepsis.
• To determine the mortality rates and associated risk factors for neonatal sepsis.

Main Methods:

• Retrospective analysis of case records of neonates admitted to Aga Khan University Hospital from November 1986 to April 1989.
• Inclusion criteria: confirmed sepsis.
• Data collected included infection type (NNC vs. NC), causative organisms, mortality, and risk factors.

Main Results:

• Of 60 neonates with sepsis, 55% had NNC and 45% had NC.
• Klebsiella species were the most frequent cause of both NNC (early-onset) and NC sepsis.
• Mortality rates varied: 44% for NC, 26% for early-onset NNC, and 43% for late-onset NNC sepsis.
• Risk factors for NNC sepsis included low birthweight, prematurity, and complicated deliveries.
• High drug resistance (67%) to ampicillin and gentamicin was noted among gram-negative organisms.

Conclusions:

• Neonatal sepsis presents a substantial burden, with a significant proportion being hospital-acquired.
• Klebsiella species are a primary concern, necessitating targeted antimicrobial strategies.
• High antimicrobial resistance underscores the need for vigilant infection control and antibiotic stewardship.