A Cohort Study on Clinical Features and Microbiological Profile in Neonatal Sepsis in Southwest of Iran

A bloodstream infection known as "sepsis" with "Neonatal sepsis," which is a bloodstream infection associated with high morbidity and mortality. To function effectively and apply the appropriate treatments, it is necessary to comprehend the bacterial etiology, antibiotic resistance profile, and risk factors. The purpose of this study was to determine the variables that contribute to neonatal sepsis and the pattern of antibiotic resistance.

This multicenter cohort study was conducted among neonates and their mothers admitted to two gynecological and maternity hospitals in Shiraz, Iran. Heel-prick venous blood was obtained from all neonates after which it was cultured and the outcome used to group the study participants as positive and negative study groups. The antibiotic susceptibility profile of isolated bacteria against commonly prescribed antibiotics was then determined using standard protocol. An independent sample t-test/chi-square where appropriate was used to determine the association between the study variables.

Among a cohort of 592 newborns, 271 (45.77%) were admitted with early onset sepsis, meanwhile, 321 patients (54.22%) had negative culture results for sepsis detection. The maternal age (t = 5.55 p-value < 0.05), gestational age (t = 4.98 p-value < 0.05), and mode of delivery (F = 17.42 p-value < 0.05) were maternal characteristics that associated with neonatal sepsis. Lethargy (F = 6.52 p-value = 0.010), low nutrition (F = 14.21 p-value < 0.05), vomit (F = 11.23 p-value = 0.001), hypothermia (F = 7.21 p-value = 0.04), and intubation (F = 15.62 p-value < 0.05) were significantly more frequent in the positive group than in the negative group. The predominant bacterial species isolated were Staphylococcus aureus (S. aureus) (60.14%) and Coagulase-negative staphylococci (CoNS) as compared to gram-negative (Escherichia coli and Klebsiella pneumonia). Ninety-one percent of the S. aureus isolates were resistant to penicillin (83 isolates, 50.9%) and ampicillin (67 isolates, 41.1%).

Both neonatal and maternal factors were associated with neonatal sepsis in these cohort of neonates admitted to health facilities in Iran, as such strengthening risk-based prevention strategies and improving institutional delivery practices are crucial in reducing morbidity and mortality among such vulnerable group.