Microbial profile and antimicrobial susceptibility patterns of neonatal blood stream infections in Durban, South Africa.

Abstract

Objectives Antimicrobial resistance (AMR) has emerged as a global threat to healthcare resulting in an increase in morbidity and mortality. Neonatal sepsis is ranked as the third highest cause of neonatal demise globally, in which AMR accounted for 31.0% of deaths. This study analysed the aetiology and antimicrobial resistance patterns of bloodstream infections within the neonatal intensive care unit (NICU) at a tertiary hospital in Durban, South Africa. Methods A retrospective data review was conducted on all positive blood cultures at three time periods: 2014, 2016 and 2018. The organisms and antimicrobial susceptibilities were analysed for significant trends using Poisson and logistic regression. Results A preponderance of gram-positive organisms (68.7%) over gram-negatives (26.8%) and fungi (4.5%) was detected. Common pathogens included coagulase-negative staphylococci (53.5%), Klebsiella pneumoniae (11.6%), enterococci (9.3%), and Acinetobacter baumannii (7.7%). Late-onset sepsis (86.8%) predominated over early-onset sepsis (13.2%). High rates of resistance to first- and second-line antibiotics were noted among gram-positive and gramnegative organisms. Multidrug resistant organisms included extended-spectrum betalactamase (ESBL) K. pneumoniae (7.6%) and multi-drug resistant A. baumannii (7.0%). A statistically significant decrease in ESBL-producing organisms was documented between 2014 and 2018 (p = 0.005). Conclusion High resistance rates were seen for first- and second-line antibiotics used for the treatment of neonatal sepsis. Ongoing microbial surveillance is essential to tailor empiric antimicrobial choices in individual units.