Epidemiology of Neonatal Sepsis at Johannesburg Hospital

Abstract

We evaluated sepsis in the neonatal unit at Johannesburg Hospital including the time of onset, clinical features, outcome of the treatment of patients, pathogens isolated, and antimicrobial sensitivity to provide site-specific guidelinesfor empiric antibiotic therapy. This was a retrospective study conducted in the neonatal unit of the Johannesburg Hospital between 1 July 2002 and 30 June 2003. All neonates with growth on blood cultures were included. Demographic, clinical, laboratory and microbiological data were reviewed. Of a total of l03 infants with l40 positive blood cultures, eight isolates were most likely to be contaminants. There were thus 132 significant isolates in 96 patients: five presented with early onset sepsis(EOS) and 91 withlate onset sepsis (LOS). Gram-negative bacilli werethe predominant isolatesin EOS and coagulL-negative staphylococci(CoNS)the predominantisolates(63)in LOS (40/63 considered significant, CoNS were not speciated as Staphylococcus epidermidis). Theremaining isolates in LOS were mostly Gram-negative organisms. The case fatality rate was 40% for EOS and l9.7% for LOS. Multiresistant sensitivity patterns (resistance to > 2 classes of antibiotics) were identified in 45 organisms (34.5%). LOS was more common than EOS in the Johannesburg Hospital neonatal unit but had a lower case fatality rate.