Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Setting
2.2.1. General Setting
2.2.2. Specific Setting
2.3. Management of Sepsis in the Study Setting
2.4. Study Population
2.5. Data Variables, Data Sources and Data Collection
2.6. Data Analysis
3. Results
3.1. Socio-Demographics and Clinical Characteristics of Neonates
3.2. Antimicrobial Use
3.2.1. Empirical Antimicrobial Use
3.2.2. Modification in Antimicrobial Use
3.3. Blood Culture Testing
3.4. Resistance of Bacterial Isolates against Antimicrobials
3.5. Hospital Exit Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Characteristic | Number | Percentage |
---|---|---|---|
Total | 549 | (100) | |
Age groups (days) | 0–3 | 463 | (84.3) |
4–6 | 23 | (4.2) | |
7–13 | 28 | (5.3) | |
14–20 | 17 | (3.1) | |
21–28 | 17 | (3.1) | |
Median (IQR) | 1 | (1–2) days | |
Sex | Male | 283 | (51.5) |
Female | 265 | (48.3) | |
Not recorded | 1 | (0.2) | |
NHIS subscriber | No | 113 | (20.6) |
Yes | 433 | (78.9) | |
Not recorded | 3 | (0.5) | |
NHIS status (n = 436) | Active subscriber | 184 | (42.2) |
Non-active subscriber | 249 | (57.1) | |
Not recorded | 3 | (0.7) | |
Residence | Urban | 385 | (70.1) |
Rural | 138 | (25.1) | |
Not recorded | 26 | (4.7) | |
Length of hospital stay | ≤7 days | 449 | (81.8) |
8–14 days | 68 | (12.4) | |
>14 days | 32 | (5.8) | |
Median (IQR) | 4 | (3–6) days |
Characteristic | Number | Percentage | |
---|---|---|---|
Total | 549 | (100) | |
Signs and Symptoms at admission | Lethargy † | 49 | (9.2) |
Seizures † | 39 | (7.3) | |
Pale skin † | 29 | (5.4) | |
Persistent diarrhoea/vomiting † | 13 | (2.4) | |
Reduced urine output † | 4 | (0.8) | |
Unconsciousness † | 3 | (0.6) | |
Body temperature * | |||
Fever (>37.5 °C) | 158 | (29.8) | |
Normal | 305 | (57.5) | |
Hypothermia (<36.5 °C) | 67 | (12.6) | |
Heart rate * | |||
Tachycardia (>160 beats/minute) | 119 | (22.5) | |
Normal | 407 | (76.9) | |
Bradycardia (<100 beats/minute) | 3 | (0.6) | |
Respiratory rate * | |||
Normal (15–60 breaths/minute) | 264 | (51.4) | |
Respiratory distress (>60 breaths/minute) | 250 | (48.6) | |
Leucocyte count (109 cells/L) * | |||
Low (<10) | 119 | (28.1) | |
Normal (10–20) | 256 | (60.5) | |
High (>20) | 48 | (11.3) |
Antimicrobial | Total n (%) |
---|---|
Gentamicin | 470 (88.8) |
Cefuroxime | 421 (79.6) |
Benzylpenicillin | 53 (10.0) |
Cefotaxime | 52 (9.8) |
Metronidazole | 17 (3.2) |
Ciprofloxacin | 7 (1.3) |
Ampicillin | 1 (0.2) |
Clindamycin | 1 (0.2) |
Combinations/Treatment regimens | n (%) |
Cefuroxime + gentamicin | 407 (76.9) |
Benzylpenicillin + gentamicin | 53 (10) |
Cefotaxime | 42 (7.9) |
Cefuroxime + gentamicin + metronidazole | 7 (1.3) |
Cefuroxime + metronidazole | 6 (1.1) |
Cefotaxime + ciprofloxacin | 3 (0.6) |
Cefotaxime + gentamicin | 3 (0.6) |
Cefotaxime + metronidazole | 2 (0.4) |
Ciprofloxacin | 2 (0.4) |
Cefuroxime + metronidazole + ciprofloxacin | 1 (0.2) |
Cefotaxime + clindamycin | 1 (0.2) |
Ciprofloxacin + metronidazole | 1 (0.2) |
Ampicillin + cefotaxime | 1 (0.2) |
Parameter | n | (%) |
---|---|---|
Number (%) of patients prescribed no antibiotic | 20 | (3.6) |
Number (%) of patients prescribed one antibiotic | 44 | (8.0) |
Number (%) of patients prescribed two antibiotics | 477 | (86.9) |
Number (%) of patients prescribed three antibiotics | 8 | (1.5) |
Number (%) of patients who received antimicrobials for empirical therapy | 529 | (96.4) |
Number (%) of antimicrobials prescribed that were consistent with national STGs | 1 | (0.2) |
Number (%) of antimicrobials prescribed that were consistent with facility-based guidelines | 502 | (94.9) |
Modified Treatment | Total n (%) |
---|---|
Cefotaxime | 46 (67.6) |
Ciprofloxacin | 13 (19.1) |
Ciprofloxacin + metronidazole | 3 (4.4) |
Cefuroxime + gentamicin | 1 (1.5) |
Cefuroxime + metronidazole + gentamicin | 1 (1.5) |
Benzylpenicillin + gentamicin | 1 (1.5) |
Ampicillin + ciprofloxacin | 1 (1.5) |
Amikacin | 1 (1.5) |
Flucloxacillin | 1 (1.5) |
Total | 68 (100) |
Bacterial Isolates | Number | Percentage |
---|---|---|
Total | 70 | (100) |
Gram-positives | 60 | (85.7) |
Coagulase-negative Staphylococcus | 34 | (48.6) |
Staphylococcus aureus | 22 | (31.4) |
Enterococcus spp. | 3 | (4.3) |
Streptococcus spp. | 1 | (1.4) |
Gram-negatives | 10 | (14.3) |
Coliforms | 4 | (5.7) |
Pseudomonas spp. | 3 | (4.3) |
Klebsiella spp. | 2 | (2.9) |
Escherichia coli | 1 | (1.4) |
Medicines | Antimicrobial Resistance Pattern | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Staphylococcus aureus (n = 22) | CoNS (n = 34) | Streptococcus spp. (n = 1) | Enterococcus spp. (n = 3) | |||||||
N | R | (%) † | N | R | (%) † | N | R | N | R | |
Penicillin | 6 | 6 | (100) | - | - | - | - | - | - | - |
Cloxacillin | 2 | 2 | (100) | 3 | 3 | (100) | - | - | 1 | 1 |
Gentamicin | 18 | 8 | (44.4) | 31 | 13 | (41.9) | 1 | 1 | 3 | 1 |
Ciprofloxacin | 14 | 2 | (14.3) | 32 | 9 | (28.1) | 1 | 1 | 3 | 1 |
Linezolid | 2 | 1 | (50) | 3 | 0 | (0) | - | - | 1 | 0 |
Tetracycline | 1 | 1 | (100) | - | - | - | - | - | - | - |
Medicines | Antimicrobial Resistance Pattern | |||||||
---|---|---|---|---|---|---|---|---|
Klebsiella spp.* (n = 1) | Escherichia coli (n = 1) | Coliforms (n = 4) | Pseudomonas spp. (n = 3) | |||||
N | R | N | R | N | R | N | R | |
Ampicillin | 1 | 1 | 1 | 1 | 4 | 4 | ||
Gentamicin | 1 | 0 | 1 | 1 | 2 | 2 | 2 | 2 |
Amikacin | 1 | 0 | 1 | 0 | 3 | 1 | 2 | 1 |
Cefuroxime | 1 | 1 | 1 | 1 | 4 | 4 | - | - |
Ceftriaxone | 1 | 1 | 1 | 1 | 3 | 1 | - | - |
Cefotaxime | 1 | 1 | 1 | 1 | 4 | 1 | - | - |
Ciprofloxacin | 1 | 0 | 1 | 0 | 4 | 1 | 2 | 0 |
Levofloxacin | 1 | 0 | 1 | 0 | - | - | - | - |
Chloramphenicol | - | - | 1 | 1 | 4 | 4 | - | - |
Antimicrobial | Number of Tests | Resistant | |
---|---|---|---|
n | % | ||
Gentamicin | 59 | 28 | (47.5) |
Ciprofloxacin | 58 | 14 | (24.1) |
Amikacin | 56 | 6 | (10.7) |
Ampicillin | 50 | 45 | (90.0) |
Co-trimoxazole | 50 | 33 | (66.0) |
Cefuroxime | 42 | 27 | (64.3) |
Erythromycin | 42 | 30 | (71.4) |
Flucloxacillin | 31 | 30 | (96.7) |
Cefotaxime | 22 | 19 | (86.4) |
Levofloxacin | 22 | 4 | (18.1) |
Ceftriaxone | 13 | 10 | (76.9) |
Chloramphenicol | 13 | 10 | (76.9) |
Lincomycin | 10 | 7 | (70) |
Ofloxacin | 9 | 2 | (22.2) |
Azithromycin | 8 | 5 | (62.5) |
Roxithromycin | 7 | 4 | (57.1) |
Penicillin | 6 | 6 | (100) |
Cloxacillin | 6 | 6 | (100) |
Linezolid | 6 | 1 | (16.7) |
Cephalexin | 6 | 5 | (83.3) |
Piperacillin + sulbactam | 6 | 5 | (83.3) |
Amoxicillin | 5 | 5 | (100) |
Sparfloxacin | 5 | 1 | (20.0) |
Benzylpenicillin | 2 | 2 | (100) |
Ampicillin + sulbactam | 2 | 2 | (100) |
Tetracycline | 1 | 1 | (100) |
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Omenako, K.A.; Enimil, A.; Marfo, A.F.A.; Timire, C.; Chinnakali, P.; Fenny, A.P.; Jeyashree, K.; Buabeng, K.O. Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021. Int. J. Environ. Res. Public Health 2022, 19, 12968. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912968
Omenako KA, Enimil A, Marfo AFA, Timire C, Chinnakali P, Fenny AP, Jeyashree K, Buabeng KO. Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021. International Journal of Environmental Research and Public Health. 2022; 19(19):12968. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912968
Chicago/Turabian StyleOmenako, Kwaku Anim, Anthony Enimil, Afia Frimpomaa Asare Marfo, Collins Timire, Palanivel Chinnakali, Ama Pokuaa Fenny, Kathiresan Jeyashree, and Kwame Ohene Buabeng. 2022. "Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021" International Journal of Environmental Research and Public Health 19, no. 19: 12968. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191912968