摘要
<strong>Background</strong><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">Neonatal sepsis is a global health problem that mainly affects low- and middle-income countries. We have previously shown that early neonatal mortality is high at the Ho Teaching Hospital (HTH) of Ghana. We sought to determine the prevalence of neonatal sepsis, sepsis-related mortality, and bacterial species patterns in neonatal and young infant sepsis in this hospital.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Methods</span></b><b><span style="font-family:Verdana;">:</span></b><b><span style="font-family:;" "=""> </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">A hospital-based study was conducted in the hospital’s neonatal intensive care unit (NICU) from March to June 2018. Blood samples from 96 babies clinically diagnosed with or at risk of sepsis were cultured using the BACTEC 9050<span style="white-space:nowrap;"><sup>®</sup> </span>machine. Clinical data including gravida, parity and antibiotic medication before delivery of mother and delivery type, gestation, birth weight and antibiotic medication status were collected for analysis. MALDI-TOF MS identified bacterial isolates, and their identities were confirmed via </span><i><span style="font-family:Verdana;">tuf</span></i><span style="font-family:Verdana;"> gene sequence typing. The data were analyzed using GraphPad Prism 8.0.2.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Results</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">Blood cultures were positive in 28 of the babies, with 14 and 12 representing early-onset and late-onset neonatal sepsis, respectively, and two cases of unknown sepsis type. Of the bacterial species that caused sepsis in the babies, coagulase-negative staphylococcus (CoNS) was the most prevalent isolate in 22 cases, followed by </span><i><span style="font-family:Verdana;">Klebsiella pneumoniae </span></i><span style="font-family:Verdana;">in </span><span style="font-family:Verdana;">two and </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;">, </span><i><span style="font-family:Verdana;">Streptococcus agalactiae</span></i><span style="font-family:Verdana;">, the </span><i><span style="font-family:Verdana;">Acinetobacter</span><span> </span></i><span style="font-family:Verdana;">species</span><span style="font-family:Verdana;">, and </span><i><span style="font-family:Verdana;">Escherichia coli</span></i><span style="font-family:Verdana;"> in the rest (one each). Of the CoNS, </span><i><span style="font-family:Verdana;">S. haemolyticus</span></i><span style="font-family:Verdana;"> and </span><i><span style="font-family:Verdana;">S. epidermidis</span></i><span style="font-family:Verdana;"> were the most prevalent species, found in eight and six cases, respectively. Thirteen neonates died, of whom seven had positive blood cultures, and two were referred. A case fatality rate of 7/26 was estimated. Neonatal mortality caused by Gram-negative bacterial infection was higher than that caused by Gram-positive bacteria. </span><b><span style="font-family:Verdana;">Conclusions</span></b></span><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">These data suggest a significant burden of sepsis among neonates and young infants and are associated with substantial morbidity and mortality at the HTH. There is a need to investigate risk factors associated with the increased sepsis rate in this hospital to inform measures to reduce the neonatal sepsis rate.</span>
<strong>Background</strong><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">Neonatal sepsis is a global health problem that mainly affects low- and middle-income countries. We have previously shown that early neonatal mortality is high at the Ho Teaching Hospital (HTH) of Ghana. We sought to determine the prevalence of neonatal sepsis, sepsis-related mortality, and bacterial species patterns in neonatal and young infant sepsis in this hospital.</span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Methods</span></b><b><span style="font-family:Verdana;">:</span></b><b><span style="font-family:;" "=""> </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">A hospital-based study was conducted in the hospital’s neonatal intensive care unit (NICU) from March to June 2018. Blood samples from 96 babies clinically diagnosed with or at risk of sepsis were cultured using the BACTEC 9050<span style="white-space:nowrap;"><sup>®</sup> </span>machine. Clinical data including gravida, parity and antibiotic medication before delivery of mother and delivery type, gestation, birth weight and antibiotic medication status were collected for analysis. MALDI-TOF MS identified bacterial isolates, and their identities were confirmed via </span><i><span style="font-family:Verdana;">tuf</span></i><span style="font-family:Verdana;"> gene sequence typing. The data were analyzed using GraphPad Prism 8.0.2.</span></span><span style="font-family:;" "=""> </span><b><span style="font-family:Verdana;">Results</span></b><b><span style="font-family:Verdana;">: </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">Blood cultures were positive in 28 of the babies, with 14 and 12 representing early-onset and late-onset neonatal sepsis, respectively, and two cases of unknown sepsis type. Of the bacterial species that caused sepsis in the babies, coagulase-negative staphylococcus (CoNS) was the most prevalent isolate in 22 cases, followed by </span><i><span style="font-family:Verdana;">Klebsiella pneumoniae </span></i><span style="font-family:Verdana;">in </span><span style="font-family:Verdana;">two and </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;">, </span><i><span style="font-family:Verdana;">Streptococcus agalactiae</span></i><span style="font-family:Verdana;">, the </span><i><span style="font-family:Verdana;">Acinetobacter</span><span> </span></i><span style="font-family:Verdana;">species</span><span style="font-family:Verdana;">, and </span><i><span style="font-family:Verdana;">Escherichia coli</span></i><span style="font-family:Verdana;"> in the rest (one each). Of the CoNS, </span><i><span style="font-family:Verdana;">S. haemolyticus</span></i><span style="font-family:Verdana;"> and </span><i><span style="font-family:Verdana;">S. epidermidis</span></i><span style="font-family:Verdana;"> were the most prevalent species, found in eight and six cases, respectively. Thirteen neonates died, of whom seven had positive blood cultures, and two were referred. A case fatality rate of 7/26 was estimated. Neonatal mortality caused by Gram-negative bacterial infection was higher than that caused by Gram-positive bacteria. </span><b><span style="font-family:Verdana;">Conclusions</span></b></span><b><span style="font-family:Verdana;">: </span></b><span style="font-family:Verdana;">These data suggest a significant burden of sepsis among neonates and young infants and are associated with substantial morbidity and mortality at the HTH. There is a need to investigate risk factors associated with the increased sepsis rate in this hospital to inform measures to reduce the neonatal sepsis rate.</span>
作者
Innocent Afeke
Misa Hirose
Kokou Hefoume Amegan-Aho
Christoph Haertel
Mareike Becker
Ahmed Moustafa
Paul Schilf
Mohamed Tarek Badr
Graceful Lord Mensah
Hintermann Kobina Mbroh
Jan Rupp
Saleh Ibrahim
Innocent Afeke;Misa Hirose;Kokou Hefoume Amegan-Aho;Christoph Haertel;Mareike Becker;Ahmed Moustafa;Paul Schilf;Mohamed Tarek Badr;Graceful Lord Mensah;Hintermann Kobina Mbroh;Jan Rupp;Saleh Ibrahim(Luebeck Institute for Experimental Dermatology, University of Luebeck, Luebeck, Germany;Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ho, Ghana;Department of Paediatrics, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ho, Ghana;Department of Paediatrics, University Hospital Würzburg, University of Würzburg, Würzburg, Germany;Department of Biology, Bioinformatics and Integrative Genomics Laboratory, American University in Cairo, New Cairo, Egypt;Institute of Medical Microbiology and Hygiene, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany;Department of Paediatrics, Ho Teaching Hospital, Volta Region, Ho, Ghana;Department of Obstetrics and Gynaecology, Ho Teaching Hospital, Volta Region, Ho, Ghana;Department of Infectious Diseases and Microbiology, University of Luebeck, Luebeck, Germany)