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CHANGING PATTERN OF BACTERIAL ISOLATES AND ANTIMICROBIAL SUSCEPTIBILITY IN NEONATAL INFECTIONS IN KORLE BU TEACHING HOSPITAL, GHANA
Abstract
Background: Most neonatal deaths in developing countries are caused by infections, birth asphyxia
and prematurity. Even though most of these deaths occur at home, newborns admitted to hospital
neonatal units have a high risk of contracting fatal multi-drug resistant infections.
Objective: To compare the type of bacteria and the pattern of antimicrobial susceptibility of
organisms causing neonatal infections in 2001/02 with 1991/92 in the same neonatal unit.
Design: We reviewed the hospital records of newborns admitted to the neonatal unit in 2001/02 that
had positive blood cultures and compared the findings with similar work done 1991/92.
Setting: Neonatal Unit, Korle Bu Teaching Hospital, Ghana.
Results: Gram negative organisms (predominantly Enterobacter, Klebsiella and Acinetobacter)
remained the predominant cause of neonatal infection. There was a reduction in the proportion
of gram negative bacteraemia [70.9% in 1991/92 vs. 54.2% in 2001/02 (p<0.001)] due to the increased
prevalence of coagulase negative staphylococcus (31.9% in 2001/02 vs. 0% in 1991/92) as a cause of
neonatal bacteraemia ten years later. In 1991/92 as 2001/02 all bacterial isolates showed less than
40% susceptibility to ampicillin. The susceptibility of Klebsiella and Enterobacter to commonly
used aminoglycosides and cephalosporins had decreased from over 80% in 1991/92 to less than
35% in 2001/02.
Conclusion: Bacterial causes of neonatal infections change over time and antimicrobial resistance is
a major cause for concern in neonatal units in resource-poor hospitals. Improving infection control
practices and instituting systems to monitor antimicrobial use and resistance will compliment
community efforts to reduce neonatal mortality.
and prematurity. Even though most of these deaths occur at home, newborns admitted to hospital
neonatal units have a high risk of contracting fatal multi-drug resistant infections.
Objective: To compare the type of bacteria and the pattern of antimicrobial susceptibility of
organisms causing neonatal infections in 2001/02 with 1991/92 in the same neonatal unit.
Design: We reviewed the hospital records of newborns admitted to the neonatal unit in 2001/02 that
had positive blood cultures and compared the findings with similar work done 1991/92.
Setting: Neonatal Unit, Korle Bu Teaching Hospital, Ghana.
Results: Gram negative organisms (predominantly Enterobacter, Klebsiella and Acinetobacter)
remained the predominant cause of neonatal infection. There was a reduction in the proportion
of gram negative bacteraemia [70.9% in 1991/92 vs. 54.2% in 2001/02 (p<0.001)] due to the increased
prevalence of coagulase negative staphylococcus (31.9% in 2001/02 vs. 0% in 1991/92) as a cause of
neonatal bacteraemia ten years later. In 1991/92 as 2001/02 all bacterial isolates showed less than
40% susceptibility to ampicillin. The susceptibility of Klebsiella and Enterobacter to commonly
used aminoglycosides and cephalosporins had decreased from over 80% in 1991/92 to less than
35% in 2001/02.
Conclusion: Bacterial causes of neonatal infections change over time and antimicrobial resistance is
a major cause for concern in neonatal units in resource-poor hospitals. Improving infection control
practices and instituting systems to monitor antimicrobial use and resistance will compliment
community efforts to reduce neonatal mortality.
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