Olivia S. Egbule¹*, Obaro L. Oyubu², Mary O. Okotie¹, Patricia K. Omenogor³ and Beranrd O. Ejechi.¹

¹Department of Microbiology, Delta State University, Abraka Nigeria
²Department of Science Laboratory Technology, Delta State University, Abraka, Nigeria
³Department of Nursing Science, Delta State University, Abraka Nigeria

*Corresponding Author: Olivia S. Egbule, Department of Microbiology, Delta State University, Abraka, Nigeria.

Received: April 30, 2024; Published: May 12, 2024

Abstract

Antimicrobial resistance in neonatal bloodstream infections (BSI) is a threat to the health system and a major contributor to morbidity and mortality within neonatal intensive care units. This study was carried out to determine the prevalence of BSI, antimicrobial resistance, and Extended Spectrum Beta Lactamase (ESBL) production. We carried out a cross-sectional study of newborns admitted to three hospitals in Delta State, Nigeria. Blood samples were collected aseptically, cultured on MacConkey, Blood and Chocolate agar respectively. Isolated bacteria were identified based on morphology, Gram stain and standard biochemical tests. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Phenotypic testing for ESBL production was carried out using the double-disc diffusion method according to CLSI guidelines. A plasmid curing test was performed on ESBL-producing isolates using 10% sodium dodecyl sulphate. A total of 70 bacterial isolates were detected in 180 blood samples, of which 50 (27.8%) were Gram-negative and 20 (11.1%) were Gram-positive. The most frequently isolated pathogen was Escherichia coli (19; 27.1%). A total of 19 (10.6%) isolates were from early-onset BSI, while 51 (28.3%) were from late-onset infection. A high rate of resistance was observed with Gentamicin and fluoroquinolone resistance being over 50% in E. coli and Klebsiella pneumoniae. All Staphylococcus aureus were resistant to erythromycin and trimethoprim-sulfamethoxazole. Twenty of the 50 Gram-negative isolates (40%) were ESBL producers with E. coli being 26.0% (13), and all harboured plasmids. Regular monitoring of pathogen spectrum and antimicrobial resistance patterns will help clinicians use drugs rationally in clinical management.

Keywords: Neonates; Intensive Care Units; Bloodstream Infection; Gram Positive Bacteria; Gram Negative Bacteria; ESBL Producers

References

1. Fleischmann-Struzek C. “The global burden of paediatric and neonatal sepsis: a systematic review”. Lancet Respiratory Medicine 6 (2018): 223-230.
2. Naghavi M., et al. “Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016”. The Lancet 390 (2017): 1151-210.
3. Lawn JE., et al. “4 million neonatal deaths: when? where? why?” The Lancet 365 (2005): 891-900.
4. Okomo U., et al. “Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: A systematic review and meta-analysis in line with the STROBE-NI reporting guidelines”. Lancet Infectious Disease 19 (2019): 1219-1234.
5. Chaurasia S., et al. “Neonatal sepsis in South Asia: huge burden and spiralling antimicrobial resistance”. BMJ 364 (2019): k5314.
6. Folgori L., et al. “Tackling antimicrobial resistance in neonatal sepsis”. Lancet Global Health 5 (2017): e1066-8.
7. Simonsen KA. “Early-onset neonatal sepsis”. Clinical Microbiology Review 27 (2014): 21-47.
8. Zaoutis TE., et al. “Risk factors for and outcomes of bloodstream infection caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species in children”. Pediatrics 115 (2005): 942-949.
9. Ndir A., et al. “Epidemiology and Burden of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae in a Pediatric Hospital in Senegal”. PLoS ONE (2016): e0143729.
10. Bitew A and Tsige E. “High Prevalence of Multidrug-Resistant and Extended-Spectrum β Lactamase-Pro-ducing Enterobacteriaceae: A Cross-Sectional Study at Arsho Advanced Medical Laboratory, AddisAbaba, Ethiopia”. Journal of Tropical Medicine (2020): 6167234.
11. Shilpakar A., et al. “Prevalence of multidrug- resistant and extended-spectrum beta-lactamase producing Gram- negative isolates from clinical samples in a tertiary care hospital of Nepal”. Tropical Medical Health 49 (2021): 23.
12. Egbule OS. “Occurrence of extended spectrum beta-lactamases and sul 1 in multi-drug resistant Escherichia coli and Salmonella isolated from poultry feeds”. Sci African (2022): 18: e01362
13. Adler A., et al. “The continuing plague of extended-spectrum β-lactamase producing enterbacterales infections: an update”. Infectious Disease Clinics of North America 34 (2020) :677-708.
14. Jyothi P., et al. “Bacteriological profile of neonatal septicemia and antibiotic susceptibility pattern of the isolates”. Journal of Natural Science, Biology, and Medicine 4 (2013): 306-309. 
15. Omoregie R., et al. “Microbiology of neonatal septicemia in a tertiary hospital in Benin City, Nigeria”. Biomark Genomic Medicine 5 (2013): 142-144.
16. Olorukooba AA., et al. “Prevalence and Factors Associated with Neonatal Sepsis in a Tertiary Hospital, North West Nigeria”. Nigerian Medical Journal 61 (2020): 60-66.
17. Egbule OS., et al. “High Rate of Antibiotic Resistance in a Neonatal Intensive Care Unit of a University Hospital”. BMRJ1 (2016): 1-6.
18. Edmond KM., et al. “Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis”. Lancet 379 (2012): 547-556.
19. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. CLSI Approved Standard M100-S15. Wayne, Clinical and laboratory Standards Institute (2018).
20. Sijhary TJ., et al. “Experiment with Gene Fusions”. 5th Edition, Cold Spring Harbor Laboratory Press, New York, (1984).
21. Ballot DE., et al. “Bacterial bloodstream infections in neonates in a developing country”. ISRN Pediatrics (2012): 2012508512.
22. Maharath A and Ahmed MS. Bacterial Etiology of Bloodstream Infections and Antimicrobial Resistance Patterns from a Tertiary Care Hospital in Malé, Maldives”. International Journal of Microbiology 18 (2021): 3088202.
23. Garba B., et al. “A study of neonatal mortality in a specialist hospital in Gusau, Zamfara, North-Western Nigeria”. International Journal of Tropical Disease and Health 28 (2017): 1-6.
24. Obiero CW., et al. “Empiric treatment of neonatal sepsis in developing countries”. The Pediatric Infectious Disease Journal 34 (2015): 659-661.
25. Khan AM., et al. “Neonatal and perinatal infections”. Pediatric Clinics of North America 64 (2017): 785-798.
26. Shane AL., et al. “Neonatal sepsis”. Lancet10104 (2017): 1770-1780.
27. Jing Z and Big L. “Analysis on the applicability of neonatal blood flow infection and antimicrobial regimen in a third class hospital”. Chin Med Rec20 (2019): 96-101.
28. Dat VQ., et al. “Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam: aetiology, drug resistance, and treatment outcome”. BMC Infectious Diseases 17 (2017): 493.
29. Zhang X., et al. “ Epidemiology and Drug Resistance of Neonatal Bloodstream Infection Pathogens in East China Children’s Medical Center from 2016 to 2020”. Frontiers in Microbiology 13 (2022): 820577.
30. Tong SY., et al. “Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management”. Clinical Microbiology Review 28 (2015): 603-661.
31. Guyot K., et al. “Raman spectroscopic analysis of the clonal and horizontal spread of CTX-M-15-producing Klebsiella pneumoniae in a neonatal intensive care unit”. European Journal of Clinical Microbiology and Infectious Diseases 31 (2012): 2827-2834.
32. Mshana SE., et al. “Predominance of Klebsiella pneumoniae ST14 carrying CTX-M-15 causing neonatal sepsis in Tanzania”. BMC Infectious Disease 13 (2013): 466.
33. Wang HM. “Analysis of pathogen distribution and drug resistance of neonatal infectious pneumonia from 2010 to 2013”. Chinese Journal of Infection Control 13 (2015): 411-412.
34. Koopmans LR., et al. “Paediatric antimicrobial use at a South African hospital”. The International Journal of Infectious Disease 74 (2018): 16-23.
35. World Health Organization. WHO priority pathogens list for R&D of new antibiotics. WHO (2017).
36. Wu PC., et al. “ Prevalence and risk factors for colonization by extendedspectrum β-lactamase-producing or ST 131 Escherichia coli among asymptomatic adults in community settings in Southern Taiwan”. Infectious Drug Resistance 12 (2019): 1063-1071.
37. Bush KGA Jacoby. “Updated functional classification of beta-lactamases”. Antimicrobe Agents Chemotherapy 54 (2010): 969-976.
38. Mshana SE., et al. “Multiple ST clonal complexes, with a predominance of ST131, of escherichia coli harbouring blaCTX-M-15 in a tertiary hospital in Tanzania”. Clinical Microbiology and Infection 8 (2011): 1279-1282.
39. Rogers BA., et al. “Escherichia coliO25b-ST131: a pandemic, multiresistant, community-associated strain”. Journal of Antimicrobe Chemotherapy 66 (2011): 1-14.
40. Majumder MAA., et al. “Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health”. Infectious Drug Resistance 29 (2020): 4713-4738.

Citation

Citation: Olivia S. Egbule., et al. “Antibiogram and ESBL Production Among Neonatal Blood Stream Infections in Intensive Care Units of Selected Hospitals in Delta State, Nigeria".Acta Scientific Microbiology 7.6 (2024): 09-16.

Copyright

Copyright: © 2024 Olivia Sochi Egbule., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.