Causes of septicemia and characteristics of babies admitted with provisional diagnosis of septicemia to the neonatal intensive care unity at the University Teaching Hospital, Lusaka

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Mulenga, Veronica
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Neonatal septicemia is a common cause of admission to the Neonatal Intensive Care Unit (NICU) at the University Teaching hospital (UTH) in Lusaka, Zambia, accounting for twenty percent of admissions, and is the third commonest cause of mortality. Financial constraints at the UTH do not allow for blood cultures to be done routinely on all babies admitted to the NICU with diagnosis of septicemia, and therefore more often than not, these babies are treated empirically with crystalline penicillin and gentamycin as first line drugs. Use of crystalline penicillin and gentamycin as first line antibiotics in UTH is based on literature, which states that Group B HemolyticStreptococcus and Escherischi Coli are the common pathogens isolated in most neonatal nurseries. A cross sectional descriptive study was carried out at the NICU UTH, Lusaka, Zambia, between 1*' December 1997 and 31^' March 1998, on babies admitted to the neonatal wing with provisional diagnosis of septicemia. This study looked at the pathogens causing septicemia and their drug sensitivity pattern, and also at the obstetric, neonatal factors and the clinical features in these babies. During the study period, 219 babies were admitted to NICU with diagnosis of septicemia. 100 babies were recruited for the study, and of these 25% were from UTH postnatal wards, 57.8% were referred from the clinics and 17.2% were straight from home. The majority of babies in this study (72.8%) were term. Average birth weight was 2.7 kilogram body weight with a male to female ratio of 1.4: 1.Thirty (32.6%) babies had positive blood cultures. The commonest organisms isolated from blood were Coagulase negative staphylococcus (CNS) (36.7%), Klebsiella pneumoniae (23.3%), and Staphylococcus aureus (23.3%). Salmonella species were isolated from 2 babies (6.7%), and other isolates were Pseudomonas aeruginosa (3.3%), Escherischi coli (E.coli) (3.3%) and Streptococcus species (3.3%). Fourteen babies (47%) presented with early onset sepsis, while 16 (53.3%) presented with late onset sepsis. Coagulase negative staphylococcus and Staphlococcus aureus were the commonest organisms isolated in babies with early onset disease whilst Klebsiella pneumoniae was commonest in those with late onset disease.In vitro sensitivity showed that all the organisms isolated were sensitive to cefotaxime. Thirteen percent of Klebsiella organisms were sensitivity to gentamycin, while Staphylococcus aureus, showed 100% sensitivity to cloxacillin. Salmonella species were resistant to all the antibiotics tested including chloramphenicol and were only sensitive to cefotaxime. Significant obstetric factors for confirmed septicemia were, delivery at home, and when age of mother was below 20 years. Gestational age and birthweight were not significant neonatal factors, but male sex was significantly associated with confirmed septicemia. Clinical features like fever, poor feeding, respiratory distress and jaundice were the commonest presenting symptoms in the babies studied, however convulsions, poor feeding and umbilical sepsis presented more commonly in those babies with confirmed septicemia than unconfirmed septicemia, but there was no statistical difference.There was no difference in mortality rates between babies with confirmed septicemia and those with unconfirmed septicemia, 16.6% and 16.1% respectively. Case fatality rate in babies with CNS infection was 9.1% and 14.3% in those with Klebsiella infection. There were no deaths among the babies with Staphylococcus aureus. According to this study, Coagulase negative staphylococcus. Staphylococcus aureus and Klebsiella pneumoniae were the commonest organisms isolated. Group B Streptococcus (GBS) and Escherischi Coli were not common isolates in these babies, the majority of whom came from the Lusaka urban clinics. Therefore continued use of crystalline penicillin and gentamycin as first line antibiotics needs to be reviewed. Cefotaxime should be the drug of choice and should be made available at all times and cloxacillin should be added to cover for Staphylococcus infections.