Neonatal Bacteraemia and Antibiotic Resistance at the Angre University Hospital, Abidjan, 2020

Research Article

J Bacteriol Mycol. 2023; 10(1): 1202.

Neonatal Bacteraemia and Antibiotic Resistance at the Angre University Hospital, Abidjan, 2020

Yapi IAD1*, Coulibaly-Diallo YM1, Bahan GAJ1, Tué Bi CG2, Koné IT2 and Kacou-N’Douba A1,3

1Bacteriology Unit, Medical Biology Department, Angre University Hospital, Côte d’Ivoire

2Neonatalogy Unit, Paediatric and Specialties Department, Angre University Hospital, Côte d’Ivoire

3Department of Microbiology, Faculty of Medical Sciences, University of Felix Houphouët Boigny, Côte d’Ivoire

*Corresponding author: Yapi IADBacteriology Unit, Medical Biology Department, Angre University Hospital, Côte d’Ivoire, 28 BP 1530 Abidjan 28, Cote d’Ivoire

Received: January 17, 2023; Accepted: March 10, 2023; Published: March 17, 2023


Background: Multi-drug resistant bacteria are an increasingly important cause of neonatal sepsis. Nowadays, they are a great concern in neonates because few therapeutic options are available.

Aim: To determine the bacteria responsible of neonatal sepsis and their antibiotic susceptibility pattern in order to improve the quality of antibiotic prescription.

Methods: A retrospective data review on positive blood cultures from the neonatal department at the university hospital of Angre between January to December 2020 was conducted. All neonates with clinical suspicion of sepsis with positive blood cultures were identified. Patient demographics, clinical details, and laboratory data were recorded and analyzed by Epi info software version

Results: Out of 221 blood cultures samples, 82 were positive (37%). The predominant age group was that between day 0 and day 7. A preponderance of bacteria of the genus Staphylococcus (48.78%) compared to enterobacteria (43.90%) was observed. The main isolated bacteria were coagulase-negative Staphylococcus (29.27%), Klebsiella pneumoniae (26.83%) and Staphylococcus aureus (19.51%). Streptococcus agalactiae was isolated in 2 cases (2.44%). Among the Enterobacteriaceae strains, 80.56% produced an Extended Spectrum Beta-Lactamase (ESBL). The rate of methicillin-resistant was observed in coagulase-negative Staphylococcus and Staphylococcus aureus in 37.50% and 31.25% of cases respectively. Out of ESBL strains, 89.65% were multi-resistant. Of the 14 strains of methicillin-resistant staphylococci, 13 (92.86%) were multidrug resistant.

Conclusion: Coagulase-negative Staphylococcus and Klebsiella pneumoniae were the common causes of neonatal sepsis. The high rate of multi-drug resistant bacteria resistant represents a great threat to neonatal survival and warrants modification of existing empirical therapy.

Keywords: Neonatal bacteraemia; Antibiotic resistance; Hospital; Abidjan

Abbreviations: ATCC: American Type Culture Collection; AMC: Amoxicillin-Clavulanic Acid; AMK: Amikacin; BLSE: Extended Spectrum Beta Lactamases; BMR: Multi-drug Resistant Bacteria; CBC: Blood Count; CIP: Ciprofloxacin; CMN: Clindamycin; CN: Gentamycin; CHU: Hospital and University Center; CO2: Carbon Dioxide; CoNS: Coagulase-Negative Staphylococcus; CRO: Ceftriaxone; CRP: C-Reactive Protein; CTZ: Ceftazidime; ESBLs: Extended Spectrum Beta Lactamases; E. Coli: Escherichia Coli; ERY: Erythromycin; EUCAST: European Committee on Antimicrobial Susceptibility Testing; FOX: Cefoxitin; K. Pneumoniae: Klebsiella Pneumonia; LEV: Levofloxacin; MDR: Multi-Drug Resistant; MRSA: Methicillin-Resistant Staphylococcus Aureus; MR-CoNS: Methicillin-Resistant Coagulase-Negative Staphylococcus; NS: Neonatal Sepsis; PTN: Pristinamycine; SA: Staphylococcus Aureus; SXT: Sulfamethoxazole-Trimetroprime; TIC: Ticarcillin-Clavulanic Acid; TOB: Tobramycin; VAN: Vancomycin; WHO: World Health Organization


Neonatal Sepsis (NS) is a major cause of morbidity and mortality and is the third leading cause of death worldwide [1]. The rapid evolution of these infections is the source of diagnostic concern for clinicians, which contributes to prescribe a significant and sometimes inappropriate prescription of broad-spectrum antibiotics. This exposition to antibiotics contributes to the emergence of resistant bacteria [2], which complicates the therapeutic treatment. In 2016, the first estimate of neonatal deaths attributable to antimicrobial resistance was published [3]. Multidrug-resistant pathogens accounted for approximately 30% of all neonatal sepsis mortality worldwide [3]. In Africa, the situation is more worrisome [4] due to insufficient access to last-resort antibiotics, a higher burden of infectious diseases, weak health systems, and limited resources. However, in a study conducted in Côte d'Ivoire in 2010, most bacteria causing neonatal sepsis were susceptible [5]. Moreover, in recent years, it is clear that few studies concerning antibiotic resistance in neonatology have been conducted. Therapeutic management may therefore be ineffective. The objective of this study was therefore to determine the bacteria responsible of neonatal sepsis and to describe their antibiotic susceptibility patterns.

Materials and Methods

Conception and Study Design

This was a retrospective cross-sectional study that took place at the medical biology department of the CHU of Angre. Data from the neonatal unit from January 1 to December 31, 2020 were examined. On the one hand, clinical data and biological parameters (CBC and CRP) were collected from the patients' medical files. On the other hand, microbiological data that include dates of blood cultures, blood culture positivity, identified organisms, and antibiotic susceptibility were extracted from the laboratory computerized database.

Study Population

Culture-proven NS was defined as one or more blood culture obtained at 0–28 days of life growing a recognized pathogenic bacterium or fungus and a clinical diagnosis of sepsis [6]. After analysis of the medical files, all clinically suspected cases of neonatal sepsis admitted to the neonatal department of the CHU of Angre were listed. Out of them, only neonates with a positive blood culture were included in the study. Neonates were defined as patients whose age ranged from 0 to 28 days of life.

Culture and Identification

Microorganism identification and culture were conducted according to the routine diagnostic standard operation procedure used by the clinical laboratory in the study hospital: For any new-born, 0.5-3 mL of blood sample was inoculated into a commercial culture bottle exclusively for new-borns and analyzed using an automated monitoring system for bacterial detection (BioMérieux Bact/ALERT). Incubation was continued until a positive result was observed or up to a maximum of 7 days. Subcultures are typically made on to blood and chocolate agar. They are incubated aerobically at 37°C with 5 to 10% CO2 for 24 to 48 hours. The microorganisms were identified to species level by conventional biochemical techniques or automated methods with the VITEK system (BioMérieux). The bacterial isolates were tested for susceptibility to antibiotics using VITEK MD 2 Compact® (BioMérieux) or the manual Kirby–Bauer disc diffusion method, as per interpretive standards established by the CA-SFM/ EUCAST 2019. Quality control strains were used: Escherichia coli ATCC 25922, Klebsiella pneumoniae ATCC 700603 and Staphylococcus aureus ATCC 29213. Routinely at the laboratory, positive blood cultures are evaluated to determine whether they represent true bacteraemia or contamination. They are each reviewed by the clinical microbiologist for decisions on the significance of the organism and the appropriate antibiotic susceptibility data to report. The clinical microbiologists have access to patients’ clinical information. Thus, Coagulase-Negative Staphylococci (CoNS), micrococci, propionibacteria, and corynebacteria grown alone in a single sample were considered contaminants and excluded. CoNS were included only when cultivated in two or more blood samples. Bacteria like Staphylococcus Aureus (SA), Enterobacteriaceae, Pseudomonas, and Acinetobacter which grown alone in a single sample without clinical signs were considered contaminants and excluded too. Repeatedly positive samples were considered to represent the same episode of infection.

Statistical Analyses

Data were entered into an Excel spreadsheet (Microsoft excel version 2019). Epi info version was used for data analyses. Mean and standard deviation were used to describe the central tendency of continuous variables based on the distribution of the data. Categorical variables were described using frequency and percentages.

Ethical Approval and Consent to Participate

The study was based entirely on routine clinical and laboratory data. The consent to participate wasn’t so obligatory. Ethics approval was obtained from the Biomedical Research Ethics Committee of the University of Felix Houphouet Boigny and the medical and scientific management of the CHU of Angre. All data were de-identified from the routine database used and shared with the investigators in a password-protected file, to which only the principal investigator and the laboratory manager had access.


General Characteristics

Between the study period, the microbiology laboratory received 221 blood cultures of new-borns and a total of 98 (44.34%) organisms were isolated. Out of the isolates, 16 were considered contamination by commensals and were excluded in further analyses: Staphylococcus aureus n=7, CoNS n=4, Klebsiella pneumoniae n=4, andEscherichia coli n=1. The rate of clinically relevant bacteraemia amongst the neonates was 37.10% (82/221). Of the 82 neonates included, 44 (53.65%) were male with a sex ratio of 1.15. The median age was 3.76 ±7.53 days. According to the time of sepsis, 70/82 (85.36%) cases were in the age range of day 0 to day 7. 24.39% (20/82) were born at term and 13.41% (11/82) were preterm. At birth, 22 (26.83%) were eutrophic, 7 (8.54%) hypotrophic, and 1 (1.22%) had macrosomia. Age and birth weight were not found in 62.20% (51/82) and 63.41% (52/82) of the cases respectively. It should be noted that these clinical data were not recorded by the prescribers in the patients' files.

Isolated Bacteria from Neonatal Sepsis

A total of 82 isolates were identified (Table 1). Sepsis was primarily caused by Gram-positive bacteria (n=45, 54.88%), compared with Gram-negative bacteria (n=37, 45.12%). The most frequent pathogens were CoNS (n=24, 29.27%), K. pneumoniae (n=22, 26.83%), and S. aureus (n=16, 19.51%). Others pathogens included are shown in the (Table 1).