Bacterial isolates, antibiogram and outcomes of blood culture proven sepsis in neonates at a tertiary institution in South East Nigeria: a cross-sectional study.

Background: Neonatal sepsis (NNS) in developing countries continues to be a diagnostic and management challenge due to the delays in identifying the aetiologic pathogens and antibiograms. Aim: To determine the predominant bacterial isolates, antibiotic susceptibility pattern and outcomes of blood culture proven sepsis in neonates. Methodology: A hospital-based cross-sectional study of 120 neonates admitted into the Special Care Baby Unit (SCBU) of Nnamdi Azikiwe University Teaching Hospital Nnewi with clinical features suggestive of sepsis. A semi-structured questionnaire and proforma were used to record neonatal, maternal and laboratory information. Blood specimens were collected for aerobic culture using Bactenecin (BACTEC)-Ped plus culture system. Antibiotic susceptibility testing was performed using the Kirby Bauer disc diffusion method. Data obtained were analysed using SPSS version 23.0. p value < 0.05 was considered as significant. Results: There were 68 males and 52 females giving a male-to-female ratio of 1.3:1. The median age at admission was 48 h. Staphylococcus aureus 13 (43.3%) was the most common bacteria isolated. The prevalence of blood culture proven sepsis were 25% and 6.7% of the subjects with positive blood culture died. Gram-positive bacteria isolated were sensitive to gentamicin, vancomycin (VA), linezolid and resistant to penicillin. Gram-negative bacteria isolated were sensitive to meropenem (MEM), imipenem (IPM), ciprofloxacin (CIP) and resistant to ceftazidime, ceftriaxone, ampicillin and amoxicillin-clavulanic acid. Conclusion: The most common bacteria isolated causing NNS using BACTEC automated blood culture system was Staphylococcus aureus. The empirical antibiotics considered for use at the study site are gentamycin, VA for Gram-positive organisms and CIP, IPM and MEM for Gram-negative organisms. Some of the participants with positive blood culture died. Therefore, there is a need for regular antibiogram profiles in all hospitals offering neonatal care.

Perception of donor breast milk and determinants of its acceptability among mothers in a developing community: a cross-sectional multi-center study in south-east Nigeria.

BACKGROUND: Due to the health and economic benefits of breast milk, the World Health Organization (WHO) recommends that for infants who cannot receive breast milk from their own mothers, the next preferred option is donated breast milk. This recommendation is however rarely practiced in most developing countries where donor milk is not widely accepted. METHODS: This cross-sectional multi-center study enrolled mothers attending antenatal or pediatric clinics in six tertiary institution in south-east Nigeria using purposive and convenient sampling method. Data collection was done using pretested questionnaires. The study aimed to assess the knowledge, acceptability and willingness to donate breast milk and/or use donated breast milk for their infants It also explored factors that determine this behavior. RESULTS: A total of 1235 mothers participated; 39% (480/1225) have heard about the concept of donor milk, while only 10% (79/759) and 7% (81/1179), respectively, had adequate knowledge of the concept and policy on donor milk. Sixty percent indicated willingness to use donor milk or donate breast milk if need arises. Respondents with lower age (p = 0.049) and with higher occupational status (p = 0.001) were more likely to have adequate knowledge of donor breast milk, while respondents with lower educational attainment (p = 0.002) and those who are non-Christians (p = 0.004) were more likely to request financial inducement for donating their breast milk. Adequate knowledge of the concept of donor milk (p = 0.001), preference of donor milk to infant formula (p = 0.001) and requirement of financial remuneration (p = 0.001) were the only significant predictors of willingness to donate and/or receive donated breast milk. CONCLUSION: The knowledge of the concept of donor breast milk and awareness of policies regulating its practice in Nigeria is low, but the prospect of its acceptability is high among mothers surveyed in south-east Nigeria. Targeted public education by relevant government agencies in collaboration with clinicians, community and religious leaders about the concept of donor breast milk to families may help increase the acceptance and practice of donating breast milk and/or use of donated breast milk among mothers in the region.

Bacteriology and Antibiogram of Urinary Tract Infection Among Female Patients in a Tertiary Health Facility in South Eastern Nigeria.

BACKGROUND: Urinary Tract Infection (UTI) is a common contagion among men and women with the incidence relatively higher among women due to their differing anatomy. An understanding of the kind of pathogens implicated in urinary tract infections as well as antibiotic susceptibility profiling may help the clinician make rationally correct empirical choice in their treatment. OBJECTIVE: This study is aimed at determining the type and antibiotic susceptibility pattern of bacterial uropathogens isolated from female patients attending Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH), Awka, Nigeria. METHOD: Two hundred and forty patients with clinically diagnosed UTI and who were on at least 5 days' antibiotic holiday were recruited into the study. Their demographic characteristics were captured using pre-tested questionnaire. Their clean catch mid-stream urine samples were collected using sterile universal container and sent to the Microbiology Department for processing. Within 30 minutes of samples collection, the specimens were cultured and the isolates were identified, after 24 h of incubation, using standard microbiological techniques. Antibiotic susceptibility tests were done with standard antibiotic discs using the Kirby-bauer disc diffusion method. RESULTS: Out of the 240 urine samples, 89.17% yielded significant bacteriuria. The pathogens implicated were Escherichia coli (28.5%), Staphylococcus aureus (28.0%), Salmonella spp (22.8%) and Pseudomonas aeruginosa (20.5%). HIV status, patients age, pregnancy status and marital status all significantly affected bacteriuria rate (p value < 0.05), while patients' location (sub-urban/rural dwelling), and level of education did not (p value > 0.05). The pattern of microbial resistance to antibiotics suggests that ceftazidime, fosfomycin and cefoxitin may not be used as first-line agents in the empirical treatment of UTIs rather; levofloxacin, meropenem or aztreonam should be considered. Levofloxacin was significantly effective against all the isolates and may be administered empirically while waiting for the culture result (Mean % susceptibility was 79.85). CONCLUSION: E. coli and S. aureus were the predominant pathogens in the study and many were resistant to the commonly prescribed antibiotics and so leave the clinicians with only few alternative drugs for UTIs treatment. Routine surveillance and monitoring studies need to be constantly conducted to update clinicians on the prevalent pathogens and the rational and empirical treatment of UTIs. Aggressive and consistent health education using every possible media is also recommended to combat the menace of drug resistance occasioned by inappropriate antibiotic use.