Causative Organisms Of Septicaemia in Infants and Neonates and thier Antibiotic Sensitivity in Three Hospitals In Khartoum State

Abstract

Review of medical literature indicated that neonatal Septicemia remains a major problem in the field of neonatal medicine . It has been demonstrated by many investigations that people who have natural or aquired immunodeficiency are predisposed to infection . It is also indicated that protein deficiency causes profound changes in many organs including the immune system. Malnourished people show an increased incidence of infectious diseases, impaired specific antibody, and defects in cell –mediated immunity . The study was carried in the periodbetween June 2001 up to March 2003 . It is a trial toidentify the microorganisms causing septicemia in neonates and infants below one year of age . The influence of the levels of immunoglobulin M and immunoglobulin G on the incidence of septicemia was investigated . The study included the isolation and identification of 98 bacterial strains from patients in three hospitals .38 isolates ( 38.8 % ) recovered from cases from patients in Ahmed Gasim Teaching Hospital , 33 isolates (33.7 % ) from the cases from patients in Omdurman pediatric Hospital,and (27) isolates (27.5% ) from patients in Maternity Teaching Hospital. These isolates were identifiedaccording to their cultural characteristics , microscopical examinations and gram stain in addition to the biological tests . API 20 identification system was used for gram negative isolates , Gram positive isolates recovered represent 79 % of the isolates whereas gram negative isolates represent 21 % of the isolates . The Predominant isolates recovered from these cases were found to be Staphylococcus aureus 74 isolate ( 76 % ) , followed by Pseudomonas aeruginosa 12 isolates ( 12 %) xii Escherichia coli 9 isolates (9 %) and Staphylococcus epidermidis 3 isolates ( 3 % ) . It was found that earlyonset sepsis 53 % ( septicemia for neonates below 6 days of age ) was more prominent than late onset sepsis (47 %) (septicemia for neonatesover 6 days of age . Gram positive bacteria were found to be slightly higher in late onset sepsis ( 85 %) than early onset sepsis (72 % ) . Staphylococcus aureus was prominent in both early and late onset sepsis ( 70 %) & ( 81 % ) respectively , whereas two isolates of Staphylococcus epidermidis were found in late onset sepsis (4 % ) and only one isolate in early onset sepsis (2 % ) . Gram negative bacteria ,were higher in early sepsis ( 28% ) than late sepsis (15 % ) . Pseudomonas aeruginosa was found in ( 14% ) of cases in early onset sepsis and ( 11 %) in late onset sepsis . E.coli was found in ( 14% ) of cases in early onset sepsis and ( 4 % ) of late onset sepsis . Using Kirby- Bauer method , isolates were examined for their susceptibility to ten commonly used antimicrobial agents including : Amoxycillin , Cephalexin , Cephradine ,Ceftriaxone Ciprofloxacin , Ceftizoxime , Gentamicin, Kanamycin, and Amoxycillin/ Clavulanic acid and Penicillin G . Escherichia coli isolates showed moderate resistance , to most of the antibiotics used , the percentage of resistance is less than 23 % . On the other hand 31 % of Staphyllococcus aureus isolates were resistant to five of the ten antimicrobial agenst used . Pseudomonas aeruginosa showed a percentage of resistance less than 25 % to six of the ten antimicrobial agents . xiii The Staphylococcus epidermidis isolates were the most resistant isolates , where 33.3% of them were completely resistent to seven of the antimicrobial agents used .However all the isolates were higley susceptible to the remaining three antimicrobial agents . The study also includedthe measurement of the levels of the two major immunoglobulins in the human blood stream namely immunoglobulin G and immunoglobulin M for the cases with positive blood culture . using spectrophotometry ( turbidimetry ) It has been found that most of the I g M levels are within the levels of controls and the standards .using the latteras reference . Concerning the levels of the I g G , it has been found that if the standard levels were taken as a measure , 19 cases will be found to be substandard , and immunodeficiency will be suspected . However ,when control levels weretaken as a measure and the standard levels were neglected , only four cases would be suspected to be immunodefficient