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.

Biochemical changes in tuberculosis.

INTRODUCTION: tuberculosis (TB) remains a global health issue with high morbidity and mortality rates especially in the developing countries. It is a multi-organ disease and can influence biochemical changes. This study sought to determine the influence of tuberculosis and its drug treatment on serum biochemical parameters in patients in Nigeria. METHODS: it was a descriptive observational cohort study on 150 subjects whose blood samples were analyzed for serum albumin, serum sodium, and serum potassium. The subjects were grouped into 3: TB group= 50 new TB subjects not on treatment, F group= 50 TB subjects on treatment for 2/12 or more and C group= 50 non-TB control subjects. These biochemical variables were compared between the 3 groups. RESULTS: male/female ratio was 1: 1.5, mean age 37.1±0.92 years, and range 18-65 years. The differences in mean values of serum albumin, calcium and sodium between the three groups were significant (p<0.001), whereas that of serum potassium was not significant (p=0.056). Those patients with new case TB had a significantly lower serum sodium, serum albumin and serum calcium than the control group and those on treatment, p<0.001. There was significant positive correlation between serum albumin and serum calcium (r=0.0.420, p<0.001) as well as serum sodium (r=0.310, p<0.001) in the study population. Similarly, the correlation between serum calcium and serum sodium was positive and significant (r=0.200, p=0.014). In contrast, the correlation between serum potassium and serum albumin and that between serum potassium and serum calcium was not significant. CONCLUSION: tuberculosis with or without anti-tuberculous medications was associated with significant reduction in serum albumin, serum sodium and serum calcium in this study.

Wide spread of carbapenemase-producing bacterial isolates in a Nigerian environment.

OBJECTIVES: The presence of carbapenemase-producing bacterial isolates is found not only in hospital and community settings but also in the environment. Carbapenemase production may be related to acquired, usually plasmid-borne, ß-lactamase genes or to chromosomal genes intrinsic to various species. The aim of this study was to evaluate the occurrence of such carbapenemase-producing bacterial isolates among environmental samples from Nigeria. METHODS: A total of 122 environmental samples were plated on carbapenem-containing media. A total of 259 isolates were recovered, among which 124 were carbapenemase-producers according to the results of the Rapidec® Carba NP test. RESULTS: The majority of isolates (n=112) recovered corresponded to natural producers of carbapenemases, i.e. Stenotrophomonas maltophilia (n=108), Burkholderia cepacia (n=1), Shewanella sp. (n=1), Sphingobacterium sp. (n=1) and Chryseobacterium gleum (n=1). Ten isolates (mainly Enterobacteriaceae and Acinetobacter baumannii) produced an acquired carbapenemase, most commonly of the NDM type. In addition, two Pseudomonas otitidis isolates were identified as producing the Ambler class B carbapenemase POM-1, further confirming that this carbapenemase is naturally produced in this environmental species. Finally, several isolates co-producing 16S rRNA methylases (ArmA, RmtC) and/or extended-spectrum ß-lactamases (CTX-M-9, CTX-M-15) were also identified. CONCLUSION: This study revealed the presence and diversity of clinically-relevant antimicrobial-resistant bacteria in the environment in Nigeria.