Etiology and antimicrobial resistance patterns of sepsis in infants 0-59 days old in Jimma, Ethiopia: a longitudinal study.

Introduction: In Ethiopia, empiric treatment for sepsis or possible serious bacterial infection (PSBI) in infants 0-59 days old is based on World Health Organization (WHO) guidelines. We aimed to assess the etiology, antimicrobial susceptibility and outcomes of empiric treatment in PSBI in Jimma, Ethiopia and created local antibiograms to assess empiric treatment guidelines in this setting.

Methods: We prospectively enrolled 363 infants 0-59 days of age admitted to Jimma University Hospital with PSBI over 12-months. Following institutional practice, blood and cerebrospinal fluid (CSF) cultures were collected; positive cultures were identified and evaluated for antibiotic susceptibility. We compared microbiologic results to the WHO guideline based empiric treatment selections at the hospital and evaluated the clinical outcomes at discharge and 30-days of age.

Results: Of 279 patients who had blood cultures obtained, 212(76.0%) were positive, yielding 216 isolates. Four CSF cultures were positive and were included in analysis of blood cultures due to the smaller number of isolates. The most common isolates were Klebsiella (31.8%), coagulase-negative Staphylococci (24.6%), and Staphylococcus aureus (11.6%). Of Klebsiella species, 87% were resistant to at least one commonly utilized antibiotic and 82% were resistant to first-line empiric antimicrobials. In-hospital mortality was 12.3% and it was highest (41%) in participants with Klebsiella. At 30-days of age, mortality for infants with positive culture was 6.6%.

Conclusions: Isolates from PSBI showed high rates of antibiotic resistance to first- and second-line antimicrobials. In this setting, the WHO empiric treatment guidelines inadequately treat infants admitted with PSBI, particularly those with Klebsiella. To provide the most effective care for PSBI in 0-59 days old infants, institutionally used guidelines should be customized to reflect local epidemiology and resistance patterns.