Changing pattern of bacterial isolates and antimicrobial susceptibility in neonatal infections in Korle Bu Teaching Hospital, Ghana

Background: Most neonatal deaths in developing countries are caused by infections, birth asphyxia and prematurity. Even though most of these deaths occur at home, newborns admitted to hospital neonatal units have a high risk of contracting fatal multi-drug resistant infections. Objective: To compare the type of bacteria and the pattern of antimicrobial susceptibility of organisms causing neonatal infections in 2001/02 with 1991/92 in the same neonatal unit. Design: We reviewed the hospital records of newborns admitted to the neonatal unit in 2001/02 that had positive blood cultures and compared the findings with similar work done 1991/92. Setting: Neonatal Unit, Korle Bu Teaching Hospital, Ghana. Results: Gram negative organisms (predominantly Enterobacter, Klebsiella and Acinetobacter) remained the predominant cause of neonatal infection. There was a reduction in the proportion of gram negative bacteraemia [70.9% in 1991/92 vs. 54.2% in 2001/02 (p<0.001)] due to the increased prevalence of coagulase negative staphylococcus (31.9% in 2001/02 vs. 0% in 1991/92) as a cause of neonatal bacteraemia ten years later. In 1991/92 as 2001/02 all bacterial isolates showed less than 40% susceptibility to ampicillin. The susceptibility of Klebsiella and Enterobacter to commonly used aminoglycosides and cephalosporins had decreased from over 80% in 1991/92 to less than 35% in 2001/02. Conclusion: Bacterial causes of neonatal infections change over time and antimicrobial resistance is a major cause for concern in neonatal units in resource-poor hospitals. Improving infection control practices and instituting systems to monitor antimicrobial use and resistance will compliment community efforts to reduce neonatal mortality.