Etiology of early-onset neonatal sepsis and antibiotic resistance in Bukavu, Democratic Republic of the Congo
Abstract Background The Democratic Republic of the Congo (DRC) ranks among the countries with the highest neonatal death rates (between 14 and 28‰). In the DRC, neonatal sepsis causes 15.6% of this mortality, but data on the bacterial etiology and associated drug susceptibility are lacking. Methods Hemocultures of 150 neonates with possible early onset neonatal sepsis (pEOS) were obtained at the Hôpital Provincial Général de Référence de Bukavu (HPGRB, Bukavu, DRC). The newborns with pEOS received an empirical first-line antimicrobial treatment (ampicillin, cefotaxime and gentamicin), based on the synopsis of international guidelines for the management of EOS which are in line with WHO recommendations. Isolates were identified by matrix-assisted laser desorption ionization - time of flight mass spectrophotometry (MALDI-TOF MS). Antibiotic resistance was assessed using the disk diffusion method. Results A total of 50 strains was obtained from 48 patients and identified. The three most prevalent species were Enterobacter cloacae complex (42%), Klebsiella pneumoniae (18%) and Serratia marcescens (12%). Enterobacter cloacae isolates were resistant to all first-line antibiotics. All K. pneumoniae and S. marcescens isolates were resistant to ampicillin, and the majority of the K. pneumoniae and half of the S. marcescens isolates were resistant to both cefotaxime and gentamicin. All E. cloacae complex strains, 89% of the K. pneumoniae and half of S. marcescens had an extended-spectrum ß-lactamase (ESBL) phenotype. Conclusions The most prevalent pathogens causing EOS in Bukavu were E. cloacae complex, K. pneumoniae and S. marcescens. Most of these isolates were resistant to the WHO recommended antibiotics.