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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.

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BACKGROUND: Infections with Staphylococcus aureus cause significant morbidity and mortality worldwide. Resistant strains of S. aureus to commonly used antibiotics are being increasingly encountered in clinical practice, necessitating the need to determine the resistance pattern in Nigeria. METHODS: Antibiotic susceptibility testing was performed on 360 S. aureus isolates from clinical specimen from seven hospitals across the six geo-political regions of Nigeria using Kirby Bauer disc diffusion technique, and E-test for vancomycin. Cefoxitin 30 µg disc was used to determine methicillin resistance, and D-test for inducible clindamycin resistance. RESULTS: Methicillin-resistant S. aureus was confirmed in 176 (48.9%) of the isolates, 346 (96%) for penicillin G and 311 (86.4%) for trimethoprim. 175 (99.4%) of the 176 resistant to methicillin were susceptible to vancomycin. Linezolid, tigecycline, chloramphenicol and clindamycin had susceptibilities of 341 (94.7%), 332 (92.2%), 298 (82.8%) and 290 (80.6%) respectively. Inducible clindamycin resistance was elucidated in 25 (29.1%) of the 86 isolates. Generally, MRSA isolates were more resistant than methicillin-sensitive S. aureus (MSSA) to all antibiotics tested. CONCLUSION: Staphylococcus aureus rates of resistance are high and call for urgent action such as antibiotic stewardship programmes and periodic surveillance to enhance clinical outcomes. While targeted therapy is preferred, options for empiric treatment include chloramphenicol, clindamycin, linezolid or vancomycin.

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BACKGROUND: Infections are common complications in critically ill patients with associated significant morbidity and mortality. AIM: This study determined the prevalence, risk factors, clinical outcome and microbiological profile of hospital-acquired infections in the intensive care unit of a Nigerian tertiary hospital. MATERIALS AND METHODS: This was a prospective cohort study, patients were recruited and followed up between September 2011 and July 2012 until they were either discharged from the ICU or died. Antimicrobial susceptibility testing of isolates was done using CLSI guidelines. RESULTS: Seventy-one patients were recruited with a 45% healthcare associated infection rate representing an incidence rate of 79/1000 patient-days in the intensive care unit. Bloodstream infections (BSI) 49.0% (22/71) and urinary tract infections (UTI) 35.6% (16/71) were the most common infections with incidence rates of 162.9/1000 patient-days and 161.6/1000 patient-days respectively. Staphylococcus aureus was the most common cause of BSIs, responsible for 18.2% of cases, while Candida spp. was the commonest cause of urinary tract infections, contributing 25.0% of cases. Eighty percent (8/10) of the Staphylococcus isolates were methicillin-resistant. Gram-negative multidrug bacteria accounted for 57.1% of organisms isolated though they were not ESBL-producing. Use of antibiotics (OR = 2.98; p = 0.03) and surgery (OR = 3.15, p< 0.05) in the month preceding ICU admission as well as urethral catheterization (OR = 5.38; p<0.05) and endotracheal intubation (OR = 5.78; p< 0.05) were risk factors for infection. CONCLUSION: Our findings demonstrate that healthcare associated infections is a significant risk factor for ICU-mortality and morbidity even after adjusting for APACHE II score.

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OBJECTIVE: To determine the seroreactivity of pregnant women to syphilis in order to justify the need for routine antenatal syphilis screening. METHODS: A multicenter retrospective analysis of routine antenatal venereal disease research laboratory (VDRL) test results between 1 September 2010 and 31 August 2012 at three specialist care hospitals in south-east Nigeria was done. A reactive VDRL result is subjected for confirmation using Treponema pallidum hemagglutination assay test. Analysis was by Epi Info 2008 version 3.5.1 and Stata/IC version 10. RESULTS: Adequate records were available regarding 2,156 patients and were thus reviewed. The mean age of the women was 27.4 years (±3.34), and mean gestational age was 26.4 weeks (±6.36). Only 15 cases (0.70%) were seropositive to VDRL. Confirmatory T. pallidum hemagglutination assay was positive in 4 of the 15 cases, giving an overall prevalence of 0.19% and a false-positive rate of 73.3%. There was no significant difference in the prevalence of syphilis in relation to maternal age and parity (P>0.05). CONCLUSION: While the prevalence of syphilis is extremely low in the antenatal care population at the three specialist care hospitals in south-east Nigeria, false-positive rate is high and prevalence did not significantly vary with maternal age or parity. Because syphilis is still a serious but preventable and curable disease, screening with VDRL alone, without confirmatory tests may not be justified. Because of the increase in the demand for evidence-based medicine and litigation encountered in medical practice, we may advocate that confirmatory test for syphilis is introduced in routine antenatal testing to reduce the problem of false positives. The government should increase the health budget that will include free routine antenatal testing including the T. pallidum hemagglutination assay.