Predictors of positive blood culture and death among neonates with suspected neonatal sepsis in Gondar University Hospital , Northwest Ethiopia

Neonatal sepsis is a common cause of neonatal morbidity and mortality in developing countries. It is a serious bacterial infection of blood with a clinical syndrome characterized by systemic signs of infection and bacteremia in the first month of life. Factors associated with positive blood culture and perinatal deaths among neonates are rarely described in developing countries. This study aimed to identify the predictors of positive blood culture due to neonatal sepsis and to identify predictors of death among neonates suspected to have sepsis at Gondar University Hospital neonatal unit, Gondar, northwest Ethiopia. A prospective cross sectional study was conducted among neonates admitted at Gondar University Hospital neonatal unit between July 2011 and June 2012. Standard data collection form was used to collect all socio-demographic data and clinical characteristics of neonates. Three milliliter of venous blood sample was collected aseptically and inoculated in to Trypton soya blood culture medium for 2-14 days aerobically. Turbidity or growth was checked every 3 days. Bacterial isolates were identified following standard procedures and anti bacterial susceptibility test was done following agar disc diffusion method. The neonates were followed for their outcome until their discharge from the hospital. A total of 181 neonates (99 male and 82 female) admitted to neonatal unit with clinical features of sepsis were studied during the study period. One hundred twenty two (67.4%) of them were of early onset and 59 (32.6%) with late onset neonatal sepsis based on clinical parameters. Out of the clinically suspected cases there were 39 (32%) and 19 (32.2%) culture proven early and late onset neonatal sepsis cases respectively. Predictors of positive blood culture in both early and late onset neonatal sepsis were failure to suck, fast breathing, lethargy, seizure, respiratory distress, meconium stained liquor, premature rupture of the membrane and low birth weight. Forty four percent of gram negatives were resistant to third generation cephalosporins while 41.2% of the isolated Staphylococcus aureus were found to be methicilin resistant (MRSA). Factors that predicted deaths were positive blood culture (p = 0.002), infection with methicilin resistant Staphylococcus aureus (p = 0.008) and gram negative sepsis (p = 0.004). Our finding suggests that failure to suck, meconium stained liquor, premature rupture of membrane, lethargy, seizure and fast breathing are significantly associated with positive blood culture in both early and late onset neonatal sepsis. Mortality rate in our setting was much more significantly associated with positive blood culture and multidrug resistant gram negative bacteria.