Abstract:
Background: Open spina bifida is associated with bacterial infection including: meningitis, and severe sepsis.
Despite empirical initiation of first or second line antibiotics to most neonates on admission sepsis
is still a major problem.
Objective: To describe the clinical profile, common bacterial isolates and antimicrobial susceptibility patterns
among neonates with infected spina bifida lesions admitted at Muhimbili National Hospital.
Methodology: A hospital based descriptive cross sectional study was conducted among 52 consecutively
recruited neonates with spina bifida admitted at neonatal unit from November 2019 to April 2020.
A structured questionnaire was used to collect information on demographic characteristics.
Physical examination was done to describe the clinical profile of the spinal bifida and swabs were
collected for bacterial culture and antibiotic susceptibility testing from all enrolled neonates with
open lesions.
Results: Majority of the participants (90.4%) had myelomeningocele and most defects (42.3%) were
located on the lumbar spine, (57.7%) consisting of intact cystic lesions, with an average diameter
of 3-5 cm amongst 63.5% of the participants; and 31(59.6%) of the lesions had necrotic tissues.
Majority of the neonates 44(84.6%) were started on empirical antibiotics on admission, 80.8%
being either ampicillin-cloxacillin/gentamycin or ceftriaxone. Most of the swabs 40(85.1%),
cultured had bacteria growth, about two thirds of the bacteria isolated 23(70%) were gram negative
with a predominance of Klebsiella spp 10 (25%) which showed good sensitivity of ≥80% to
amikacin and meropenem but had high resistance to ceftriaxone (90%), amoxclavulinic acid
(80%), tazocin (70%), and ciprofloxacin (60%); common gram positive bacteria isolated was
Staphylococcus aureus 6 (15%) with high sensitivity to meropenem (83%) and high level of
resistance other antibiotic tested including vancomycin (50%). The likelihood of isolating bacteria
from spina bifida lesions was significantly higher in neonates who had associated bladder-bowel
incontinence (p=0.025).
Conclusion: Majority of the participants had open, medium to large lesions located in the lumbar area, 40% of
which had ruptured resulting in a very high bacterial colonisation rate of >85%. There was very
low threshold (9.1%) for prenatal diagnosis of spina bifida by obstetric ultrasound. Most spina
bifida defects were colonised by gram negative bacteria commonly Klebsiella spp sensitive to
meropenem and amikacin, but resistant to the first and second-line antibiotics recommended in our
national guidelines. Neonates who had coexisting bladder-bowel incontinence were more likely to
have the lesions colonised by bacteria.
