Clinical Profile, Common Bacterial Isolates and Antimicrobial Susceptibility Test among Neonates with Spina Bifida Admitted at Muhimbili National Hospital

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.