Abstract:
Introduction: Omphalitis is a true medical emergency that can rapidly progress to neonatal sepsis
and death if not promptly diagnosed and appropriately treated. Empirical therapy is widely practised
in low-income countries like Ethiopia, paving the way for drug resistance and posing a significant
challenge. Objective: To determine the magnitude, bacterial profile, antibiotic susceptibility
patterns and associated factors of omphalitis among clinically suspected neonates attending four
government health institutions in the Arba Minch, southern Ethiopia, 2023.
Methods: A facility-based multi-centre cross-sectional study was conducted among clinically
suspected 379 neonates attending inpatient, outpatient departments and NICU of government
institutes of Arba Minch from 1
st June to 28th December 2023. Study participants were consecutively
recruited and their demographic and clinical data were collected by using a pretested semi structured questionnaire. Samples were aseptically collected and inoculated into a series of bacterial
culture media following standard operating procedure. The antibiotic susceptibility tests were
performed using the Kirby–Bauer disc diffusion technique. Bivariable and multivariable logistic
regression models (SPSS version 25) were used to analyse the association between dependent and
independent variables; a P-value ≤0.05 was considered statistically significant.
Results: The overall magnitude of culture positive omphalitis was 34.3% (n=130) (95% CI: 29.5-
39.3); Gram-positives (GPC) and Gram-negative bacteria (GNB) were detected in 50.4% (n=71)
and 49.6% (n=70), respectively. The most prevailing pathogens were S. aureus (n=38, 53.5%) and
E. coli (n=33, 47.1%). GNB were highly resistant (>60%) to tetracycline, sulfamethoxazole trimethoprim and ampicillin. Multidrug resistance was observed in 36.2% (n=51); methicillin resistant S. aureus and methicillin-resistant-coagulase-negative Staphylococcus were 34.1% (n=14)
and 37.5% (n=6), respectively. Overall, 15.7% (n=11) and 10% (n=7) of GNB were extended spectrum beta-lactamases and carbapenemase producers. Lack of hand washing practice of mothers
[AOR=2.08, (95% CI: 1.26-3.41), P-value=0.004] and gestation period (<37 weeks) [AOR=2.3,
(95% CI: 1.33-3.93), P-value = 0.003] were statistically associated. Conclusions: Overall, the
magnitude of culture positive omphalitis is higher, and WHO-prioritized drug-resistant bacterial
pathogens were also detected. There are particular concerns about maternal factors such as hand
hygiene and antenatal care. Thus, a more holistic omphalitis management approach diagnostic and
antimicrobial stewardship program is critical in the study setting.
