MAGNITUDE, BACTERIAL PROFILE, ANTIBIOTICS SUSCEPTIBILITY PATTERNS AND FACTORS ASSOCIATED WITH OMPHALITIS AT GOVERNMENT HEALTH INSTITUTIONS IN ARBA MINCH, SOUTHERN

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.