Neonatal sepsis is common and often fatal in Malawi. The aim of this retrospective study was to report causes, antibiotic resistance and outcome of sepsis in Malawian neonates. We reviewed all blood and cerebrospinal fluid isolates collected between January, 1996, and December, 2001, from inpatients aged 0-30 days with suspected sepsis at the Queen Elizabeth Central Hospital, Blantyre. In vitro resistance to antibiotics commonly used in Malawi was assessed. Case-fatality rate was analysed with respect to age, bacterial pathogen and infection site. A total of 801 bacteria were isolated from 784 neonates over six years – 599 isolates from blood and 202 from cerebrospinal fluid. Overall, 54% of bacteria were Gram positive and 46% were Gram negative. The commonest causes of neonatal sepsis were Group B Streptococcus (17%) and non-typhoidal Salmonella (14%). In vitro antibiotic susceptibility to the first-line antibiotic combination of penicillin and gentamicin was 78% for all isolates, but in vitro sensitivity to gentamicin for Klebsiella spp. and non-typhoidal Salmonella was 33% and 53% respectively. In-hospital case-fatality rate was known for only 301 cases and was high at 48%. Group B Streptococcus was associated with the best outcome. Mortality was significantly higher if presentation was in the first week of life or if sepsis was due to Gram-negative bacteria. Malawi Medical Journal Vol. 17(3) 2005: 92-96

Aim: The aim of this retrospective study was to report causes, antibiotic resistance and outcome of neonatal sepsis (often fatal in developing countries) in Malawi.Methods: All blood and cerebrospinal fluid isolates collected between January 1996 and December 2001 from inpatients aged 0-30 days with suspected sepsis at Queen Elizabeth Central Hospital, Blantyre, Malawi were reviewed. In vitro resistance to antibiotics commonly used in Malawi was assessed. Case fatality rate was analysed with respect to age, bacterial pathogen and infection site.Results: A total of 801 bacteria were isolated from 784 neonates over 6 years-599 isolates from blood and 202 from cerebrospinal fluid. Overall, 54% of bacteria were gram-positive and 46% gram-negative. The commonest causes of neonatal sepsis were group B Streptococcus (17%) and non-typhoidal Salmonella (14%). In vitro antibiotic susceptibility to the first-line antibiotic combination of penicillin and gentamicin was 78% for all isolates, but in vitro sensitivities to gentamicin for Klebsiella spp and non-typhoidal Salmonella were only 33% and 53%, respectively. Inhospital case fatality rate was known for only 301 cases and was high at 48%. Group B Streptococcus was associated with the best outcome. Mortality was significantly higher if presentation was in the 1st week of life or if sepsis was caused by gram-negative bacteria. The causes of neonatal sepsis in this population show a different pattern from other studies in developing countries.

In two hospitals in Malawi, where HIV prevalence among tuberculosis patients is 80-90%, the treatment outcome in patients registered with smear-negative pulmonary tuberculosis was determined in relation to chest x-ray (CXR) findings and certain laboratory parameters. Of 70 patients who were registered and treated, 32 (46%) were known to have died. Mortality was particularly high in those with a normal / minimally abnormal CXR (62%) and in those with a white cell count of less than 3.5 × 109 /l (77%). The reasons for this high mortality among patients with smear-negative PTB are not known and requires more research.