SEVERE KLEBSIELLA INFECTION AS A CAUSE OF MORTALITY IN NEONATES IN HARARE, ZIMBABWE - EVIDENCE FROM POSTMORTEM BLOOD CULTURES

Postmortem blood cultures were taken from 105 neonates dying at Harare Hospital during a 1-year period. The infants were characterized by pr ematurity (63% <37 weeks gestation), low birth weight (60% <2500 g) an d low Apgar score at 1 min (43% <3). More than one-half of the infants died within 48 hours of admission. Positive blood cultures within 10 minutes of death occurred in 44% of infants, and Klebsiella sp. were b y far the most common isolates. Positive blood cultures were associate d with very low birth weight (<1500 g), and with babies who survived f or >48 hours. Antibodies to human immunodeficiency virus type 1 were f ound in 40% of the infants, and a high proportion of these had Klebsie lla bacteremia. Nearly all the infants had received antibiotic therapy , usually penicillin and gentamicin. Very few babies who had received a cephalosporin had a positive blood culture, and in vitro tests showe d that although many organisms were resistant to penicillin and the am inoglycosides, very few showed resistance to the cephalosporins. Our f indings suggest that cephalosporins may be useful in treating severe n eonatal sepsis, particularly when there is no response to more standar d therapy.