Shobowale EO, Solarin AU, Elikwu CJ, Onyedibe KI, Akinola IJ, Faniran AA. Neonatal sepsis in a Nigerian private tertiary hospital: Bacterial isolates, risk factors, and antibiotic susceptibility patterns. Ann Afr Med 2017;16:52-8

Abstract

Furthermore, standard protocol for sepsis evaluation is inclusive of other samples such as cerebrospinal fluid, urine, stools, aspirates, wound, and mucosal swabs [2],[3]The researchers did not address the possible compounding effect of prior antibiotic use for the subjects or their mothers before presentation to hospitalIt was not clear whether just one or all of the criteria for sepsis had to be present or a combination of a number of them occurring for a clinical diagnosis of neonatal sepsis to be madeThe statement that “parents who refuse to provide informed consent shall be excluded…….” is suggestive of a study proposal statementThere is no statement on whether ethical approval for the study was sought for or obtained from an appropriate bodyA certain formula (“Kish;” with no reference of its source), was used to obtain a sample size of 120; but only the results of 100 neonates were analyzed, and no account was made of the differenceThere is a disparity between the list of antibiotics tested for sensitivity as stated in the methodology and what was displayed as shown in [Figure 1] of this letter (captioned as Figure 2 in Shobowale, et al). Percentages for “Birth weight” categories (>2500 g and <2500 g), socioeconomic status and Gender were also wrong. Since there were 100 cases, the percentages of any number out of these 100 cases should correspond to the numbers with no decimal placesThe categorizations for age (<3 and > 3 days) did not capture age of exactly 3 days at presentation; similarly for “Birth weight,” weight of exactly 2500 g was not includedIn [Table 2], the figures and percentages for “Early” and “Late” onset sepsis do not tally for both “Died” and “Discharged” categoriesIn spite of much higher proportionate mortality among neonates born “Within” the hospital than neonates in the “Out born” category (8 out of 21 or 38.1%, compared to 4 out of 79 or 5.1%), yet the authors stated that delivery outside a tertiary hospital was a risk factor for mortality. {Figure 1}{Table 1}{Table 2}{Table 3} Conclusions There are serious methodological flaws and inconsistencies that need to be clarified to make the findings validThere are overt disparities and inconsistencies in antibiotic testing and sensitivity results; similarly, the data analysis has lots of calculation errors and misinterpretations resulting in incorrect statements on the conclusionsIf the results could be considered based on some of the findings, it seems that with a higher rate of positive blood cultures among neonates >3 days old and higher mortality among inborn neonates, it is possible that nosocomial infection was a significant contributor to this mortality rate in this hospital.