{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:28:26Z","timestamp":1791822506303,"version":"4.3.4"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T00:00:00Z","timestamp":1605225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Sepsis is one of the major causes of neonatal death worldwide as well as in Bangladesh. The objective of the present study was to identify the risk factors and causative organisms of neonatal sepsis after delivery in a tertiary care hospital, Bangladesh.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a case-control study conducted in the neonatal ward of Rajshahi Medical College Hospital (RMCH), a 1000-bed tertiary hospital situated in Rajshahi, Bangladesh. Neonates diagnosed as neonatal sepsis by clinical and laboratory parameters were included as cases in this study. Admitted neonates unsuspected or undiagnosed for sepsis were considered as controls. Maternal and neonatal information and their laboratory reports were collected and analyzed. Both bivariate and multiple logistic regression models were used to identify the risk factors of neonatal sepsis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 91 cases and 193 controls were included in the study. Maternal history of urinary tract infection (UTI) during the third trimester of pregnancy (aOR 2.75, 95% CI: 1.04\u20137.23, p &lt;0.05), premature birth (aOR 2.77, 95% CI: 1.08\u20137.13, p &lt;0.05) and APGAR score &lt;7 at five minutes (aOR 2.58, 95% CI: 1.04\u20136.39, p &lt;0.05) were associated with onset of neonatal sepsis in multiple logistic regression model. All these factors were also associated with developing early-onset neonatal sepsis, while maternal UTI and male sex of neonates were associated with developing late-onset neonatal sepsis. <jats:italic>Escherichia coli<\/jats:italic> (40.7%), <jats:italic>Staphylococcus aureus<\/jats:italic> (27.5%), and <jats:italic>Klebsiella pneumoniae<\/jats:italic> (18.7%) were the commonly isolated organisms causing neonatal sepsis. All these organisms were highly resistant to common antibiotics like amoxicillin, cephalosporins, aminoglycosides and quinolones. Carbapenemase group of drugs along with amikacin, nitrofurantoin and linezolid were the most sensitive drugs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Strengthening the existing facility for antenatal screening for early diagnosis and treatment of maternal infection during pregnancy as well as identifying high-risk pregnancy for adequate perinatal management is necessary to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics according to local epidemiology and culture and sensitivity reports may minimize the increasing hazards of antibiotic resistance.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0242275","type":"journal-article","created":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T18:26:30Z","timestamp":1605291990000},"page":"e0242275","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":34,"title":["Risk factors and etiology of neonatal sepsis after hospital delivery: A case-control study in a tertiary care hospital of Rajshahi, Bangladesh"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5415-6399","authenticated-orcid":true,"given":"Md. Abdur","family":"Rafi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Morsed Zaman","family":"Miah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Abdul","family":"Wadood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3822-5489","authenticated-orcid":true,"given":"Md. Golam","family":"Hossain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,13]]},"reference":[{"issue":"9859","key":"pone.0242275.ref001","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1016\/S0140-6736(12)61728-0","article-title":"Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010.","volume":"380","author":"R Lozano","year":"2012","journal-title":"Lancet"},{"issue":"8","key":"pone.0242275.ref002","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/S1473-3099(14)70804-7","article-title":"Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, South Asia, and Latin America for 2012: A systematic review and meta-analysis","volume":"14","author":"AC Seale","year":"2014","journal-title":"Lancet Infect Dis"},{"issue":"9966","key":"pone.0242275.ref003","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/S0140-6736(14)61698-6","article-title":"Global, regional, and national causes of child mortality in 2000\u201313, with projections to inform post-2015 priorities: An updated systematic analysis.","volume":"385","author":"L Liu","year":"2015","journal-title":"Lancet"},{"issue":"1","key":"pone.0242275.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0170267","article-title":"Managing neonatal and early childhood syndromic sepsis in sub-district hospitals in resource poor settings: Improvement in quality of care through introduction of a package of interventions in rural Bangladesh.","volume":"12","author":"AE Rahman","year":"2017","journal-title":"PLoS One."},{"key":"pone.0242275.ref005","article-title":"International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. In: Pediatric Critical Care Medicine.","author":"B Goldstein","year":"2005","journal-title":"Pediatr Crit Care Med"},{"issue":"3","key":"pone.0242275.ref006","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2011.037","article-title":"Inflammation Neonatal sepsis","volume":"21","author":"I Mihatov Stefanovic","year":"2011","journal-title":"Biochem Medica"},{"issue":"SUPPL. 2","key":"pone.0242275.ref007","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/S0195-6701(07)60026-7","article-title":"Defining common infections in children and neonates.","volume":"65","author":"KN Haque","year":"2007","journal-title":"J Hosp Infect."},{"issue":"11","key":"pone.0242275.ref008","article-title":"Neurological complications after neonatal bacteremia: The clinical characteristics, risk factors, and outcomes.","volume":"9","author":"SM Chu","year":"2014","journal-title":"PLoS One."},{"key":"pone.0242275.ref009","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2019.e02519","article-title":"Unfinished agenda of the neonates in developing countries: magnitude of neonatal sepsis: systematic review and meta-analysis.","volume":"5","author":"D Amare","year":"2019","journal-title":"Heliyon."},{"issue":"1","key":"pone.0242275.ref010","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-018-1176-x","article-title":"Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal","volume":"18","author":"B Pokhrel","year":"2018","journal-title":"BMC Pediatr"},{"issue":"1","key":"pone.0242275.ref011","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s12887-017-0892-y","article-title":"Bacterial etiologic agents causing neonatal sepsis and associated risk factors in Gondar, Northwest Ethiopia.","volume":"17","author":"T Geyesus","year":"2017","journal-title":"BMC Pediatr"},{"issue":"2","key":"pone.0242275.ref012","doi-asserted-by":"crossref","first-page":"75","DOI":"10.4103\/0974-777X.154444","article-title":"Bacteriological profile of neonatal septicemia in a tertiary care hospital from Western India.","volume":"7","author":"VA Muley","year":"2015","journal-title":"J Glob Infect Dis."},{"issue":"3","key":"pone.0242275.ref013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pmed.1000213","article-title":"New approaches to preventing, diagnosing, and treating neonatal sepsis.","volume":"7","author":"K Edmond","year":"2010","journal-title":"PLoS Med."},{"key":"pone.0242275.ref014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1742-4755-11-82","article-title":"UNICEF Report: Enormous progress in child survival but greater focus on newborns urgently needed.","volume":"11","author":"T Wardlaw","year":"2014","journal-title":"Reproductive Health"},{"key":"pone.0242275.ref015","article-title":"Determinants and Outcome of Community-Acquired Late-Onset Neonatal Sepsis in Rural Bangladesh.","author":"KN Saqeeb","year":"2019","journal-title":"Glob Pediatr Heal."},{"key":"pone.0242275.ref016","article-title":"Incidence and risk factors of neonatal infections in a rural Bangladeshi population: A community-based prospective study.","author":"DK Mitra","year":"2018","journal-title":"J Heal Popul Nutr."},{"issue":"4","key":"pone.0242275.ref017","first-page":"839","article-title":"Study of Risk Factors, Causative Organisms & Their Sensitivity Pattern in Neonatal Sepsis in a Community Based Tertiary Level Hospital.","volume":"28","author":"AR Quddus","year":"2019","journal-title":"Mymensingh Med J"},{"key":"pone.0242275.ref018","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3855\/jidc.3136","article-title":"Neonatal sepsis following prolonged rupture of membranes in a tertiary care hospital in Karachi, Pakistan","volume":"8","author":"MM Alam","year":"2014","journal-title":"Journal of Infection in Developing Countries"},{"issue":"5","key":"pone.0242275.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0154798","article-title":"Risk factors for neonatal sepsis in public hospitals of Mekelle City, North Ethiopia, 2015: Unmatched case control study.","volume":"11","author":"D Gebremedhin","year":"2016","journal-title":"PLoS One."},{"issue":"11","key":"pone.0242275.ref020","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1007\/s12098-010-0246-3","article-title":"Causes of child deaths in India, 1985\u20132008: a systematic review of literature.","volume":"77","author":"C Lahariya","year":"2010","journal-title":"Indian J Pediatr"},{"issue":"2","key":"pone.0242275.ref021","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S0022-3476(96)70254-8","article-title":"Volume of blood required to detect common neonatal pathogens","volume":"129","author":"RL Schelonka","year":"1996","journal-title":"J Pediatr"},{"key":"pone.0242275.ref022","article-title":"pathol MT-AJ clin, 1966 undefined.","author":"A Bayer","journal-title":"Antibiotic susceptibility testing by a standardized single disc method"},{"key":"pone.0242275.ref023","first-page":"100","article-title":"Performance Standards for Antimicrobial Susceptibility Testing Performance Standards for Antimicrobial Susceptibility Testing Suggested Citation.","author":"JB Patel","year":"2016"},{"issue":"3","key":"pone.0242275.ref024","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"AP Magiorakos","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"pone.0242275.ref025","first-page":"2018","article-title":"Risk Factors for Neonatal Sepsis: A Retrospective Case-Control Study Among Neonates Who Were Delivered by Caesarean Section at the Trauma and Specialist Hospital, Winneba, Ghana.","author":"A P","year":"2018","journal-title":"Biomed Res Int"},{"issue":"2","key":"pone.0242275.ref026","first-page":"131","article-title":"Predictors of Early Onset Neonatal Sepsis among Neonates in Dodoma, Tanzania: A Case Control Study.","volume":"62","author":"Pendo P Masanja","year":"2016","journal-title":"J Trop Pediatr"},{"issue":"2","key":"pone.0242275.ref027","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3329\/jbcps.v30i2.11406","article-title":"Bacteriological Profile of Neonatal Sepsis in a Tertiary Hospital in Bangladesh.","volume":"30","author":"S Begum","year":"2012","journal-title":"J Bangladesh Coll Physicians Surg."},{"issue":"8","key":"pone.0242275.ref028","article-title":"Risk of Early-Onset Neonatal Infection with Maternal Infection or Colonization: A Global Systematic Review and Meta-Analysis.","volume":"10","author":"GJ Chan","year":"2013","journal-title":"PLoS Med."},{"issue":"2","key":"pone.0242275.ref029","first-page":"131","article-title":"Predictors of Early Onset Neonatal Sepsis among Neonates in Dodoma, Tanzania: A Case Control Study.","volume":"62","author":"OA Adejumo by","year":"2016","journal-title":"J Trop Pediatr"},{"issue":"8","key":"pone.0242275.ref030","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1097\/INF.0b013e31825c4b5a","article-title":"Risk factors for neonatal sepsis and perinatal death among infants enrolled in the prevention of perinatal sepsis trial, Soweto, South Africa.","volume":"31","author":"SJ Schrag","year":"2012","journal-title":"Pediatr Infect Dis J"},{"key":"pone.0242275.ref031","unstructured":"Kpikpitse, Semuatu S, Mohamed. NEONATAL SEPSIS IN RURAL GHANA: A CASE CONTROL STUDY OF RISK FACTORS IN A BIRTH COHORT 1 MATE SIAKWA [Internet]. Vol. 4, International Journal of Research In Medical and Health Sciences. 2014 [cited 2020 Apr 11]. Available from: http:\/\/www.ijsk.org\/ijrmhs.html"},{"key":"pone.0242275.ref032","doi-asserted-by":"crossref","first-page":"S10","DOI":"10.1097\/INF.0b013e3181958769","article-title":"Pathogens Associated With Sepsis in Newborns and Young Infants in Developing Countries","volume":"28","author":"AKM Zaidi","year":"2009","journal-title":"Pediatr Infect Dis J"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0242275","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T18:27:10Z","timestamp":1605292030000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0242275"}},"subtitle":[],"editor":[{"given":"Yung-Fu","family":"Chang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,11,13]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0242275","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,13]]}}}