Journal of Tropical Pediatrics Vol. 48 April 2002  Oxford University Press 2002 123 Bacterial Colonization of Neonates’ Skin in a Nigerian Hospital Colonization of neonates’ skin is desirable because of their vulnerability to infections. The skin of a healthy fetus is sterile in utero but during delivery it may become contaminated by the mother 1 or by the delivery team. 2,3 Studies carried out in Europe and North America, 4,5 have described the colonization of neonates’ skin with various micro-organisms, but such a study has not been done in Nigeria. Hence, the present study was carried out to compare the pattern of bacterial colonization of preterm neonates with that of full-term neonates’ surface skin, and the in vitro sensitivity profile of some of the bacterial isolates. Ten preterm (neonates delivered at less than 37 weeks of gestation) and nine full-term neonates were recruited on a volunteer basis at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTH) in Ile-Ife, south-western Nigeria, between October 1998 and January 1999. The hospital is a major referral center for over a million people. Inclu- sion in the study was based on thorough clinical evaluation of each subject and some of the criteria used included, absence of skin infection or any detectable illness. Collection of isolates was done as described by Carr and Kloss. 6 Samples were taken at 3, 7, 15, 21, and 28 days from each neonate at six body sites: the anterior nares, axilla, groin, pinna, umbilicus, and fore-arm. Quantitative bacterial counts were done (Eastick et al.) 7 employing phosphate buffered 0.1 Triton solution, which was applied to 1–3 cm 2 of each site under study for approximately 5 s. Each swab was then used to inoculate the entire surface of nutrient agar, mannitol salt agar, and eosin methyl- ene blue agar plates. Bacterial colonies that grew on these plates were Gram-stained and characterized, 7 and coagulase negative staphylococci (CONS) were identified. The antibiotic sensitivity test was deter- mined. 8 Altogether 696 bacterial isolates were cultured from both groups (53.45 per cent). Isolates recovered from full-term neonates were 46 per cent as against 55 per cent from preterm neonates. Staphylococci predominated (96.01 per cent) with CONS accounting for 57.98 per cent. Staphylococcus epidermidis alone was 29.31 per cent of the CONS. Staphylococcus aureus (44.63 per cent), Micrococcus sp. (1.96 per cent), Corynebacterium sp. (1.5 per cent), and Bacillus subtilis (0.66 per cent) were the common isolates. Gram-negative rods accounted for 31.61 per cent, made up of Escherichia coli (31.36 per cent), Klebsiella pneumoniae (26.36 per cent), Proteus mirabilis (23.63 per cent), and others. The distribution of bacterial isolates were not that differ- ent qualitatively and quantitatively amongst preterm and full-term neonates. The antibiotic susceptibility test of the isolates revealed virtually all isolates randomly selected for the study (n = 84) except three were multiresistant. While Hall 9 demonstrated that 83 per cent of blood culture isolates of CONS in neonates were resistant to five out of 10 antibiotics, D’Angio, et al. 10 reported 65 per cent of surface skin isolates of CONS were resistant to eight of 12 antibiotics by day 4 and 82 per cent were resistant at 1 week and beyond. Our study highlights the prevalence of multiresis- tant organisms on the skin of neonates early in life in this environment, which is of epidemiological signifi- cance in treating infections caused by these micro- organisms. A. K. AKO-NAI, a N. B. OGUNBOR, a D. O. KOLAWOLE, a S. E. A. TORIMIRO, b and A. O. ONIPEDE a Departments of a Microbiology and b Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria References 1. Ako-nai KA, Torimiro SEA, Lamikanra A, Ogunniyi AD. A survey of nasal carriage of Staphylococcus aureus in a neonatal unit in Ile-Ife, Nigeria. Ann Trop Paediatr 1991; 11–39. 2. Love GJ, Gezon HM, Thompson DJ, Rogers KD, Hatch FF. Relation of intensity of staphylococcal infection in newborn infants to contamination of nurses’ hands and surrounding environment. Paediatrics 1963; 32: 956–65. 3. Mortimer EA Jr, Wolisky E, Rammelkamp CH. The trans- mission of staphylococcus by the hands of personnel. In: Maibach HI, Hildick-Smith G (eds), Skin Bacteria and their Role in Infection. McGraw-Hill Inc, New York; 187–99. 4. Keyworth N, Millar MR, Pollard KI. Development of cutaneous microflora in premature neonates. Arch Dis Child 1992; 67: 797–801. 5. Price PB. The bacteriology of a normal skin, a new quantitative test applied to a study of the bacteria flora and the disinfections action of mechanical cleansing. J Infect Dis 1938; 63: 301–18. 6. Carr DL, Kloss WE. Temporal study of the staphylococci and micrococci of normal infant skin. Appl Environ Microbiol 1997; 35: 673–80. 7. Eastick K, Leeming JP, Bennell D, Millar MR. Reservoirs of coagulase-negative staphylococci in preterm infants. Arch Dis Child 1996; 74: 79–104. 8. Ericsson HM, Sherries JC. The agar dilution method. Acta Pathol Microbiol Immunol Scand 1971; 217 (Suppl.): 11–12. 9. Hall SL. Coagulase-negative staphylococcal infections in neonates. Paediat Infect Dis J 10: 57–66. 10. D’Angio CT, McGowan KI, Baumgart S, St. Geme J, Harris MC. Surface colonization with coagulase-negative staphylococci in premature neonates. J Paediatr 198; 114: 1029–34. Research Letters