Early onset neonatal bloodstream infections in South African hospitals
Abstract Background Neonatal sepsis is a leading cause of death in low- and middle- income countries (LMIC). Increasing antibiotic resistance in early onset (< 72 h of life) bloodstream infection (EO-BSI) pathogens in LMIC has reduced the effectiveness of the recommended empiric antibiotic regime...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12879-024-10406-z |
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| author | Genevieve Theron Adrie Bekker Larisse Bolton Andrew Whitelaw Arnoldus Engelbrecht Louisa Erasmus Aaqilah Fataar Chandre Geldenhuys Marlize Kunneke Dave Le Roux Natasha O’Connell Kessendri Reddy Natasha Rhoda Lloyd Tooke Mark Wates Thandi Wessels Angela Dramowski |
| author_facet | Genevieve Theron Adrie Bekker Larisse Bolton Andrew Whitelaw Arnoldus Engelbrecht Louisa Erasmus Aaqilah Fataar Chandre Geldenhuys Marlize Kunneke Dave Le Roux Natasha O’Connell Kessendri Reddy Natasha Rhoda Lloyd Tooke Mark Wates Thandi Wessels Angela Dramowski |
| author_sort | Genevieve Theron |
| collection | DOAJ |
| description | Abstract Background Neonatal sepsis is a leading cause of death in low- and middle- income countries (LMIC). Increasing antibiotic resistance in early onset (< 72 h of life) bloodstream infection (EO-BSI) pathogens in LMIC has reduced the effectiveness of the recommended empiric antibiotic regimen (ampicillin plus gentamicin). Methods We retrospectively analysed blood culture-confirmed EO-BSI episodes at nine neonatal units from three central and six peripheral hospitals in the Western Cape Province, South Africa between 1 January 2017 and 31 December 2018. Clinical and electronic laboratory records were reviewed to determine pathogen profile, empiric antibiotic coverage rates and factors associated with EO-BSI attributable mortality, stratified by hospital type. Results Of the 8252 blood culture specimens submitted for the investigation of suspected EO-BSI, 136 EO-BSI episodes yielding 141 pathogens were identified with an EO-BSI rate of 1.3 and 0.5 episodes/1000 live births at central and peripheral hospitals respectively. Preterm (93/136; 68.3%) and low birth weight (84/136; 61.8%) neonates were most affected. The predominant pathogens were Streptococcus agalactiae (46/136; 34%), Klebsiella pneumoniae (17/136; 13%), Listeria monocytogenes (11/136; 8%), Acinetobacter baumannii (11/136; 8%) and Escherichia coli (11/136; 8%). The empiric antibiotic (ampicillin plus gentamicin) coverage rate was 64% (95% CI 51–74) at central hospitals and 84% (95% CI 74–94) at peripheral hospitals. Neonates with Gram-negative EO-BSI and discordant empiric antibiotic therapy had almost four-fold and three-fold higher odds of death respectively. Conclusion Preterm and low birth weight neonates are most vulnerable to EO-BSI and have higher odds of death with Gram-negative pathogens and discordant empiric antibiotic therapy. |
| format | Article |
| id | doaj-art-9eb7f332ff0b4c1d80174a64847f5a63 |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj-art-9eb7f332ff0b4c1d80174a64847f5a632025-01-26T12:17:20ZengBMCBMC Infectious Diseases1471-23342025-01-0125111010.1186/s12879-024-10406-zEarly onset neonatal bloodstream infections in South African hospitalsGenevieve Theron0Adrie Bekker1Larisse Bolton2Andrew Whitelaw3Arnoldus Engelbrecht4Louisa Erasmus5Aaqilah Fataar6Chandre Geldenhuys7Marlize Kunneke8Dave Le Roux9Natasha O’Connell10Kessendri Reddy11Natasha Rhoda12Lloyd Tooke13Mark Wates14Thandi Wessels15Angela Dramowski16Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDepartment of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversitySouth African Centre for Epidemiological Modelling and Analysis (SACEMA), School for Data Science and Computational Thinking, Stellenbosch UniversityDivision of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDepartment of Paediatrics, Worcester Provincial HospitalDepartment of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDepartment of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDepartment of Paediatrics, Paarl HospitalDepartment of Paediatrics, Worcester Provincial HospitalDepartment of Paediatrics, New Somerset HospitalDepartment of Paediatrics, Khayelitsha District HospitalDivision of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDepartment of Neonatology, Cape Town, School of Child and Adolescent Health, Faculty of Health Sciences, Mowbray Maternity Hospital, University of Cape TownDepartment of Neonatology, Groote Schuur HospitalDepartment of Paediatrics, Karl Bremer HospitalDepartment of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDepartment of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch UniversityAbstract Background Neonatal sepsis is a leading cause of death in low- and middle- income countries (LMIC). Increasing antibiotic resistance in early onset (< 72 h of life) bloodstream infection (EO-BSI) pathogens in LMIC has reduced the effectiveness of the recommended empiric antibiotic regimen (ampicillin plus gentamicin). Methods We retrospectively analysed blood culture-confirmed EO-BSI episodes at nine neonatal units from three central and six peripheral hospitals in the Western Cape Province, South Africa between 1 January 2017 and 31 December 2018. Clinical and electronic laboratory records were reviewed to determine pathogen profile, empiric antibiotic coverage rates and factors associated with EO-BSI attributable mortality, stratified by hospital type. Results Of the 8252 blood culture specimens submitted for the investigation of suspected EO-BSI, 136 EO-BSI episodes yielding 141 pathogens were identified with an EO-BSI rate of 1.3 and 0.5 episodes/1000 live births at central and peripheral hospitals respectively. Preterm (93/136; 68.3%) and low birth weight (84/136; 61.8%) neonates were most affected. The predominant pathogens were Streptococcus agalactiae (46/136; 34%), Klebsiella pneumoniae (17/136; 13%), Listeria monocytogenes (11/136; 8%), Acinetobacter baumannii (11/136; 8%) and Escherichia coli (11/136; 8%). The empiric antibiotic (ampicillin plus gentamicin) coverage rate was 64% (95% CI 51–74) at central hospitals and 84% (95% CI 74–94) at peripheral hospitals. Neonates with Gram-negative EO-BSI and discordant empiric antibiotic therapy had almost four-fold and three-fold higher odds of death respectively. Conclusion Preterm and low birth weight neonates are most vulnerable to EO-BSI and have higher odds of death with Gram-negative pathogens and discordant empiric antibiotic therapy.https://doi.org/10.1186/s12879-024-10406-zNeonateEarly onset bloodstream infectionAntimicrobial resistanceEmpiric antibioticSepsis |
| spellingShingle | Genevieve Theron Adrie Bekker Larisse Bolton Andrew Whitelaw Arnoldus Engelbrecht Louisa Erasmus Aaqilah Fataar Chandre Geldenhuys Marlize Kunneke Dave Le Roux Natasha O’Connell Kessendri Reddy Natasha Rhoda Lloyd Tooke Mark Wates Thandi Wessels Angela Dramowski Early onset neonatal bloodstream infections in South African hospitals BMC Infectious Diseases Neonate Early onset bloodstream infection Antimicrobial resistance Empiric antibiotic Sepsis |
| title | Early onset neonatal bloodstream infections in South African hospitals |
| title_full | Early onset neonatal bloodstream infections in South African hospitals |
| title_fullStr | Early onset neonatal bloodstream infections in South African hospitals |
| title_full_unstemmed | Early onset neonatal bloodstream infections in South African hospitals |
| title_short | Early onset neonatal bloodstream infections in South African hospitals |
| title_sort | early onset neonatal bloodstream infections in south african hospitals |
| topic | Neonate Early onset bloodstream infection Antimicrobial resistance Empiric antibiotic Sepsis |
| url | https://doi.org/10.1186/s12879-024-10406-z |
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