Alemayehu Mekonnen Gezmu1, Andre N H Bulabula2, Angela Dramowski3, Adrie Bekker4, Marina Aucamp5, Sajini Souda6, Britt Nakstad7. 1. Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana. Electronic address: gezmuam@ub.ac.bw. 2. Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: andybulabula@gmail.com. 3. Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: dramowski@sun.ac.za. 4. Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: adrie@sun.ac.za. 5. Academic Unit for Infection Prevention and Control, Tygerberg Hospital, Cape Town, South Africa. Electronic address: marina.aucamp@westerncape.gov.za. 6. Department of Pathology, Faculty of Medicine, University of Botswana, Gaborone, Botswana. Electronic address: soudas@ub.ac.bw. 7. Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: britt.nakstad@medisin.uio.no.
Abstract
BACKGROUND: Epidemiological data on neonatal bloodstream infections (BSI) in sub-Saharan Africa are extremely limited. METHODS: A comparative analysis of laboratory-confirmed neonatal BSI episodes was conducted retrospectively in two large neonatal units in Botswana and South Africa (January 1 to December 31, 2017). Routine laboratory and ward register data were used to determine BSI rates, the pathogen spectrum, and BSI outcomes. RESULTS: In 2017, the Princess Marina Hospital (PMH) and Tygerberg Hospital (TBH) neonatal units admitted 1187 and 2826 neonates, respectively. The BSI incidence rate was 12.1/1000 patient-days (95% confidence interval (CI) 10.2-14.3) at PMH and 3.5/1000 patient-days (95% CI 2.9-4.1) at TBH (p < 0.0001). Most BSI episodes were hospital-acquired (260/284; 91.6%). The blood culture contamination rate was substantially higher at PMH than TBH (152/1116 (13.6%) vs 122/2559 (4.8%); p < 0.001). The crude mortality rate in neonates with BSI was 21.2% (53/250) and significantly higher at TBH than PMH (38/128 (29.7%) vs 15/122 (12.3%), p = 0.001). Factors independently associated with death were birth weight <1500 g (adjusted odds ratio (aOR) 2.8, 95% CI 1.3-6.4; p = 0.02) and male sex (aOR 2.1, 95% CI 1.1-3.7; p = 0.01). Klebsiella pneumoniae was the dominant BSI pathogen in both units, accounting for two-thirds of BSI, and was associated with a large infection outbreak at PMH. Antibiotic resistance rates were substantial in both neonatal units, particularly for K. pneumoniae (98/122 (80.3%), extended-spectrum beta-lactamase (ESBL)-producers) and Staphylococcus aureus (22/33 (66.7%), methicillin-resistant). CONCLUSIONS: BSI rates and associated mortality were substantial in these two neonatal units in sub-Saharan Africa. ESBL-producing K. pneumoniae remains a leading BSI and outbreak pathogen.
BACKGROUND: Epidemiological data on neonatal bloodstream infections (BSI) in sub-Saharan Africa are extremely limited. METHODS: A comparative analysis of laboratory-confirmed neonatal BSI episodes was conducted retrospectively in two large neonatal units in Botswana and South Africa (January 1 to December 31, 2017). Routine laboratory and ward register data were used to determine BSI rates, the pathogen spectrum, and BSI outcomes. RESULTS: In 2017, the Princess Marina Hospital (PMH) and Tygerberg Hospital (TBH) neonatal units admitted 1187 and 2826 neonates, respectively. The BSI incidence rate was 12.1/1000 patient-days (95% confidence interval (CI) 10.2-14.3) at PMH and 3.5/1000 patient-days (95% CI 2.9-4.1) at TBH (p < 0.0001). Most BSI episodes were hospital-acquired (260/284; 91.6%). The blood culture contamination rate was substantially higher at PMH than TBH (152/1116 (13.6%) vs 122/2559 (4.8%); p < 0.001). The crude mortality rate in neonates with BSI was 21.2% (53/250) and significantly higher at TBH than PMH (38/128 (29.7%) vs 15/122 (12.3%), p = 0.001). Factors independently associated with death were birth weight <1500 g (adjusted odds ratio (aOR) 2.8, 95% CI 1.3-6.4; p = 0.02) and male sex (aOR 2.1, 95% CI 1.1-3.7; p = 0.01). Klebsiella pneumoniae was the dominant BSI pathogen in both units, accounting for two-thirds of BSI, and was associated with a large infection outbreak at PMH. Antibiotic resistance rates were substantial in both neonatal units, particularly for K. pneumoniae (98/122 (80.3%), extended-spectrum beta-lactamase (ESBL)-producers) and Staphylococcus aureus (22/33 (66.7%), methicillin-resistant). CONCLUSIONS: BSI rates and associated mortality were substantial in these two neonatal units in sub-Saharan Africa. ESBL-producing K. pneumoniae remains a leading BSI and outbreak pathogen.
Authors: Moses Vurayai; Jonathan Strysko; Kgomotso Kgomanyane; One Bayani; Margaret Mokomane; Tichaona Machiya; Tonya Arscott-Mills; David M Goldfarb; Andrew P Steenhoff; Carolyn McGann; Britt Nakstad; Alemayehu Gezmu; Melissa Richard-Greenblatt; Susan Coffin Journal: Antimicrob Resist Infect Control Date: 2022-01-24 Impact factor: 4.887
Authors: Silke Gastine; Christina Obiero; Zoe Kane; Phoebe Williams; John Readman; Sheila Murunga; Johnstone Thitiri; Sally Ellis; Erika Correia; Borna Nyaoke; Karin Kipper; John van den Anker; Mike Sharland; James A Berkley; Joseph F Standing Journal: J Antimicrob Chemother Date: 2022-02-02 Impact factor: 5.790