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Early onset neonatal bloodstream infections in South African hospitals

Article scientifique 2025 Anglais

Résumé

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.

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Theron, G., Bekker, A., Bolton, L., Whitelaw, A., Engelbrecht, A., Erasmus, L., Fataar, A., Geldenhuys, C., Kunneke, M., Roux, D., O’Connell, N., Reddy, K., Rhoda, N., Tooke, L., Wates, M., Wessels, T., Dramowski, A. (2025). Early onset neonatal bloodstream infections in South African hospitals. https://doi.org/10.1186/s12879-024-10406-z

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Auteur(s)

Genevieve Theron Adrie Bekker Larisse Bolton Andrew Whitelaw Arnoldus Engelbrecht Louisa Erasmus Aaqilah Fataar Chandre Geldenhuys Marlize Kunneke Damien Roux Natasha O’Connell Kessendri Reddy Natasha Rhoda Lloyd Tooke Mark Wates Thandi Wessels Angela Dramowski

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