Bacterial Infections in Neonates, Madagascar, 2012–2014

Abstract

Severe bacterial infections are a leading cause of death among neonates in low-income countries, which harbor several factors leading to emergence and spread of multidrug-resistant bacteria. Low-income countries should prioritize interventions to decrease neonatal infections; however, data are scarce, specifically from the community. To assess incidence, etiologies, and antimicrobial drug–resistance patterns of neonatal infections, during 2012–2014, we conducted a community-based prospective investigation of 981 newborns in rural and urban areas of Madagascar. The incidence of culture-confirmed severe neonatal infections was high: 17.7 cases/1,000 live births. Most (75%) occurred during the first week of life. The most common (81%) bacteria isolated were gram-negative. The incidence rate for multidrug-resistant neonatal infection was 7.7 cases/1,000 live births. In Madagascar, interventions to improve prevention, early diagnosis, and management of bacterial infections in neonates should be prioritized.

Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines

“…All studies were hospital-based except for one community (home-based surveillance) study from Madagascar. 63 Hospital-based studies were mostly tertiary referral facilities (university or large national hospitals), and only 23 from district or secondary referral hospitals. 34,48,51,54,[59][60][61][62][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78] 139 studies were in urban settings whereas others reported data from predominantly rural populations: five studies from Kenya, 54,61,64,65,68 three from Mozambique, 59,72,73 two from Nigeria, 79,80 and one from Cameroon.…”

“…77 88 studies involved prospective data collection, 61 were retrospective reviews (26 laboratory-based surveillance of aetiological data), and two studies had both retrospective and prospective components. There was one randomised trial, 28 one before-and-after study, 81 three case-control studies, 42,78,82 six observational cohort studies, 38,48,63,[83][84][85] and the remaining 139 studies were cross-sectional designs.…”

“…Case ascertainment by physician diagnosis was reported in 44 (54%) of 81 observational studies, 26 of which documented the individual clinical signs used for the diagnosis of neonatal sepsis or meningitis. Only seven studies 36,63,74,[86][87][88][89] reported using the WHO/IMCI clinical algorithm, two studies 90,91 used the French National Agency for Accreditation and Health clinical diagnostic criteria, 92 and one Ugandan study 93 reported using criteria adopted from International Paediatric Sepsis Consensus 94 and Indian Academy of Paediatrics. 95 30 (37%) of these observational studies reported microbiological or laboratory criteria for diagnosis of neonatal infection syndromes (sepsis or meningitis), and 56 studies (69%) described micro biological sample type and sampling strategy (clinical indication vs routine sampling) as well as number of neonates sampled.…”

“…Between eight and 44% of cultures were positive among studies using automated techniques, and 14-87% among studies using manual methods. Of 19 studies that reported disaggregated cerebrospinal fluid culture data, only 11 31,48,63,68,73,89,90,[102][103][104][105] reported on both the number of lumbar punctures carried out and the number of these that were positive. Across these studies, 1738 lumbar punctures were reported, of which 135 (8%) were positive, with positivity ranging from 0 to 100% (appendix p 30).…”

Meat and Fish as Sources of Extended-Spectrum β-Lactamase–Producing Escherichia coli, Cambodia

“…We also selected ESBL-producing E. coli from 88 recently pregnant healthy women living in Steung Meanchey and participating in the Bacterial Infections and antibiotic Resistant Diseases among Young children in low-income countries (BIRDY) program, a surveillance program of bacterial infections among young children in low- and middle-income countries ( 6 ). During September 2015–December 2016, ESBL-producing E. coli isolates were cultured from rectal swabs or fecal samples collected at or just after delivery (Appendix Table 3).…”