Etiology of Bacteremia in Young Infants in Six Countries

Abstract

Background:Neonatal illness is a leading cause of death worldwide; sepsis is one of the main contributors. The etiologies of community-acquired neonatal bacteremia in developing countries have not been well characterized.Methods:Infants <2 months of age brought with illness to selected health facilities in Bangladesh, Bolivia, Ghana, India, Pakistan and South Africa were evaluated, and blood cultures taken if they were considered ill enough to be admitted to hospital. Organisms were isolated using standard culture techniques.Results:Eight thousand eight hundred and eighty-nine infants were recruited, including 3177 0–6 days of age and 5712 7–59 days of age; 10.7% (947/8889) had a blood culture performed. Of those requiring hospital management, 782 (54%) had blood cultures performed. Probable or definite pathogens were identified in 10.6% including 10.4% of newborns 0–6 days of age (44/424) and 10.9% of infants 7–59 days of age (39/358). Staphylococcus aureus was the most commonly isolated species (36/83, 43.4%) followed by various species of Gram-negative bacilli (39/83, 46.9%; Acinetobacter spp., Escherichia coli and Klebsiella spp. were the most common organisms). Resistance to second and third generation cephalosporins was present in more than half of isolates and 44% of the Gram-negative isolates were gentamicin-resistant. Mortality rates were similar in hospitalized infants with positive (5/71, 7.0%) and negative blood cultures (42/557, 7.5%).Conclusions:This large study of young infants aged 0–59 days demonstrated a broad array of Gram-positive and Gram-negative pathogens responsible for community-acquired bacteremia and substantial levels of antimicrobial resistance. The role of S. aureus as a pathogen is unclear and merits further investigation.

Bacteriological and clinical profile of community acquired pneumonia in hospitalised children with associated co-morbidity in a tertiary care centre of Western Rajasthan, India

“…In contrast, it is the most frequently recovered pathogen in parapneumonic effusions/empyema complicating pneumonia and also commonly isolated in blood cultures from infants with bacteraemia. [20][21][22] Therefore it is reasonable to conclude that S. aureus may be an important pathogen in childhood pneumonia as well.…”

Neonatal group B streptococcus disease in developing countries: are we ready to deploy a vaccine?

“…Similarly, a multicenter study based in six developing countries that enrolled nearly 9000 infants did not identify a single case of GBS among neonates [12]. This study excluded critically ill newborns and hence may have failed to account for the early mortality that can occur in neonatal GBS disease [12]. In these cases, early-onset GBS disease may have been consistently missed, leading to underestimation of the true burden of disease in resource-limited settings.…”

“…However, out of the 259 neonatal deaths recorded, 62% were not investigated for bacteremia, including over half of these deaths, which occurred within the first 48 h after birth [11]. Similarly, a multicenter study based in six developing countries that enrolled nearly 9000 infants did not identify a single case of GBS among neonates [12]. This study excluded critically ill newborns and hence may have failed to account for the early mortality that can occur in neonatal GBS disease [12].…”

“…In several studies evaluating neonatal sepsis in developing countries, Gram-negative bacteria have accounted for a large proportion of positive results [5,8,11,12]. A prospective surveillance study in India identified Gram-negative bacteria in 68% of neonatal sepsis episodes, with no cases of GBS documented [6].…”

Challenges in the Management of Sepsis in a Resource-Poor Setting

“…In developed countries, population sepsis incidence ranged from 22 to 240/100,000, of severe sepsis from 13 to 300/100,000 and of septic shock 11/100,000 [14]- [19], with a case fatality rate up to 30% for sepsis, 50% for severe sepsis and 80% for septic shock, depending on the setting and severity of the disease [14]- [19]. In developing countries, national population incidences are unknown, but various hospital based studies among neonates from different countries show a prevalence ranging from 6 -9/1000 live births in Ethiopia to 20.3 -29.3/1000 live births in India [7] [20] [21]. It is also important to note that 20% -30% of survivors of neonatal sepsis come down with neurological sequelae [22].…”