Laboratory-confirmed bloodstream infections in two large neonatal units in sub-Saharan Africa

Int J Infect Dis. 2021 Feb:103:201-207. doi: 10.1016/j.ijid.2020.11.169. Epub 2020 Nov 20.

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.

Keywords: Africa; Antimicrobial resistance; Bloodstream infection; Low birth weight; Neonate; Outbreak; Outcome; Sepsis.

Publication types

  • Comparative Study

MeSH terms

  • Botswana / epidemiology
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Cross Infection / mortality
  • Disease Outbreaks*
  • Drug Resistance, Microbial*
  • Female
  • Humans
  • Incidence
  • Infant, Newborn
  • Klebsiella Infections / epidemiology*
  • Klebsiella Infections / microbiology
  • Klebsiella Infections / mortality
  • Klebsiella pneumoniae / drug effects
  • Klebsiella pneumoniae / isolation & purification*
  • Laboratories, Hospital
  • Male
  • Neonatal Sepsis / epidemiology*
  • Neonatal Sepsis / microbiology
  • Neonatal Sepsis / mortality
  • Retrospective Studies
  • South Africa / epidemiology
  • Tertiary Care Centers