Bacteraemia in Malawian neonates and young infants 2002–2007: a retrospective audit

Abstract

ObjectivesTo assess the causes of bacteraemia in young infants and susceptibility to first-line antibiotics (benzylpenicillin plus gentamicin) at the Queen Elizabeth Central Hospital (QECH), Malawi during 2002–2007.DesignRetrospective analysis of demographic and microbiological data using laboratory records.SettingQECH is Malawi's largest hospital with 7000 neonates admitted annually, 9% for septicaemia.PatientsAll infants aged 60 days or less admitted to QECH that had a blood culture taken over the 6-year period.Main outcome measures6754 blood cultures were taken. 3323 organisms were isolated: one-third were pathogens, two-thirds contaminants. Gram-positive organisms (53%) were more common than gram-negatives (47%). Four organisms made up half of all pathogens: Staphylococcus aureus (15.3%), group B streptococci (13.5%), non-typhoidal salmonellae (12.6%) and Escherichia coli (10.5%). Apart from non-typhoidal salmonellae and Streptococcus pneumoniae, most organisms were more common in the first week of life than later. Overall, 28% of isolates during 2002–2007 were resistant to first-line antibiotic, higher than observed during 1996–2001 (22%). Penicillin susceptibility fluctuated while gram-negative resistance to gentamicin increased from 17% to 27% over the study period.ConclusionsIn the QECH, pathogens causing young infant sepsis are an unusual mix of organisms seen in both developed and developing countries. Resistance to first-line antibiotics is higher than observed in most studies. Ongoing monitoring is needed and clinical outcome data would aid interpretation of findings. A high proportion of blood cultures were contaminated with skin flora—improved training and supervision of phlebotomists are needed to improve the utility of taking blood cultures.

Neonatal Sepsis; Common Bacterial Isolates and Their Antimicrobial Susceptibility Patterns in Neonatal Intensive Care Unit, Islamabad

“…3 The neonatal mortality rate ofPakistan is 49/1000 live births. 4 In neonatal sepsis the commonest bacterial isolates are gram positive bacterial agents in developed countries 2 and according to a study conducted at a tertiary care hospital of Australia, staphylococcal sepsis is the most common bacterial isolate among gram positive bacteria. 5 Similarly, group B Streptococcus is considered as one of the most common pathogens in the early onset sepsis 6 but is relatively uncommon in countries like Pakistan.…”

To Assess the Culture Proven Neonatal Sepsis at a Tertiary Care Centre: An Institutional Based Study

“…This is contrary to reports from other developing countries where CNS are usually amongst the least common organisms. 17 The reason for this might be because isolated CNS is excluded from analysis as it is often considered to be a contaminant. 17 Although CNS is often considered a contaminant, it is a pathogen in neonates, compromised hosts and patients with foreign bodies.…”

“…17 The reason for this might be because isolated CNS is excluded from analysis as it is often considered to be a contaminant. 17 Although CNS is often considered a contaminant, it is a pathogen in neonates, compromised hosts and patients with foreign bodies. 8 Further evaluations such as a repeat blood culture are required to determine the clinical significance of CNS.…”

The Treatment of Possible Severe Infection in Infants

“…A similar review of neonatal blood cultures done over that same period of time showed that 53% of the pathogens were Gram-positive and 47% Gram-negative. The four most common pathogens were S. aureus , GBS, Salmonella Typhimurium, and E. coli 22. Klebsiella sp , Acinebacter sp and Enterobacter sp , all considered nosocomial infections, accounted for 7.3%, 3.1% and 4.6% of the Gram negative pathogens The results of our study differ because we included all cases of possible severe bacterial infection, as this reflects clinical practice; only 147 (45%) blood or CSF samples grew bacteria of which 62 (42%) were coagulase negative staphylococci that may, or may not, have been contaminants.…”

“…Cephalosporins are bactericidal antibiotics and although CNS penetration is modest, higher doses safely achieve therapeutic CSF drug levels. In Malawi benzylpenicillin is appropriate for GBS infections and for most S. pneumoniae infections 21,2223,24…”