Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014–19: a cross-sectional study

Mashau, Rudzani; Meiring, Susan; Dramowski, Angela; Magobo, Rindidzani E.; Quan, Vanessa; Perovic, Olga; Gottberg, Anne von; Cohen, Cheryl; Velaphi, Sithembiso; Schalkwyk, Erika van; Govender, Nelesh P.

doi:10.1016/s2214-109x(22)00246-7

Cited by 35 publications

(24 citation statements)

References 25 publications

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“…(n = 12) and E. coli (n = 3) accounting for only a minority of BSI-associated deaths. These findings are consistent with previous reports from sub-Saharan African countries 10,23,27–29 and other LMICs. 26 Reasons proposed for the predominance of Klebsiella species in neonatal BSI in sub-Saharan Africa include the continual emergence and dominance of multidrug-resistant ESBL-producing strains, 14 high levels of carriage among care givers, 15 and horizontal transfer of ESBL-carrying plasmid in hospitals and the community.…”

Section: Discussionsupporting

confidence: 93%

Etiology of Bacterial Sepsis and Isolate Resistance Patterns in Hospitalized Neonates in Zambia

Egbe

Cowden

Mwananyanda

et al. 2023

Pediatric Infectious Disease Journal

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Background: The Sepsis Prevention in Neonates in Zambia study is a prospective cohort study that evaluated an infection prevention and control (IPC) bundle in the University Teaching Hospital neonatal intensive care unit (NICU) in Lusaka, Zambia. We present here the etiologies, antimicrobial resistance profiles, and associated mortality of bloodstream infections (BSI) in this cohort. Methods: Venous blood was collected from neonates with clinically suspected sepsis and cultured with an automated blood culture system. Organism identification and susceptibility testing were done using the Vitek II system. We used the CDC National Health Safety Network criteria to define pathogens and commensals. Results: There were 1120 blood cultures performed for 1060 neonates with suspected sepsis. Overall, 38% (424/1120) of cultures were positive of which 72% (306/424) grew pathogens. Blood cultures obtained after, as compared to before, 2 days of hospitalization were more likely to yield a pathogen (77% vs. 65%; P < 0.001). Klebsiella pneumoniae was the most prevalent organism, accounting for 74% (225/306) of all pathogens. K. pneumoniae isolates were highly resistant: 98% (221/225) were extended-spectrum beta-lactamase (ESBL)-positive, while 81% were resistant to gentamicin (182/225) and fluoroquinolones (177/219). Only one isolate was carbapenem resistant. Observed mortality rate was 32% (122/380); 61% (75/122) of the deaths was related to Klebsiella BSI. Conclusions: Multidrug-resistant ESBL-producing Klebsiella species were the main organisms responsible for BSI and were associated with increased mortality. BSI risk increased with prolonged hospitalization, underscoring the importance of IPC measures in the NICU.

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Section: Discussionsupporting

confidence: 93%

Etiology of Bacterial Sepsis and Isolate Resistance Patterns in Hospitalized Neonates in Zambia

Egbe

Cowden

Mwananyanda

et al. 2023

Pediatric Infectious Disease Journal

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“…It has been observed that gram positive agents are isolated at a higher rate. In a long-term cross-sectional study conducted by Mashau et al (12), it was stated that the frequency of gram-negative agents increased and antibiotic sensitivity decreased. In addition, Ureaplasma species are also reported as the causative agent of neonatal meningitis (13).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Risk and Prognostic Factors in Neonatal Meningitis

Parlakay¹,

Çakır²,

Dorum³

et al. 2023

jcp

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Introduction:Neonatal meningitis is one of the important causes of mortality and morbidity in newborns. In this study, it was aimed to examine the microbiological factors, biochemical and clinical characteristics of neonatal meningitis cases, to reveal the risk factors, and to investigate the effect on the morbidities associated with meningitis in the first year of life. Materials and Methods:The files of patients diagnosed with meningitis in the level 3 Neonatal Intensive Care Unit between January 2010 and December 2015 were retrospectively analyzed. Results: There were 118 patients diagnosed with meningitis. The median gestational age of the patients was 32 weeks (24-40 weeks), and the median birth weight was 1987 grams (690-5020 grams). Most of the meningitis patients (n=106, 90%) were with late sepsis. The diagnosis day of those with poor prognosis was found to be greater [9.7 (2-28) days to 15.5 (3-138) days, p=0.03]. Cerebrospinal fluid (CSF) leukocytes were significantly higher in term babies with abnormal cranial magnetic resonance imaging (MRI) findings (p=0.037) and loss in hearing tests (p=0.045). CSF sugar levels were significantly lower in preterm babies with neuromotor retardation (p=0.001), history of seizures (p=0.003), abnormal cranial MRI findings (p=0.008) and hearing loss (p=0.005). Conclusion:In the long term, a significant number of cases with neonatal meningitis have neuromotor retarda-tion and hearing problems. Factors that can be used as predictors for poor neurological development; late-onset day, increased CSF leukocyte in all babies, and decreased CSF sugar in preterm babies. ÖzGiriş: Menenjit, yenidoğanlarda önemli bir mortalite ve morbidite nedenidir. Bu çalışmada, yenidoğan menen-jitlerinin mikrobiyolojik, biyokimyasal ve klinik özelliklerinin incelenmesi ve yaşamın ilk yılındaki morbid-itelere etkili risk faktörlerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Ocak 2010-Aralık 2015 tarihleri arasında 3. Düzey Yenidoğan Yoğun Bakım Ünitesi'nde menenjit tanısı alan hastaların dosyaları geriye dönük olarak incelendi. Bulgular: Menenjit teşhisi konan 118 hasta vardı. Hastaların ortanca gebelik yaşı 32 hafta (24-40 hafta), ortanca doğum ağırlığı 1987 gram (690-5020 gram) idi. Menenjit hastalarının çoğu (n=106, %90) geç sepsis hastasıydı. Prognozu kötü olanların tanı günü daha fazla [9,7 (2-28) gün ile 15,5 (3-138) gün] olarak bulundu,

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“…Similarly, data from South African populations indicated that the most frequent pathogens were K. pneumoniae, Acinetobacter baumannii and S. aureus and that the prevalence of multidrug-resistant organisms, especially carbapenem-resistant A. baumannii, was increasing. 17 The most common risk factors for bacterial meningitis in neonates are premature birth, maternal GBS colonization, prolonged rupture of membranes and very low birth weight. 6 A systematic review of risk factors for neonatal meningitis found that low birth weight, EOM and positive CSF cultures were associated with mortality.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidemiology and Outcomes of Neonatal Meningitis: Results of the Turkish Neo-Meningitis Nationwide Study

Oncel,

Cizmeci,

Karadag-Oncel

et al. 2023

Pediatric Infectious Disease Journal

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Objective: To investigate the incidence and etiology of neonatal meningitis and to assess the associated risk factors, complications and outcomes in a nationwide multicenter retrospective descriptive study. Method: Twenty-seven centers from 7 geographical regions participated in the study. Newborns with a positive cerebrospinal fluid culture and/or cerebrospinal fluid polymerase chain reaction were included in the study. Demographic characteristics, clinical, laboratory and neuroimaging findings and mortality characteristics were analyzed. Results: A total of 634 confirmed cases of neonatal meningitis were included in the final analysis. The incidence was 2.51 per 1000 intensive care unit hospitalizations and mortality was observed in 149 (23.5%). Gram-positive bacteria were the predominant pathogens (54.5%), with coagulase-negative Staphylococci accounting for 45.3% of the cases, followed by gram-negative organisms (37.3%). Viral and fungal organisms were isolated in 3.2% and 1.7% of the infants, respectively. Gram-negative culture growth was more common in infants who died (51% vs. 34.6%; P < 0.001). In the multivariable model, the odds of mortality was higher in those with respiratory distress requiring invasive ventilatory support [odds ratio (OR): 10.3; 95% confidence interval (CI): 4.9–21.7; P < 0.01], hypotension requiring inotropes (OR: 4.4; 95% CI: 2.7–7.1; P < 0.001), low birth weight status (OR: 2.5; 95% CI: 1.4–4.6; P = 0.002), lack of exposure to antenatal steroids (OR: 2.4; 95% CI: 1.3–4.4; P = 0.005) and the presence of concomitant sepsis (OR: 1.9; 95% CI: 1.1–3.2; P = 0.017). Conclusions: In this nationwide study, neonatal meningitis was found to be associated with high mortality. Coagulase-negative Staphylococci was the most common causative microorganism followed by gram-negative bacteria. Severe clinical presentation with invasive mechanical ventilation and inotrope requirement, as well as concomitant sepsis, low birth weight status and lack of exposure to antenatal steroids, were found to be independent risk factors for mortality.

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Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014–19: a cross-sectional study

Cited by 35 publications

References 25 publications

Etiology of Bacterial Sepsis and Isolate Resistance Patterns in Hospitalized Neonates in Zambia

Etiology of Bacterial Sepsis and Isolate Resistance Patterns in Hospitalized Neonates in Zambia

Evaluation of Risk and Prognostic Factors in Neonatal Meningitis

Epidemiology and Outcomes of Neonatal Meningitis: Results of the Turkish Neo-Meningitis Nationwide Study

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