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

Abstract

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.

Antibiotic Use for Sepsis in Hospitalized Neonates in Botswana: Factors Associated with Guideline-Divergent Prescribing

“…Two main exposure variables were investigated: (1) time of neonatal sepsis, classified as either early-onset sepsis (EOS) if occurring in the first 3 days of life or late-onset sepsis (LOS) neonatal sepsis if occurring after the first 3 days of life at the time that antibiotics were first prescribed [31,32]; and (2) estimated gestational age (EGA) in weeks. Although early-onset sepsis may be defined as up to 7 days, for continuously hospitalized patients, day of life 0-3 is often used to assess differences related to hospitalbased exposures [20,[31][32][33][34][35][36][37][38]. To address the differences in sepsis definitions, we evaluated the day of life of sepsis onset as a continuous variable for additional insight.…”

“…In this prospective cohort of 467 neonates admitted to the neonatal unit between November 2020 and December 2021, we examined the use of antibacterial and antimicrobial agents prescribed for 325 neonates during their first episode of suspected sepsis. In our cohort, the overall median EGA was 34 weeks (IQR [30][31][32][33][34][35][36][37][38], and 81 (25%) neonates had perinatal exposure to HIV. The in-hospital mortality rate was 11% (35/325) (Table 1).…”