Population‐Based Incidence and Etiology of Community‐Acquired Neonatal Bacteremia in Mirzapur, Bangladesh: An Observational Study

Abstract

Background To devise treatment strategies for neonatal infections, the population-level incidence and antibiotic susceptibility of pathogens must be defined. Methods Surveillance for suspected neonatal sepsis was conducted in Mirzapur, Bangladesh, from February 2004 through November 2006. Community health workers assessed neonates on postnatal days 0, 2, 5, and 8 and referred sick neonates to a hospital, where blood was collected for culture from neonates with suspected sepsis. We estimated the incidence and pattern of community-acquired neonatal bacteremia and determined the antibiotic susceptibility profile of pathogens. Results The incidence rate of community-acquired neonatal bacteremia was 3.0 per 1000 person–neonatal periods. Among the 30 pathogens identified, the most common was Staphylococcus aureus (n = 10); half of all isolates were gram positive. Nine were resistant to ampicillin and gentamicin or to ceftiaxone, and 13 were resistant to cotrimoxazole. Conclusion S. aureus was the most common pathogen to cause community-acquired neonatal bacteremia. Nearly 40% of infections were identified on days 0–3, emphasizing the need to address maternal and environmental sources of infection. The combination of parenteral procaine benzyl penicillin and an aminoglycoside is recommended for the first-line treatment of serious community-acquired neonatal infections in rural Bangladesh, which has a moderate level of neonatal mortality. Additional population-based data are needed to further guide national and global strategies. Trial registration ClinicalTrials.gov identifier: NCT00198627.

Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO's currently recommended antibiotics--systematic review and meta-analysis

“…The number of positive cultures included in each study varied from 3030 31 to 784 12. Five studies (four from Africa and one from India) provided data for 72% of all positive isolates included in the review (2914 of 4049) 12 21 23 28 35…”

Cotrimoxazole and neonatal kernicterus: a review

“…SMX-TMP is a combination of sulfamethoxazole (SMX) and trimethoprim (TMP) that is used for the treatment of protozoan and bacterial infections, particularly for urinary and respiratory tract infections (Darmstadt et al, 2009; Ladhani & Garbash, 2005; Ogra & Faden, 1985; Paap & Nahata, 1990; Salter, 1982; Thaver et al, 2009; Velvis et al, 1986). This combination is extensively used in the home--based neonate care setting in developing countries for treating pneumonia and sepsis in neonates (Bang et al, 1993, 1999; Bhutta et al, 2009).…”

Neonatal Sepsis: A Profile of a Changing Spectrum

“…There have been rela vely few studies from India repor ng specifi c rates of EONS. A study from a home based surveillance program from Bangladesh reported the clinical EONS to be 50 per 1000 live births and that of blood cultureconfi rmed EONS, 2.9 per 1000 live births 22 .…”