Serious community-acquired neonatal infections in rural Southeast Asia (Bohol Island, Philippines)

Abstract

Objective: To determine the bacterial etiology, clinical presentation and risk factors for outcome of serious community-acquired infections in young infants.Study Design: Infants younger than 60 days, admitted for severe pneumonia or suspected sepsis/meningitis were prospectively evaluated using complete blood count, blood culture, chest radiograph, cerebrospinal fluid (CSF) culture in suspected meningitis. w 2 or Fisher's exact test and stepwise logistic regression were used for analysis.Results: Thirty-four of 767 enrolled infants had a positive blood or CSF culture. Gram-negative bacteria were more frequent than Gram positive: overall (P ¼ 0.004), in those below 7 days of age (P ¼ 0.002) and among home deliveries (P ¼ 0.012). Case fatality rates were higher among infants below 1 week old (OR 4.14, P<0.001), those with dense (OR 2.92, P<0.001) or diffuse radiographic infiltrates (OR 2.79, P ¼ 0.003).Conclusions: Gram-negative enteric bacteria are the predominant causes of community-acquired infections in Filipino infants below 2 months old. Age below 7 days and radiographic pneumonia predicted death.

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

“…Furthermore, on the basis of either maternal report or the serum antimicrobial substance test, ~14% of neonates with cultures received antibiotics before specimen sampling, potentially further impairing sensitivity. Overall, the positivity rate of 5.8% (95% CI, 3.9%–8.2%) was comparable to those in studies of community-acquired neonatal infection in Bohol, the Philippines (4.4% [95% CI, 3.1%–6.2%]), and in Matlab, Bangladesh (13.8% [6.0%–27.2%]) [6, 8]. These low positivity rates may reflect a lack of specificity in clinical criteria, suggesting the need to further refine IMCI algorithms [5], in addition to the limitations of conventional blood cultures.…”

“…S. aureus was also the most prevalent among neonates in the population-based Matlab ALRI study (5/8) [8] and in the facility-based 4-country WHO Young Infants Clinical Signs Study (19/84) [4]. However, the etiology in our study population is markedly different from bacterial profiles of nosocomial neonatal infections in Bangladesh [34] and of nonnosocomial infections among young infants <60 days old in rural Philippines [6], where gram-negative pathogens such as Klebsiella pneumonia , Pseudomonas aeruginosa , and Enterobacter species predominate. Group B streptococci were uncommonly isolated, similar to hospital-based studies from Bangladesh [20] and other locations in developing countries [35, 36].…”

“…The World Health Organization (WHO) Young Infants Clinical Signs Study Group conducted a multicenter prospective study of bacterial etiology among infants <90 days of age who were brought to health facilities by their parents or caregivers, thus underestimating the incidence and including nosocomial infections [4, 5]. Recent studies of sepsis etiology among Filipino neonates [6] and Kenyan children <5 years old [7] included only community-acquired sepsis but were also limited by self-referral selection bias due to lack of surveillance [7]. A population-based study in Bangladesh investigated the incidence and etiology of bacterial infections among children <5 years old and estimated an incidence rate of 17.4 cases per 1000 person-years among neonates.…”

Neonatal community‐acquired pneumonia: Pathogens and treatment

“…In this study, we found that gram negatives were most prevalent, of which the most common were E. coli , K. pneumonia and H. influenzae , while in blood cultures, the most common pathogen was K. pneumoniae . These findings are similar to data in Malaysia showing that E. coli and K. pneumoniae are also common causes of CAP but different from the findings in the United States 14,15 . These different findings may be due to the differences in geographical exposure and prevalence of bacteria.…”

Pneumonia among young infants in rural Southeast Asia (Bohol Island, Philippines)

“…This study showed that compared to sepsis and meningitis, radiographic pneumonia was mild and uncommon, present in only 10% of infants with an 8.8% case fatality rate (CFR). However, in a large study that we conducted on serious community acquired infections among infants below 2 months of age (Quiambao et al. 2007), we noted that radiographic pneumonia was present in 27%, with 21% CFR.…”