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

BACKGROUND: Few population-level estimates of invasive neonatal infections have been reported from sub-Saharan Africa. We estimated the national incidence risk, aetiology, and pathogen antimicrobial susceptibility for culture-confirmed neonatal bloodstream infections and meningitis in South Africa....

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Autores principales: Mashau, Rudzani C, Meiring, Susan T, Dramowski, Angela, Magobo, Rindidzani E, Quan, Vanessa C, Perovic, Olga, von Gottberg, Anne, Cohen, Cheryl, Velaphi, Sithembiso, van Schalkwyk, Erika, Govender, Nelesh P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Ltd 2022
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9296659/
https://www.ncbi.nlm.nih.gov/pubmed/35839815
http://dx.doi.org/10.1016/S2214-109X(22)00246-7
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author Mashau, Rudzani C
Meiring, Susan T
Dramowski, Angela
Magobo, Rindidzani E
Quan, Vanessa C
Perovic, Olga
von Gottberg, Anne
Cohen, Cheryl
Velaphi, Sithembiso
van Schalkwyk, Erika
Govender, Nelesh P
author_facet Mashau, Rudzani C
Meiring, Susan T
Dramowski, Angela
Magobo, Rindidzani E
Quan, Vanessa C
Perovic, Olga
von Gottberg, Anne
Cohen, Cheryl
Velaphi, Sithembiso
van Schalkwyk, Erika
Govender, Nelesh P
author_sort Mashau, Rudzani C
collection PubMed
description BACKGROUND: Few population-level estimates of invasive neonatal infections have been reported from sub-Saharan Africa. We estimated the national incidence risk, aetiology, and pathogen antimicrobial susceptibility for culture-confirmed neonatal bloodstream infections and meningitis in South Africa. METHODS: We conducted a cross-sectional study of neonates (<28 days of life) admitted to neonatal or paediatric wards of 256 public sector health facilities in South Africa during 2014–19. Diagnostic pathology records from Jan 1, 2014, to Dec 31, 2019, were extracted from a national pathology data warehouse. A case was defined as a neonate with at least one positive blood or cerebrospinal fluid culture during a 14-day period. Incidence risk was calculated using annual numbers of registered livebirths. Among the causative pathogens identified, we calculated the proportion of cases attributed to each of them, as well as the rates of antibiotic susceptibility of Gram-positive and Gram-negative bacteria. FINDINGS: Among 43 438 records of positive cultures, there were 37 631 incident cases of neonatal infection with at least one pathogen isolated. The overall incidence risk of culture-confirmed infections was 6·0 per 1000 livebirths (95% CI 6·0–6·1). The incidence risk of late-onset sepsis (days 3–27 of life) was 4·9 per 1000 livebirths (4·9–5·0) and that of early-onset sepsis (days 0–2 of life) was 1·1 per 1000 livebirths (1·1–1·1); risk ratio 4·4 (95% CI 4·3–4·5). The cause of infection differed by syndrome, timing of infection onset, facility, and province, although Klebsiella pneumoniae (26%), Acinetobacter baumannii (13%), and Staphylococcus aureus (12%) were the dominant pathogens overall. Gram-negative bacteria had declining susceptibility to most antibiotics over the study period. INTERPRETATION: We found a high incidence risk of late-onset sepsis with provincial variations, predominance of K pneumoniae, and declining antibiotic susceptibility among Gram-negative bacteria. This national surveillance in an upper-middle-income country provides a baseline burden of neonatal infections against which the impact of future clinical and public health interventions can be measured. FUNDING: Bill & Melinda Gates Foundation.
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spelling pubmed-92966592022-07-22 Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014–19: a cross-sectional study Mashau, Rudzani C Meiring, Susan T Dramowski, Angela Magobo, Rindidzani E Quan, Vanessa C Perovic, Olga von Gottberg, Anne Cohen, Cheryl Velaphi, Sithembiso van Schalkwyk, Erika Govender, Nelesh P Lancet Glob Health Articles BACKGROUND: Few population-level estimates of invasive neonatal infections have been reported from sub-Saharan Africa. We estimated the national incidence risk, aetiology, and pathogen antimicrobial susceptibility for culture-confirmed neonatal bloodstream infections and meningitis in South Africa. METHODS: We conducted a cross-sectional study of neonates (<28 days of life) admitted to neonatal or paediatric wards of 256 public sector health facilities in South Africa during 2014–19. Diagnostic pathology records from Jan 1, 2014, to Dec 31, 2019, were extracted from a national pathology data warehouse. A case was defined as a neonate with at least one positive blood or cerebrospinal fluid culture during a 14-day period. Incidence risk was calculated using annual numbers of registered livebirths. Among the causative pathogens identified, we calculated the proportion of cases attributed to each of them, as well as the rates of antibiotic susceptibility of Gram-positive and Gram-negative bacteria. FINDINGS: Among 43 438 records of positive cultures, there were 37 631 incident cases of neonatal infection with at least one pathogen isolated. The overall incidence risk of culture-confirmed infections was 6·0 per 1000 livebirths (95% CI 6·0–6·1). The incidence risk of late-onset sepsis (days 3–27 of life) was 4·9 per 1000 livebirths (4·9–5·0) and that of early-onset sepsis (days 0–2 of life) was 1·1 per 1000 livebirths (1·1–1·1); risk ratio 4·4 (95% CI 4·3–4·5). The cause of infection differed by syndrome, timing of infection onset, facility, and province, although Klebsiella pneumoniae (26%), Acinetobacter baumannii (13%), and Staphylococcus aureus (12%) were the dominant pathogens overall. Gram-negative bacteria had declining susceptibility to most antibiotics over the study period. INTERPRETATION: We found a high incidence risk of late-onset sepsis with provincial variations, predominance of K pneumoniae, and declining antibiotic susceptibility among Gram-negative bacteria. This national surveillance in an upper-middle-income country provides a baseline burden of neonatal infections against which the impact of future clinical and public health interventions can be measured. FUNDING: Bill & Melinda Gates Foundation. Elsevier Ltd 2022-07-12 /pmc/articles/PMC9296659/ /pubmed/35839815 http://dx.doi.org/10.1016/S2214-109X(22)00246-7 Text en © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Articles
Mashau, Rudzani C
Meiring, Susan T
Dramowski, Angela
Magobo, Rindidzani E
Quan, Vanessa C
Perovic, Olga
von Gottberg, Anne
Cohen, Cheryl
Velaphi, Sithembiso
van Schalkwyk, Erika
Govender, Nelesh P
Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014–19: a cross-sectional study
title Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014–19: a cross-sectional study
title_full Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014–19: a cross-sectional study
title_fullStr Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014–19: a cross-sectional study
title_full_unstemmed Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014–19: a cross-sectional study
title_short Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014–19: a cross-sectional study
title_sort culture-confirmed neonatal bloodstream infections and meningitis in south africa, 2014–19: a cross-sectional study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9296659/
https://www.ncbi.nlm.nih.gov/pubmed/35839815
http://dx.doi.org/10.1016/S2214-109X(22)00246-7
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