Development of a Bloodstream Infection Surveillance Programme at a Resource-Limited South African Neonatal Unit
<b>Background</b>: Data from African neonatal units conducting bloodstream infection (BSI) surveillance is limited. <b>Methods</b>: Prospective clinical and laboratory surveillance of incident BSI episodes was conducted among in-patients at the 132-bed neonatal service at Tyg...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-04-01
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| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/14/4/392 |
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| Summary: | <b>Background</b>: Data from African neonatal units conducting bloodstream infection (BSI) surveillance is limited. <b>Methods</b>: Prospective clinical and laboratory surveillance of incident BSI episodes was conducted among in-patients at the 132-bed neonatal service at Tygerberg Hospital, Cape Town, South Africa (2017–2021), describing patient demographics, BSI rates, pathogen profiles, and empiric antibiotic concordance rates. <b>Results:</b> In total, 842 BSI episodes were identified in 740 neonates; most were preterm (661/740; 89.3%) and of low birth weight (640/740; 86.5%). The early onset BSI rate (<3 days of life) was 2.9/1000 live births, with <i>S. agalactiae</i>, <i>K. pneumoniae</i>, and <i>E. coli</i> predominating. Over time, ampicillin plus gentamicin coverage rates for early onset BSI pathogens declined from 93.8% to 63.6%. The healthcare-associated BSI rate (onset >3 days of life) was 3.4/1000 in-patient days, with <i>K. pneumoniae</i>, <i>S. aureus</i>, and <i>S. marcescens</i> predominating. Antibiotic coverage rates for healthcare-associated BSIs improved over time, from 72.2% to 89.2% (piperacillin plus amikacin) and from 68.1% to 84.6% (meropenem). Nearly one-third of BSI episodes were fatal (244/842; 29.0%), with two-thirds of these deaths considered BSI-attributable. Gram-negative BSIs increased mortality (OR 2.88; 95% CI 1.93–4.32) compared to Gram-positive BSIs (<i>p</i> < 0.001). Discordant empiric antibiotic therapy (OR 1.55; 95% CI 1.10–2.17) increased the risk of death compared to concordant therapy (<i>p</i> = 0.012). <b>Conclusions</b>: Neonatal BSI surveillance demonstrated that Gram-negative pathogens remain important causes of early onset and healthcare-associated BSIs in this resource-limited neonatal service. Declining coverage rates for empiric antibiotics prescribed for early onset BSI highlight the need for a change in treatment guidelines to minimise discordant therapy. |
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| ISSN: | 2079-6382 |