A Retrospective Analysis of Pathogen Profile, Antimicrobial Resistance and Mortality in Neonatal Hospital-acquired Bloodstream Infections from 2009-2018 at Tygerberg Hospital, South Africa

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2021 Jan 14

PMID 33444334

Citations 19

Authors

Kessendri Reddy

Adrie Bekker

Andrew C Whitelaw

Tonya M Esterhuizen

Angela Dramowski

Affiliations

Soon will be listed here.

Abstract

Background: Analysis of hospital-acquired bloodstream infection (HA-BSI) trends is important to monitor emerging antimicrobial resistance (AMR) threats and guide empiric antibiotic choices.

Methods: A retrospective 10-year review of neonatal HA-BSI was performed at Tygerberg Hospital's neonatal unit in Cape Town, South Africa. Neonatal clinical and laboratory data from 2014 to 2018 (Period 2) was compared with published data from 2009 to 2013 (Period 1).

Results: The neonatal unit's HA-BSI rate declined between periods from 3.9/1000 inpatient-days in Period 1 to 3.3/1000 inpatient-days in Period 2 (p = 0.002). Pathogen yield and blood culture contamination rate were unchanged (11.0% to 10.4%, p = 0.233; 5.1% to 5.3%, p = 0.636 respectively). Gram-negative pathogens predominated (1047/1636; 64.0%); Klebsiella species, Staphylococcus aureus, Serratia marcescens, Enterococcus species and Acinetobacter baumannii were the most frequent pathogens. Extended spectrum beta-lactamase production was observed in 319/432 (73.8%) of Klebsiella species, methicillin resistance in 171/246 (69.5%) of Staphylococcus aureus and extensive drug resistance in 115/137 (83.9%) of Acinetobacter species (2009-2018). The crude mortality rate of neonatal HA-BSI episodes increased from Period 1 to Period 2 from 139/717 (19.4%) to 179/718 (24.9%) (p = 0.014), but HA-BSI attributable mortality remained unchanged (97/139 [69.8%] vs 118/179 [65.9%], p = 0.542). The in-vitro activity of piperacillin-tazobactam and amikacin declined during Period 2 (74.6% to 61.4%; p<0.001).

Conclusion: Although HA-BSI rates declined in the neonatal unit, antimicrobial resistance rates in BSI pathogens remained high. Continuous BSI surveillance is a valuable tool to detect changes in pathogen and AMR profiles and inform empiric antibiotic recommendations for neonatal units in resource-limited settings.

Citing Articles

ESKAPE pathogen incidence and antibiotic resistance in patients with bloodstream infections at a referral hospital in Limpopo, South Africa, 2014-2019: A cross-sectional study.

Mthombeni T, Burger J, Lubbe M, Julyan M, Lekalakala-Mokaba M Afr J Lab Med. 2024; 13(1):2519.

PMID: 39649114 PMC: 11621878. DOI: 10.4102/ajlm.v13i1.2519.

Epidemiology of healthcare-associated bloodstream infection in South African neonatal units.

Dramowski A, Bolton L, Bekker A, Engelbrecht A, Erasmus L, Fataar A BMC Infect Dis. 2024; 24(1):1350.

PMID: 39593003 PMC: 11600642. DOI: 10.1186/s12879-024-10219-0.

Bacterial profiles and their antibiotic susceptibility patterns in neonatal sepsis at the University of Gondar Comprehensive Specialized Hospital, Ethiopia.

Deress T, Belay G, Ayenew G, Ferede W, Worku M, Feleke T Front Microbiol. 2024; 15:1461689.

PMID: 39498130 PMC: 11532188. DOI: 10.3389/fmicb.2024.1461689.

Prevalence of carbapenem-resistant gram-negative bacteria among neonates suspected for sepsis in Africa: a systematic review and meta-analysis.

Sisay A, Asmare Z, Kumie G, Gashaw Y, Getachew E, Ashagre A BMC Infect Dis. 2024; 24(1):838.

PMID: 39155370 PMC: 11330605. DOI: 10.1186/s12879-024-09747-6.

The burden of hospital-acquired infections (HAI) in sub-Saharan Africa: a systematic review and meta-analysis.

Melariri H, Freercks R, van der Merwe E, Ten Ham-Baloyi W, Oyedele O, Murphy R EClinicalMedicine. 2024; 71:102571.

PMID: 38606166 PMC: 11007440. DOI: 10.1016/j.eclinm.2024.102571.

References

Giannoni E, Agyeman P, Stocker M, Posfay-Barbe K, Heininger U, Spycher B . Neonatal Sepsis of Early Onset, and Hospital-Acquired and Community-Acquired Late Onset: A Prospective Population-Based Cohort Study. J Pediatr. 2018; 201:106-114.e4. DOI: 10.1016/j.jpeds.2018.05.048. View

Hammoud M, Al-Taiar A, Al-Abdi S, Bozaid H, Khan A, AlMuhairi L . Late-onset neonatal sepsis in Arab states in the Gulf region: two-year prospective study. Int J Infect Dis. 2017; 55:125-130. DOI: 10.1016/j.ijid.2017.01.006. View

van der Zwet W, Kaiser A, van Elburg R, Berkhof J, Fetter W, Parlevliet G . Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect. 2005; 61(4):300-11. DOI: 10.1016/j.jhin.2005.03.014. View

Guo J, Luo Y, Wu Y, Lai W, Mu X . Clinical Characteristic and Pathogen Spectrum of Neonatal Sepsis in Guangzhou City from June 2011 to June 2017. Med Sci Monit. 2019; 25:2296-2304. PMC: 6451358. DOI: 10.12659/MSM.912375. View

Korang S, Safi S, Gluud C, Lausten-Thomsen U, Jakobsen J . Antibiotic regimens for neonatal sepsis - a protocol for a systematic review with meta-analysis. Syst Rev. 2019; 8(1):306. PMC: 6896287. DOI: 10.1186/s13643-019-1207-1. View

Ramirez M, Traglia G, Lin D, Tran T, Tolmasky M . Plasmid-Mediated Antibiotic Resistance and Virulence in Gram-negatives: the Paradigm. Microbiol Spectr. 2015; 2(5):1-15. PMC: 4335354. DOI: 10.1128/microbiolspec.PLAS-0016-2013. View

Al-Taiar A, Hammoud M, Cuiqing L, Lee J, Lui K, Nakwan N . Neonatal infections in China, Malaysia, Hong Kong and Thailand. Arch Dis Child Fetal Neonatal Ed. 2012; 98(3):F249-55. DOI: 10.1136/archdischild-2012-301767. View

Dramowski A, Madide A, Bekker A . Neonatal nosocomial bloodstream infections at a referral hospital in a middle-income country: burden, pathogens, antimicrobial resistance and mortality. Paediatr Int Child Health. 2015; 35(3):265-72. DOI: 10.1179/2046905515Y.0000000029. View

Ballot D, Bandini R, Nana T, Bosman N, Thomas T, Davies V . A review of -multidrug-resistant Enterobacteriaceae in a neonatal unit in Johannesburg, South Africa. BMC Pediatr. 2019; 19(1):320. PMC: 6731552. DOI: 10.1186/s12887-019-1709-y. View

10.

Gkentzi D, Kortsalioudaki C, Cailes B, Zaoutis T, Kopsidas J, Tsolia M . Epidemiology of infections and antimicrobial use in Greek Neonatal Units. Arch Dis Child Fetal Neonatal Ed. 2018; 104(3):F293-F297. DOI: 10.1136/archdischild-2018-315024. View

11.

Cailes B, Kortsalioudaki C, Buttery J, Pattnayak S, Greenough A, Matthes J . Antimicrobial resistance in UK neonatal units: neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed. 2017; 103(5):F474-F478. DOI: 10.1136/archdischild-2017-313238. View

12.

Kishk R, Mandour M, Farghaly R, Ibrahim A, Nemr N . Pattern of Blood Stream Infections within Neonatal Intensive Care Unit, Suez Canal University Hospital, Ismailia, Egypt. Int J Microbiol. 2014; 2014:276873. PMC: 4217241. DOI: 10.1155/2014/276873. View

13.

Humphries R, Abbott A, Hindler J . Understanding and Addressing CLSI Breakpoint Revisions: a Primer for Clinical Laboratories. J Clin Microbiol. 2019; 57(6). PMC: 6535595. DOI: 10.1128/JCM.00203-19. View

14.

Zingg W, Posfay-Barbe K, Pittet D . Healthcare-associated infections in neonates. Curr Opin Infect Dis. 2008; 21(3):228-34. DOI: 10.1097/QCO.0b013e3282fcec5f. View

15.

Bianchi-Jassir F, Paul P, To K, Carreras-Abad C, Seale A, Jauneikaite E . Systematic review of Group B Streptococcal capsular types, sequence types and surface proteins as potential vaccine candidates. Vaccine. 2020; 38(43):6682-6694. PMC: 7526974. DOI: 10.1016/j.vaccine.2020.08.052. View

16.

Rothe C, Schlaich C, Thompson S . Healthcare-associated infections in sub-Saharan Africa. J Hosp Infect. 2013; 85(4):257-67. DOI: 10.1016/j.jhin.2013.09.008. View

17.

Kabwe M, Tembo J, Chilukutu L, Chilufya M, Ngulube F, Lukwesa C . Etiology, Antibiotic Resistance and Risk Factors for Neonatal Sepsis in a Large Referral Center in Zambia. Pediatr Infect Dis J. 2016; 35(7):e191-8. DOI: 10.1097/INF.0000000000001154. View

18.

Malik A, Hasani S, Khan H, Ahmad A . Nosocomial infections in newborns. Indian Pediatr. 2001; 38(1):68-71. View

19.

Tsai M, Hsu J, Chu S, Lien R, Huang H, Chiang M . Incidence, clinical characteristics and risk factors for adverse outcome in neonates with late-onset sepsis. Pediatr Infect Dis J. 2013; 33(1):e7-e13. DOI: 10.1097/INF.0b013e3182a72ee0. View

20.

Chaurasia S, Sivanandan S, Agarwal R, Ellis S, Sharland M, Sankar M . Neonatal sepsis in South Asia: huge burden and spiralling antimicrobial resistance. BMJ. 2019; 364:k5314. PMC: 6340339. DOI: 10.1136/bmj.k5314. View