Cultureconfirmed neonatal bloodstream infections and meningitis in South Africa 201419 a crosssectional study

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dc.citation.doi10.1016/S2214-109X(22)00246-7
dc.citation.epage1178
dc.citation.spage1170
dc.contributor.authorMashau, Rudzani C.
dc.contributor.authorMeiring, Susan
dc.contributor.authorDramowski, Angela
dc.contributor.authorMagobo, Rindidzani E.
dc.contributor.authorQuan, Vanessa C.
dc.contributor.authorVon Gottberg, Anne
dc.contributor.authorCohen, Cheryl
dc.contributor.authorVelaphi, Sithembiso
dc.contributor.authorGovender, Nelesh
dc.contributor.authorPerovic, Olga
dc.date.accessioned2023-10-19T09:06:17Z
dc.date.available2023-10-19T09:06:17Z
dc.description.abstractBackground: 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 cultureconfirmed 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.
dc.identifier.citationMashau RC, Meiring ST, Dramowski A, et al. Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014-19: a cross-sectional study. Lancet Glob Health. 2022;10(8):e1170-e1178. doi:10.1016/S2214-109X(22)00246-7
dc.identifier.issn2214-109X
dc.identifier.urihttps://hdl.handle.net/10539/36820
dc.journal.titleLANCET Global Health
dc.journal.volume10
dc.subjectMeningitis
dc.subjectNeonatal bloodstream
dc.subjectNeonatal infections
dc.subjectSub-Saharan Africa
dc.subject.otherSDG-3: Good health and well-being
dc.titleCultureconfirmed neonatal bloodstream infections and meningitis in South Africa 201419 a crosssectional study
dc.typeArticle
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