Journal Article

Clinical predictors of bacteraemia in neonates with suspected early-onset sepsis in Malawi: a prospective cohort study

Dube, Queen, Gordon, Stephen B, Lester, Rebecca, Ghambi, Lugano, Iroh Tam, Pui-Ying, Twabi, Hussein H, Feasey, Nicholas A, Nielsen, Maryke, de Baat, Tessa, van Weissenbruch, Mirjam M, Kawaza, Kondwani

2023

Overview

ObjectivesWe studied neonates with suspected early-onset sepsis (EOS, sepsis developing in the first 72 hours after delivery) in Malawi to (1) describe clinical characteristics and microbiological findings, (2) identify which patient characteristics may be associated with pathogen positivity on blood culture, and (3) describe mortality and its potential determinants.DesignProspective observational study (May 2018–June 2019).SettingNeonatal ward in Queen Elizabeth Central Hospital, the largest government hospital in Malawi.PatientsAll neonates with suspected EOS in whom a blood culture was obtained.ResultsOut of 4308 neonatal admissions, 1244 (28.9%) had suspected EOS. We included 1149 neonates, of which 109 blood cultures had significant growth (9.5%). The most commonly isolated pathogens were Staphylococcus aureus, Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli and Acinetobacter baumanii. Many of the Gram negatives were extended-spectrum beta lactamase-producing Enterobacteriaceae, and these were 40–100% resistant to first-line and second-line antimicrobials. Gestational age (GA) of <32 weeks was associated with pathogen-positive blood cultures (<28 weeks: adjusted OR (AOR) 2.72, 95% CI 1.04 to 7.13; 28–32 weeks: AOR 2.26, 95% CI 1.21 to 4.21; p=0.005). Mortality was 17.6% (202/1149) and associated with low birth weight (<1000 g: AOR 47.57, 95% CI 12.59 to 179.81; 1000–1500 g: AOR 11.31, 95% CI 6.97 to 18.36; 1500–2500 g: AOR 2.20, 95% CI 1.42 to 3.39; p<0.001), low Apgar scores at 5 min (0–3: AOR 18.60, 95% CI 8.81 to 39.27; 4–6: AOR 4.41, 95% CI 2.81 to 6.93; p<0.001), positive maternal venereal disease research laboratory status (AOR 2.53, 95% CI 1.25 to 5.12; p=0.001) and congenital anomalies (AOR 7.37, 95% CI 3.61 to 15.05; p<0.001). Prolonged rupture of membranes was inversely associated with mortality (AOR 0.43, 95% CI 0.19 to 0.98; p 0.007).ConclusionIn Malawi, EOS was suspected in nearly a third of neonatal admissions and had a high mortality. Ten per cent were culture-confirmed and predicted by low GA. To reduce the impact of suspected neonatal sepsis in least developed countries, improved maternal and antenatal care and development of rapid point of care methods to more accurately guide antimicrobial use could simultaneously improve outcome and reduce antimicrobial resistance.

• Publisher: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health,BMJ Publishing Group LTD
• Subject: Age / Anti-Bacterial Agents - therapeutic use / Antimicrobial agents / Antimicrobial resistance / Apgar score / Attrition (Research Studies) / Bacteremia / Bacteremia - diagnosis / Bacteremia - drug therapy / Bacteremia - epidemiology / Birth weight / Blood / Blood culture / Blood tests / Body Weight / Cohort analysis / Congenital defects / Congenital diseases / Congenital Impairments / Developed countries / Developed Nations / Developing countries / Drug dosages / Drug resistance / E coli / Female / Gestational age / Global child health / Guidelines / HIV / Hospitals / Human immunodeficiency virus / Humans / Infant / Infant mortality / Infant, Newborn / Infections / Laboratories / LDCs / Low birth weight / Malawi - epidemiology / Mortality / Mortality Rate / Neonatal Sepsis - diagnosis / Neonatal Sepsis - drug therapy / Neonatal Sepsis - epidemiology / Neonates / Neonatology / Newborn babies / Observational studies / Pathogens / Patients / Pediatrics / Pregnancy / Prospective Studies / Public health / Sepsis / Sepsis - diagnosis / Sepsis - drug therapy / Sepsis - epidemiology / Sexually transmitted diseases / STD / Womens health / β Lactamase