Hospital-acquired neonatal infections in developing countries.
Hospital-born babies in developing countries are at increased risk of neonatal infections because of poor intrapartum and postnatal infection-control practices. We reviewed data from developing countries on rates of neonatal infections among hospital-born babies, range of pathogens, antimicrobial resistance, and infection-control interventions. Reported rates of neonatal infections were 3-20 times higher than those reported for hospital-born babies in industrialised countries. Klebsiella pneumoniae, other gram-negative rods (Escherichia coli, Pseudomonas spp, Acinetobacter spp), and Staphylococcus aureus were the major pathogens among 11,471 bloodstream isolates reported. These infections can often present soon after birth. About 70% would not be covered by an empiric regimen of ampicillin and gentamicin, and many might be untreatable in resource-constrained environments. The associated morbidity, mortality, costs, and adverse effect on future health-seeking behaviour by communities pose barriers to improvement of neonatal outcomes in developing countries. Low-cost, "bundled" interventions using systems quality improvement approaches for improved infection control are possible, but should be supported by evidence in developing country settings.
Zaidi
Anita K M
AK
Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan. ianita.zaidi@aku.edu
Huskins
W Charles
WC
Thaver
Durrane
D
Bhutta
Zulfiqar A
ZA
Abbas
Zohair
Z
Goldmann
Donald A
DA
D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D003906:Developing Countries / Q000706:statistics & numerical data*; D024881:Drug Resistance, Bacterial; D006801:Humans; D015994:Incidence; D007224:Infant Care; D007231:Infant, Newborn; D017053:Infection Control; D007710:Klebsiella Infections / Q000453:epidemiology; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology