title: Hospital-acquired neonatal infections in developing countries.
abstract: 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.
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan. ianita.zaidi@aku.edu
authors.forename: Anita K M
authors.initials: AK
authors.lastname: Zaidi
authors.forename: W Charles
authors.initials: WC
authors.lastname: Huskins
authors.forename: Durrane
authors.initials: D
authors.lastname: Thaver
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: Zohair
authors.initials: Z
authors.lastname: Abbas
authors.forename: Donald A
authors.initials: DA
authors.lastname: Goldmann
mesh_terms: 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