Population-based incidence and etiology of community-acquired neonatal bacteremia in Mirzapur, Bangladesh: an observational study.
BACKGROUND
To devise treatment strategies for neonatal infections, the population-level incidence and antibiotic susceptibility of pathogens must be defined.


METHODS
Surveillance for suspected neonatal sepsis was conducted in Mirzapur, Bangladesh, from February 2004 through November 2006. Community health workers assessed neonates on postnatal days 0, 2, 5, and 8 and referred sick neonates to a hospital, where blood was collected for culture from neonates with suspected sepsis. We estimated the incidence and pattern of community-acquired neonatal bacteremia and determined the antibiotic susceptibility profile of pathogens.


RESULTS
The incidence rate of community-acquired neonatal bacteremia was 3.0 per 1000 person-neonatal periods. Among the 30 pathogens identified, the most common was Staphylococcus aureus (n = 10); half of all isolates were gram positive. Nine were resistant to ampicillin and gentamicin or to ceftiaxone, and 13 were resistant to cotrimoxazole.


CONCLUSIONS
S. aureus was the most common pathogen to cause community-acquired neonatal bacteremia. Nearly 40% of infections were identified on days 0-3, emphasizing the need to address maternal and environmental sources of infection. The combination of parenteral procaine benzyl penicillin and an aminoglycoside is recommended for the first-line treatment of serious community-acquired neonatal infections in rural Bangladesh, which has a moderate level of neonatal mortality. Additional population-based data are needed to further guide national and global strategies.
Darmstadt
Gary L
GL
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Saha
Samir K
SK
Choi
Yoonjoung
Y
El Arifeen
Shams
S
Ahmed
Nawshad Uddin
NU
Bari
Sanwarul
S
Rahman
Syed M
SM
Mannan
Ishtiaq
I
Crook
Derrick
D
Fatima
Kaniz
K
Winch
Peter J
PJ
Seraji
Habibur Rahman
HR
Begum
Nazma
N
Rahman
Radwanur
R
Islam
Maksuda
M
Rahman
Anisur
A
Black
Robert E
RE
Santosham
Mathuram
M
Sacks
Emma
E
Baqui
Abdullah H
AH
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001419:Bacteria / Q000145:classification / Q000187:drug effects; D001459:Bangladesh / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification
D000900:Anti-Bacterial Agents