title: Invasive bacterial infections in neonates and young infants born outside hospital admitted to a rural hospital in Kenya.
abstract: BACKGROUND
  Bacterial sepsis is thought to be a major cause of young infant deaths in low-income countries, but there are few precise estimates of its burden or causes. We studied invasive bacterial infections (IBIs) in young infants, born at home or in first-level health units ("outborn") who were admitted to a Kenyan rural district hospital during an 8-year period.
  
  
  METHODS
  Clinical and microbiologic data, from admission blood cultures and cerebrospinal fluid cultures on all outborn infants aged less than 60 days admitted from 2001 to 2009, were examined to determine etiology of IBI and antimicrobial susceptibilities.
  
  
  RESULTS
  Of the 4467 outborn young infants admitted, 748 (17%) died. Five hundred five (11%) had IBI (10% bacteremia and 3% bacterial meningitis), with a case fatality of 33%. The commonest organisms were Klebsiella spp., Staphylococcus aureus, Streptococcus pneumoniae, Group B Streptococcus, Acinetobacter spp., Escherichia coli, and Group A Streptococcus. Notably, some blood culture isolates were seen in outborn neonates in the first week of life but not in inborns: Salmonella, Aeromonas, and Vibrio spp. Eighty-one percent of isolates were susceptible to penicillin and/or gentamicin and 84% to ampicillin and/or gentamicin. There was a trend to increasing in vitro antimicrobial resistance to these combinations from 2008 but without a worse outcome.
  
  
  CONCLUSIONS
  IBI is common in outborn young infants admitted to rural African hospitals with a high mortality. Presumptive antimicrobial use is justified for all young infants admitted to the hospital.
authors.affiliation: Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya. atalbert@kilifi.kemri-wellcome.org
authors.forename: Alison W A
authors.initials: AW
authors.lastname: Talbert
authors.forename: Michael
authors.initials: M
authors.lastname: Mwaniki
authors.forename: Salim
authors.initials: S
authors.lastname: Mwarumba
authors.forename: Charles R J C
authors.initials: CR
authors.lastname: Newton
authors.forename: James A
authors.initials: JA
authors.lastname: Berkley
mesh_terms: D001419:Bacteria / Q000145:classification* / Q000302:isolation & purification*; D001769:Blood / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology