title: Bacteraemia in Malawian neonates and young infants 2002-2007: a retrospective audit.
abstract: OBJECTIVE
  To assess the causes of bacteraemia in young infants and susceptibility to first-line antibiotics (benzylpenicillin plus gentamicin) at the Queen Elizabeth Central Hospital (QECH), Malawi during 2002-2007.
  
  
  METHODS
  Retrospective analysis of demographic and microbiological data using laboratory records.
  
  
  METHODS
  QECH is Malawi's largest hospital with 7000 neonates admitted annually, 9% for septicaemia.
  
  
  METHODS
  All infants aged 60 days or less admitted to QECH that had a blood culture taken over the 6-year period.
  
  
  METHODS
  6754 blood cultures were taken. 3323 organisms were isolated: one-third were pathogens, two-thirds contaminants. Gram-positive organisms (53%) were more common than gram-negatives (47%). Four organisms made up half of all pathogens: Staphylococcus aureus (15.3%), group B streptococci (13.5%), non-typhoidal salmonellae (12.6%) and Escherichia coli (10.5%). Apart from non-typhoidal salmonellae and Streptococcus pneumoniae, most organisms were more common in the first week of life than later. Overall, 28% of isolates during 2002-2007 were resistant to first-line antibiotic, higher than observed during 1996-2001 (22%). Penicillin susceptibility fluctuated while gram-negative resistance to gentamicin increased from 17% to 27% over the study period.
  
  
  CONCLUSIONS
  In the QECH, pathogens causing young infant sepsis are an unusual mix of organisms seen in both developed and developing countries. Resistance to first-line antibiotics is higher than observed in most studies. Ongoing monitoring is needed and clinical outcome data would aid interpretation of findings. A high proportion of blood cultures were contaminated with skin flora-improved training and supervision of phlebotomists are needed to improve the utility of taking blood cultures.
authors.affiliation: Department of General Medicine, The Royal Children's Hospital, Melbourne, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Gwee
authors.forename: Benjamin
authors.initials: B
authors.lastname: Coghlan
authors.forename: Dean
authors.initials: D
authors.lastname: Everett
authors.forename: Newton
authors.initials: N
authors.lastname: Chagoma
authors.forename: Amos
authors.initials: A
authors.lastname: Phiri
authors.forename: Lorna
authors.initials: L
authors.lastname: Wilson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Molyneux