title: Bloodstream infections and antimicrobial resistance patterns in a South African neonatal intensive care unit.
abstract: BACKGROUND
  Bloodstream infections remain a leading cause of morbidity and mortality in neonatal intensive care units (NICU) worldwide. Commonly isolated NICU pathogens are increasingly resistant to standard antimicrobial treatment regimes.
  
  
  OBJECTIVE
  The primary aim of this study was to determine the burden of bloodstream infections (BSI) in an NICU in a low-to-middle-income country and to describe the spectrum of pathogens isolated together with their drug susceptibility patterns.
  
  
  METHODS
  This retrospective, descriptive study included NICU patients admitted to the Tygerberg Children's Hospital, Cape Town, between 1 January and 31 December 2008. All blood culture samples submitted to the reference laboratory were extracted and clinical data on patients were obtained by hospital record review.
  
  
  RESULTS
  There were 78 culture-confirmed episodes of BSI in 54/503 (11%) patients admitted; median gestational age was 31 weeks (IQR 29-37) and birth weight 1370 g (IQR 1040-2320). Common isolates included coagulase-negative Staphylococcus (22/78, 28%), Klebsiella spp. (17/78, 22%), Acinetobacter spp. (14/78, 18%), Candida spp. (9/78, 11·5%) and methicillin-resistant Staphylococcus aureus (5/78, 6%). There was a predominance of gram-negative organisms (38/78, 48·7%). All Staphylococcus aureus isolates were methicillin-resistant and 59% of Klebsiella pneumoniae isolates were extended spectrum β-lactamase (ESBL) producers. Acinetobacter baumanii isolates showed low susceptibility to the aminoglycosides, carbapenems and cephalosporins. Of 54 infants admitted to the NICU with BSI, 25 (46%) died; 9/25 deaths (36%) were attributable solely to infection.
  
  
  CONCLUSIONS
  Compared with overall mortality in the NICU, that attributable solely or partly to BSI was high. Many bacterial BSI isolates were resistant to current empiric antibiotic regimens. Regular microbiological and clinical surveillance of BSI in NICUs is required to inform appropriate antibiotic protocols and monitor the impact of infection prevention strategies.
authors.forename: G
authors.initials: G
authors.lastname: Morkel
authors.forename: A
authors.initials: A
authors.lastname: Bekker
authors.forename: B J
authors.initials: BJ
authors.lastname: Marais
authors.forename: G
authors.initials: G
authors.lastname: Kirsten
authors.forename: J
authors.initials: J
authors.lastname: van Wyk
authors.forename: A
authors.initials: A
authors.lastname: Dramowski
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000935:Antifungal Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D025141:Drug Resistance, Fungal; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005658:Fungi / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents
keywords: Antimicrobial resistance,; Bloodstream infection,; Healthcare-associated infection; Neonatal intensive care unit,