Etiology of bacteremia in young infants in six countries.
BACKGROUND
Neonatal illness is a leading cause of death worldwide; sepsis is one of the main contributors. The etiologies of community-acquired neonatal bacteremia in developing countries have not been well characterized.


METHODS
Infants <2 months of age brought with illness to selected health facilities in Bangladesh, Bolivia, Ghana, India, Pakistan and South Africa were evaluated, and blood cultures taken if they were considered ill enough to be admitted to hospital. Organisms were isolated using standard culture techniques.


RESULTS
Eight thousand eight hundred and eighty-nine infants were recruited, including 3177 0-6 days of age and 5712 7-59 days of age; 10.7% (947/8889) had a blood culture performed. Of those requiring hospital management, 782 (54%) had blood cultures performed. Probable or definite pathogens were identified in 10.6% including 10.4% of newborns 0-6 days of age (44/424) and 10.9% of infants 7-59 days of age (39/358). Staphylococcus aureus was the most commonly isolated species (36/83, 43.4%) followed by various species of Gram-negative bacilli (39/83, 46.9%; Acinetobacter spp., Escherichia coli and Klebsiella spp. were the most common organisms). Resistance to second and third generation cephalosporins was present in more than half of isolates and 44% of the Gram-negative isolates were gentamicin-resistant. Mortality rates were similar in hospitalized infants with positive (5/71, 7.0%) and negative blood cultures (42/557, 7.5%).


CONCLUSIONS
This large study of young infants aged 0-59 days demonstrated a broad array of Gram-positive and Gram-negative pathogens responsible for community-acquired bacteremia and substantial levels of antimicrobial resistance. The role of S. aureus as a pathogen is unclear and merits further investigation.
From the *Center for Global Health and Development, Boston University; Department of Global Health, Boston University School of Public Health; †Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; ‡Global Development Division, Bill and Melinda Gates Foundation, Seattle, Washington; §Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia; ¶Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan; ‖Child Health Research Foundation, Dhaka, Bangladesh; **Post Graduate Institute of Medical Education and Research, Chandigarh, India; ††Department of Pediatrics, Hospital del Niño "Dr. Ovidio Aliaga Uría," La Paz, Bolivia; ‡‡Department of Microbiology, All India Institute for Medical Sciences, Delhi, India; §§Department of Paediatrics & Child Health, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; ¶¶Department of Pediatrics, Division of Neonatology, All India Institute for Medical Sciences, Delhi, India; ‖‖Department of Neonatology, Dhaka Shishu Hospital, Dhaka, Bangladesh; ***Department of Pediatrics, Hospital Materno Infantil, La Paz, Bolivia; †††Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; ‡‡‡Sick Kids Center for Global Child Health, Toronto, Canada; §§§School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; ¶¶¶World Health Organization Southeast Asian Regional Office, Delhi, India; and ‖‖‖Members of the YICSS Group are listed in Appendix 2.
Davidson H
DH
Hamer
Gary L
GL
Darmstadt
John B
JB
Carlin
Anita K M
AK
Zaidi
Kojo
K
Yeboah-Antwi
Samir K
SK
Saha
Pallab
P
Ray
Anil
A
Narang
Eduardo
E
Mazzi
Praveen
P
Kumar
Arti
A
Kapil
Prakash M
PM
Jeena
Ashok
A
Deorari
A K Azad
AK
Chowdury
Andrés
A
Bartos
Zulfiqar A
ZA
Bhutta
Yaw
Y
Adu-Sarkodie
Miriam
M
Adhikari
Emmanuel
E
Addo-Yobo
Martin W
MW
Weber
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D001431:Bacteriological Techniques; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D006094:Gram-Positive Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male
D000900:Anti-Bacterial Agents