Neonatal nosocomial bloodstream infections at a referral hospital in a middle-income country: burden, pathogens, antimicrobial resistance and mortality.
BACKGROUND
Data on nosocomial bloodstream infection (BSI) rates, pathogens, mortality and antimicrobial resistance in African neonates are limited.


METHODS
Nosocomial neonatal BSI at Tygerberg Hospital, Cape Town were retrospectively reviewed between 1 January 2009 and 31 December 2013. Laboratory and hospital data were used to determine BSI rates, pathogen profile, mortality and antimicrobial resistance in selected nosocomial pathogens.


RESULTS
Of 6521 blood cultures taken over 5 years, 1145 (17.6%) were culture-positive, and 717 (62.6%) discrete nosocomial BSI episodes were identified. Nosocomial BSI rates remained unchanged over time (overall 3.9/1000 patient days, 95% CI 3.6-4.2, χ(2) for trend P = 0.23). Contamination rates were relatively high (5.1%, 95% CI 4.6-5.7%). Among BSI pathogens, Gram-negatives predominated (65% vs 31% Gram-positives and 4% fungal); Klebsiella pneumoniae (235, 30%), Staphylococcus aureus (112, 14%) and Enterococci (88, 11%) were most prevalent. Overall crude BSI mortality was 16% (112/717); Gram-negative BSI was significantly associated with mortality (P = 0.007). Mortality occurred mostly in neonates of very low (33/112, 29%) or extremely low (53/112, 47%) birthweight. Deaths attributed to nosocomial BSI declined significantly over time (χ(2) for trend P = 0.01). The prevalence of antibiotic-resistant pathogens was high: methicillin-resistant Staphylococcus aureus 66%, multidrug-resistant A. baumanni 90% and extended-spectrum β-lactamase-producing K. pneumoniae 73%.


CONCLUSIONS
The burden of nosocomial neonatal BSI at this middle-income country referral neonatal unit is substantial and remained unchanged over the study period, although attributable mortality declined significantly. Nosocomial BSI pathogens exhibited high levels of antimicrobial resistance.
Angela
A
Dramowski
Ayanda
A
Madide
Adrie
A
Bekker
D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005658:Fungi / Q000145:classification / Q000302:isolation & purification*; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D015995:Prevalence; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis
Antimicrobial resistance; Bloodstream infection,; Healthcare-associated infection,; Hospital-acquired infection,; Neonates,; Nosocomial,; Sepsis,