title: Etiology, Antibiotic Resistance and Risk Factors for Neonatal Sepsis in a Large Referral Center in Zambia.
abstract: BACKGROUND
  In sub-Saharan Africa, there is scanty data on the causes of neonatal sepsis and antimicrobial resistance among common invasive pathogens that might guide policy and practice.
  
  
  METHODS
  A cross-sectional observational prevalence and etiology study of neonates with suspected sepsis admitted to the neonatal intensive care unit, University Teaching Hospital, Lusaka, Zambia, between October 2013 and May 2014. Data from blood cultures and phenotypic antibiotic susceptibility testing were compared with multivariate analysis of risk factors for neonatal sepsis.
  
  
  RESULTS
  Of 313 neonates with suspected sepsis, 54% (170/313) were male; 20% (62/313) were born to HIV-positive mothers; 33% (103/313) had positive blood cultures, of which 85% (88/103) were early-onset sepsis. Klebsiella species was the most prevalent isolate, accounting for 75% (77/103) of cases, followed by coagulase-negative staphylococci [6% (7/103)], Staphylococcus aureus [6% (6/103)], Escherichia coli [5% (5/103)] and Candida species [5% (5/103)]. For Klebsiella species, antibiotic resistance ranged from 96%-99% for World Health Organization-recommended first-line therapy (gentamicin and ampicillin/penicillin) to 94%-97% for third-generation cephalosporins. The prevalence of culture-confirmed sepsis increased from 0 to 39% during the period December 2013 to March 2014, during which time mortality increased 29%-47%; 93% (14/15) of late-onset sepsis and 82% (37/45) of early-onset sepsis aged 4-7 days were admitted >2 days before the onset of symptoms. Culture results for only 25% (26/103) of cases were available before discharge or death. Maternal HIV infection was associated with a reduced risk of neonatal sepsis [odds ratio, 0.46 (0.23-0.93); P = 0.029].
  
  
  CONCLUSIONS
  Outbreaks of nosocomial multiantibiotic-resistant infections are an important cause of neonatal sepsis and associated mortality. Reduced risk of neonatal sepsis associated with maternal HIV infection is counterintuitive and requires further investigation.
authors.affiliation: From the *UNZA-UCLMS Research and Training Programme, University Teaching Hospital, Lusaka, Zambia; †HerpeZ, ‡Department of Pathology and Microbiology, and §Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia; ¶Division of Infection and Immunity, University College London, United Kingdom; ‖Harvard Medical School, Boston, Massachusetts; **Zambia Centre for Applied Health Research and Development, Boston, Massachusetts; ††Center for Global Health and Development, Boston University School of Public Health (BUSPH), Boston, Massachusetts; ‡‡Department of Global Health, Boston, Massachusetts; §§Department of Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia; ¶¶Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London and Great Ormond Street Hospital, London, United Kingdom; ‖‖Therapeutic Immunology, Departments of Laboratory Medicine and Microbiology, Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden; and ***Department of Infection, Immunity and Inflammation, NIHR Biomedical Research Centre, University College London Hospitals, London, United Kingdom.
authors.forename: Mwila
authors.initials: M
authors.lastname: Kabwe
authors.forename: John
authors.initials: J
authors.lastname: Tembo
authors.forename: Lophina
authors.initials: L
authors.lastname: Chilukutu
authors.forename: Moses
authors.initials: M
authors.lastname: Chilufya
authors.forename: Francis
authors.initials: F
authors.lastname: Ngulube
authors.forename: Chileshe
authors.initials: C
authors.lastname: Lukwesa
authors.forename: Monica
authors.initials: M
authors.lastname: Kapasa
authors.forename: Virve
authors.initials: V
authors.lastname: Enne
authors.forename: Hannah
authors.initials: H
authors.lastname: Wexner
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mwananyanda
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.forename: Sylvestor
authors.initials: S
authors.lastname: Sinyangwe
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Ahmed
authors.forename: Nigel
authors.initials: N
authors.lastname: Klein
authors.forename: Markus
authors.initials: M
authors.lastname: Maeurer
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
authors.forename: Matthew
authors.initials: M
authors.lastname: Bates
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008826:Microbial Sensitivity Tests; D000071074:Neonatal Sepsis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D011247:Pregnancy; D015995:Prevalence; D012017:Referral and Consultation; D012307:Risk Factors; D015024:Zambia / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents