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Clinical predictors of bacteraemia in neonates with suspected early-onset sepsis in Malawi: a prospective cohort study.
de Baat, Tessa; Lester, Rebecca; Ghambi, Lugano; Twabi, Hussein H; Nielsen, Maryke; Gordon, Stephen B; van Weissenbruch, Mirjam M; Feasey, Nicholas A; Dube, Queen; Kawaza, Kondwani; Iroh Tam, Pui-Ying.
Afiliación
  • de Baat T; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi t.debaat@amsterdamumc.nl.
  • Lester R; Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands.
  • Ghambi L; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Twabi HH; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
  • Nielsen M; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Gordon SB; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi.
  • van Weissenbruch MM; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Feasey NA; Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Dube Q; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Kawaza K; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
  • Iroh Tam PY; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
Arch Dis Child ; 108(5): 350-356, 2023 05.
Article en En | MEDLINE | ID: mdl-36549867
OBJECTIVES: We studied neonates with suspected early-onset sepsis (EOS, sepsis developing in the first 72 hours after delivery) in Malawi to (1) describe clinical characteristics and microbiological findings, (2) identify which patient characteristics may be associated with pathogen positivity on blood culture, and (3) describe mortality and its potential determinants. DESIGN: Prospective observational study (May 2018-June 2019). SETTING: Neonatal ward in Queen Elizabeth Central Hospital, the largest government hospital in Malawi. PATIENTS: All neonates with suspected EOS in whom a blood culture was obtained. RESULTS: Out of 4308 neonatal admissions, 1244 (28.9%) had suspected EOS. We included 1149 neonates, of which 109 blood cultures had significant growth (9.5%). The most commonly isolated pathogens were Staphylococcus aureus, Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli and Acinetobacter baumanii. Many of the Gram negatives were extended-spectrum beta lactamase-producing Enterobacteriaceae, and these were 40-100% resistant to first-line and second-line antimicrobials. Gestational age (GA) of <32 weeks was associated with pathogen-positive blood cultures (<28 weeks: adjusted OR (AOR) 2.72, 95% CI 1.04 to 7.13; 28-32 weeks: AOR 2.26, 95% CI 1.21 to 4.21; p=0.005). Mortality was 17.6% (202/1149) and associated with low birth weight (<1000 g: AOR 47.57, 95% CI 12.59 to 179.81; 1000-1500 g: AOR 11.31, 95% CI 6.97 to 18.36; 1500-2500 g: AOR 2.20, 95% CI 1.42 to 3.39; p<0.001), low Apgar scores at 5 min (0-3: AOR 18.60, 95% CI 8.81 to 39.27; 4-6: AOR 4.41, 95% CI 2.81 to 6.93; p<0.001), positive maternal venereal disease research laboratory status (AOR 2.53, 95% CI 1.25 to 5.12; p=0.001) and congenital anomalies (AOR 7.37, 95% CI 3.61 to 15.05; p<0.001). Prolonged rupture of membranes was inversely associated with mortality (AOR 0.43, 95% CI 0.19 to 0.98; p 0.007). CONCLUSION: In Malawi, EOS was suspected in nearly a third of neonatal admissions and had a high mortality. Ten per cent were culture-confirmed and predicted by low GA. To reduce the impact of suspected neonatal sepsis in least developed countries, improved maternal and antenatal care and development of rapid point of care methods to more accurately guide antimicrobial use could simultaneously improve outcome and reduce antimicrobial resistance.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Bacteriemia / Sepsis / Sepsis Neonatal Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies País/Región como asunto: Africa Idioma: En Revista: Arch Dis Child Año: 2023 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Bacteriemia / Sepsis / Sepsis Neonatal Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies País/Región como asunto: Africa Idioma: En Revista: Arch Dis Child Año: 2023 Tipo del documento: Article