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. 2023 Jul 12;10(8):ofad362.
doi: 10.1093/ofid/ofad362. eCollection 2023 Aug.

Multidrug-Resistant Bacterial Infections Among Very Low Birthweight Infants With Late-Onset Sepsis in Johannesburg, South Africa

Genesis Licona  1 , Daynia Ballot  2 , Troy D Moon  3 , Ritu Banerjee  3 , Gustavo Amorim  4 , Alexander G Agthe  1 , Jörn-Hendrik Weitkamp  1
Affiliations

Multidrug-Resistant Bacterial Infections Among Very Low Birthweight Infants With Late-Onset Sepsis in Johannesburg, South Africa

Genesis Licona et al. Open Forum Infect Dis. .

Abstract

Background: An estimated 2.4 million babies died within the first 28 days of life in 2020. The third leading cause of neonatal death continues to be neonatal sepsis. Sepsis-causing bacterial pathogens vary temporally and geographically and, with a rise in multidrug-resistant organisms (MDROs), pose a threat to the neonatal population.

Methods: This was a single-center, retrospective study of very low birth weight (VLBW) infants with late-onset sepsis (LOS) admitted to a neonatal unit in South Africa. We aimed to calculate the prevalence of multidrug-resistant (MDR) infections in this population. The data collected included demographic and clinical characteristics, length of hospital stay, risk factors for MDRO and mortality, and microbiology results. Logistic regression was used to assess the association between prespecified risk factors with MDR infections and mortality.

Results: Of 2570 VLBW infants admitted, 34% had LOS, of which 33% was caused by MDROs. Infection with Acinetobacter spp., Pseudomonas spp., extended-spectrum beta-lactamase Klebsiella spp., or Escherichia coli was associated with the highest mortality in the LOS cohort. Infants with congenital infections (adjusted odds ratio [aOR], 5.13; 95% CI, 1.19-22.02; P = .028) or a history of necrotizing enterocolitis (aOR, 2.17; 95% CI, 1.05-4.49; P = .037) were at significantly higher risk for MDR infections.

Conclusions: More than one-third of LOS cases in VLBW infants were caused by MDROs in this study. MDR infections cause substantial neonatal mortality. Antimicrobial stewardship programs, infection control protocols, and ongoing surveillance are needed to prevent further emergence and spread of MDR infections worldwide.

Keywords: neonatal sepsis; sub-Saharan Africa; very low birthweigth infants.

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Conflict of interest statement

Potential conflicts of interest. All authors: no reported conflicts.

Figures

Figure 1.
Figure 1.
Pathogen distribution in LOS and MDRO groups. Abbreviations: LOS, late-onset sepsis; MDRO, multidrug-resistant organism.
Figure 2.
Figure 2.
Proportion of deaths in LOS by isolated bacterial pathogens. Abbreviations: ESBL, extended-spectrum beta-lactamase; LOS, late-onset sepsis.
See this image and copyright information in PMC

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