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. 2024 Nov 26;24(1):1350.
doi: 10.1186/s12879-024-10219-0.

Epidemiology of healthcare-associated bloodstream infection in South African neonatal units

Angela Dramowski  1 , Larisse Bolton  2 , Adrie Bekker  3 , Arnoldus Engelbrecht  4 , Louisa Erasmus  3 , Aaqilah Fataar  3 , Chandre Geldenhuys  5 , Marlize Kunneke  4 , Dave Le Roux  6 , Natasha O' Connell  7 , Kessendri Reddy  8 , Natasha Rhoda  9   10 , Lloyd Tooke  10   11 , Mark Wates  12 , Thandi Wessels  3 , Cari van Schalkwyk  2 , Andrew Whitelaw  8
Affiliations

Epidemiology of healthcare-associated bloodstream infection in South African neonatal units

Angela Dramowski et al. BMC Infect Dis. .

Abstract

Background: Reports of healthcare-associated bloodstream infection (HA-BSI) epidemiology in African neonatal units are limited.

Methods: We conducted a cross-sectional study (2017-2018) in nine neonatal units in the Western Cape Province, South Africa, including central, regional and district hospitals (416 beds) using laboratory and clinical records. Patient demographics, HA-BSI rates, pathogen spectrum, and hospital outcomes and empiric antibiotic coverage rates were determined.

Results: Over two years, 23,748 neonates were admitted with unit occupancy rates ranging from 79 to 93%. 485 HA-BSI episodes occurred, with median onset at 11 (IQR 7-24) days of life. Most HA-BSI episodes (348; 72%) affected very low birth weight neonates (< 1500 g). The overall HA-BSI rate was 2.0/1000 patient days. The highest HA-BSI rate was observed at the central unit with onsite surgery (3.8/1000 patient days). Crude HA-BSI mortality was 31.8% (154/485) with two-thirds of deaths occurring within three days of BSI onset. Higher mortality was observed for Gram-negative/fungal BSI compared to Gram-positive BSI (RR 1.5; 95%CI 1.1-2.0; p = 0.01) and very preterm neonates (gestation < 32 weeks) versus ≥ 32 weeks (RR 1.5; 95%CI 1.1-2.1; p = 0.01). Mean estimated empiric antibiotic coverage rates varied by unit type: 66-79% for piperacillin-tazobactam plus amikacin, 60-76% for meropenem and 84-92% for meropenem plus vancomycin.

Conclusion: Most HA-BSI events affected preterm neonates at the central hospital with onsite surgery. One-third of patients with HA-BSI died, with highest mortality in preterm infants and Gram-negative/fungal BSI. Empiric antibiotic regimens provide moderate coverage of circulating pathogens but require annual review given increasing carbapenem resistance rates.

Keywords: Antimicrobial resistance; Bloodstream infection; Healthcare-associated infection; Hospital-acquired infection; Neonatal intensive care unit; Neonate; Nosocomial; Sepsis.

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Conflict of interest statement

Declarations. Ethical approval: The Stellenbosch University Health Research Ethics Committee (SU HREC) and the Tygerberg Hospital management reviewed and approved the study protocol SU HREC approvals (N18/07/068, N20/07/070), in accordance with the Declaration of Helsinki standards. The Stellenbosch University Health Research Ethics Committee (SU HREC) approved a waiver of individual informed consent for the retrospective analysis of neonatal bloodstream infection data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Healthcare-associated bloodstream infection (HA-BSI) episodes by birth weight category and postnatal age (n = 485)
Fig. 2
Fig. 2
Coverage estimates for empiric antibiotic regimens for healthcare-associated bloodstream infection (HA-BSI) in Western Cape neonatal units (2017–2018)
See this image and copyright information in PMC

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