Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Levels & trends in Child Mortality: Report 2022, estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation. New York: United Nations Children’s Fund; 2023.
    1. Levels & Trends in Child Mortality. Report 2020. United Nations Children’s Fund, The (UNICEF); 2020.
    1. Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2017;389(10082):1884. - PMC - PubMed
    1. Sass L, Karlowicz MG. Healthcare-Associated Infections in the Neonate. Principles and Practice of Pediatric Infectious Diseases. 2018;560-566.e3. doi:10.1016/B978-0-323-40181-4.00094-3
    1. Zingg W, Posfay-Barbe KM, Pittet D. Healthcare-associated infections in neonates. Curr Opin Infect Dis. 2008;21(3):228–34. - PubMed

Substances

LinkOut - more resources