A cross-sectional study was conducted in nine neonatal units in the Western Cape Province, South Africa between 2017 and 2018 to investigate the epidemiology of healthcare-associated bloodstream infection (HA-BSI) in this region. The analysis was based on clinical and laboratory records from central, regional and district hospitals covering a total of 416 beds.
The objective was to assess patient demographics, HA-BSI incidence, causative pathogen spectrum, hospital outcomes, and empiric antibiotic coverage rates. In this two-year span, 23,748 neonates were admitted to these units. A total of 485 HA-BSI episodes with the median onset at 11 days of life occurred, primarily affecting the very low birth weight neonates (< 1500 g).
The overall HA-BSI rate was determined to be 2.0/1000 patient days, the highest prevalence of which was observed in the central unit with on-site surgical facilities (​3.8/1000 patient days). Crude HA-BSI mortality was 31.8%, with an alarming two-thirds of deaths happening within three days after the onset of BSI. A higher mortality rate was observed for neonates with Gram-negative/fungal BSI and notably preterm neonates. The findings also highlighted the need for annual review of empiric antibiotic regimens as increasing resistance to carbapenem was observed.
Furthermore, this study divulges a stark disparity in the regional distribution of neonatal deaths, with 80% occurring in Sub-Saharan Africa and South Asia. HA-BSI adds significantly to infection-related neonatal deaths, accentuating the urgent need for adequate measures for infection prevention and control (IPC) and heightened surveillance, especially in low- and middle-income countries (LMIC).
Source: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-10219-0