Population-based incidence and etiology of community-acquired neonatal bacteremia in Mirzapur, Bangladesh: an observational study

Abstract

Background: To devise treatment strategies for neonatal infections, the population-level incidence and antibiotic susceptibility of pathogens must be defined.

Methods: Surveillance for suspected neonatal sepsis was conducted in Mirzapur, Bangladesh, from February 2004 through November 2006. Community health workers assessed neonates on postnatal days 0, 2, 5, and 8 and referred sick neonates to a hospital, where blood was collected for culture from neonates with suspected sepsis. We estimated the incidence and pattern of community-acquired neonatal bacteremia and determined the antibiotic susceptibility profile of pathogens.

Results: The incidence rate of community-acquired neonatal bacteremia was 3.0 per 1000 person-neonatal periods. Among the 30 pathogens identified, the most common was Staphylococcus aureus (n = 10); half of all isolates were gram positive. Nine were resistant to ampicillin and gentamicin or to ceftiaxone, and 13 were resistant to cotrimoxazole.

Conclusion: S. aureus was the most common pathogen to cause community-acquired neonatal bacteremia. Nearly 40% of infections were identified on days 0-3, emphasizing the need to address maternal and environmental sources of infection. The combination of parenteral procaine benzyl penicillin and an aminoglycoside is recommended for the first-line treatment of serious community-acquired neonatal infections in rural Bangladesh, which has a moderate level of neonatal mortality. Additional population-based data are needed to further guide national and global strategies.

Trial registration: ClinicalTrials.gov NCT00198627.

Figures

Figure 1

Surveillance profile of community-acquired neonatal sepsis, including 500 blood cultures and 1981 hospital visits for 10,006 neonates born from February 2004 through November 2006 in Mirzapur, Bangladesh. Solid arrows indicate yes, dashed arrows indicate no, shaded ovals indicate neonates, and boxes indicate community health worker (CHW) assessments, hospital visits, or cultures. The referral recommendation (*) was missing in 5 CHW assessments; 2 hospital visits without blood culture were followed after 2 of the 5 assessments. The interval (†) indicates the time between the CHW assessment and the hospital visit. Blood cultures performed on hospitalization days 0–3 only are indicated by a double dagger (‡).