Population-based incidence and etiology of community-acquired neonatal bacteremia in Mirzapur, Bangladesh: an observational study
Gary L Darmstadt, Samir K Saha, Yoonjoung Choi, Shams El Arifeen, Nawshad Uddin Ahmed, Sanwarul Bari, Syed M Rahman, Ishtiaq Mannan, Derrick Crook, Kaniz Fatima, Peter J Winch, Habibur Rahman Seraji, Nazma Begum, Radwanur Rahman, Maksuda Islam, Anisur Rahman, Robert E Black, Mathuram Santosham, Emma Sacks, Abdullah H Baqui, Bangladesh Projahnmo-2 (Mirzapur) Study Group, Nawshad Uddin Ahmed, Saifuddin Ahmed, Nabeel Ashraf Ali, Abdullah H Baqui, Nazma Begum, Sanwarul Bari, Robert E Black, Atique Iqbal Chowdhury, Derrick Crook, Gary L Darmstadt, Shams El Arifeen, Fazlul Haque, Zahid Hasan, Amnesty LeFevre, Ishtiaq Mannan, Anisur Rahman, Qazi Sadequr Rahman, Radwanur Rahman, Syed Moshfiqur Rahman, Taufiqur Rahman, Samir K Saha, Mathuram Santosham, Habibur Rahman Seraji, Ashrafuddin Siddik, Hugh Waters, Peter J Winch, K Zaman, Gary L Darmstadt, Samir K Saha, Yoonjoung Choi, Shams El Arifeen, Nawshad Uddin Ahmed, Sanwarul Bari, Syed M Rahman, Ishtiaq Mannan, Derrick Crook, Kaniz Fatima, Peter J Winch, Habibur Rahman Seraji, Nazma Begum, Radwanur Rahman, Maksuda Islam, Anisur Rahman, Robert E Black, Mathuram Santosham, Emma Sacks, Abdullah H Baqui, Bangladesh Projahnmo-2 (Mirzapur) Study Group, Nawshad Uddin Ahmed, Saifuddin Ahmed, Nabeel Ashraf Ali, Abdullah H Baqui, Nazma Begum, Sanwarul Bari, Robert E Black, Atique Iqbal Chowdhury, Derrick Crook, Gary L Darmstadt, Shams El Arifeen, Fazlul Haque, Zahid Hasan, Amnesty LeFevre, Ishtiaq Mannan, Anisur Rahman, Qazi Sadequr Rahman, Radwanur Rahman, Syed Moshfiqur Rahman, Taufiqur Rahman, Samir K Saha, Mathuram Santosham, Habibur Rahman Seraji, Ashrafuddin Siddik, Hugh Waters, Peter J Winch, K Zaman
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.
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Source: PubMed