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Assessment of Intestinal Transcytosis of Neonatal Escherichia coli Bacteremia Isolates
Published on: February 17, 2023
Etiology of bacteremia in young infants in six countries
Davidson H Hamer1, Gary L Darmstadt, John B Carlin
1From the *Center for Global Health and Development, Boston University; Department of Global Health, Boston University School of Public Health; †Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; ‡Global Development Division, Bill and Melinda Gates Foundation, Seattle, Washington; §Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia; ¶Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan; ‖Child Health Research Foundation, Dhaka, Bangladesh; **Post Graduate Institute of Medical Education and Research, Chandigarh, India; ††Department of Pediatrics, Hospital del Niño "Dr. Ovidio Aliaga Uría," La Paz, Bolivia; ‡‡Department of Microbiology, All India Institute for Medical Sciences, Delhi, India; §§Department of Paediatrics & Child Health, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; ¶¶Department of Pediatrics, Division of Neonatology, All India Institute for Medical Sciences, Delhi, India; ‖‖Department of Neonatology, Dhaka Shishu Hospital, Dhaka, Bangladesh; ***Department of Pediatrics, Hospital Materno Infantil, La Paz, Bolivia; †††Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; ‡‡‡Sick Kids Center for Global Child Health, Toronto, Canada; §§§School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; ¶¶¶World Health Organization Southeast Asian Regional Office, Delhi, India; and ‖‖‖Members of the YICSS Group are listed in Appendix 2.
Insights
Neonatal illness and sepsis are major global threats. This study identified diverse bacterial pathogens causing bloodstream infections in infants across six countries, revealing significant antimicrobial resistance. Further research is needed on Staphylococcus aureus.
Area of Science:
- Global Health
- Infectious Diseases
- Neonatology
Background:
- Neonatal illness is a significant cause of mortality worldwide, with sepsis being a primary contributor.
- The specific causes of community-acquired bloodstream infections (bacteremia) in newborns in developing nations remain poorly understood.
Purpose of the Study:
- To characterize the etiologies of community-acquired bacteremia in infants younger than two months in six developing countries.
- To assess the antimicrobial resistance patterns of identified pathogens.
Main Methods:
- A prospective study involving infants under two months of age presenting with illness at healthcare facilities in Bangladesh, Bolivia, Ghana, India, Pakistan, and South Africa.
- Blood cultures were obtained from hospitalized infants, and bacterial organisms were isolated using standard microbiological techniques.
Main Results:
- Out of 8,889 infants, 10.7% underwent blood culturing. Pathogens were identified in 10.6% of these infants.
- Staphylococcus aureus was the most frequently isolated Gram-positive pathogen, while Gram-negative bacilli (Acinetobacter spp., Escherichia coli, Klebsiella spp.) were also common.
- Over half of the isolates showed resistance to second and third-generation cephalosporins, and 44% of Gram-negative isolates were resistant to gentamicin.
Conclusions:
- This study highlights a wide range of Gram-positive and Gram-negative bacteria causing community-acquired bacteremia in young infants.
- Significant antimicrobial resistance was observed, posing a challenge for treatment.
- The etiological role of Staphylococcus aureus requires further investigation.
Background:
Neonatal illness is a leading cause of death worldwide; sepsis is one of the main contributors. The etiologies of community-acquired neonatal bacteremia in developing countries have not been well characterized.
Methods:
Infants <2 months of age brought with illness to selected health facilities in Bangladesh, Bolivia, Ghana, India, Pakistan and South Africa were evaluated, and blood cultures taken if they were considered ill enough to be admitted to hospital. Organisms were isolated using standard culture techniques.
Results:
Eight thousand eight hundred and eighty-nine infants were recruited, including 3177 0-6 days of age and 5712 7-59 days of age; 10.7% (947/8889) had a blood culture performed. Of those requiring hospital management, 782 (54%) had blood cultures performed. Probable or definite pathogens were identified in 10.6% including 10.4% of newborns 0-6 days of age (44/424) and 10.9% of infants 7-59 days of age (39/358). Staphylococcus aureus was the most commonly isolated species (36/83, 43.4%) followed by various species of Gram-negative bacilli (39/83, 46.9%; Acinetobacter spp., Escherichia coli and Klebsiella spp. were the most common organisms). Resistance to second and third generation cephalosporins was present in more than half of isolates and 44% of the Gram-negative isolates were gentamicin-resistant. Mortality rates were similar in hospitalized infants with positive (5/71, 7.0%) and negative blood cultures (42/557, 7.5%).
Conclusions:
This large study of young infants aged 0-59 days demonstrated a broad array of Gram-positive and Gram-negative pathogens responsible for community-acquired bacteremia and substantial levels of antimicrobial resistance. The role of S. aureus as a pathogen is unclear and merits further investigation.
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