Neonatal bloodstream infection in a resource-limited setting

Healthcare-associated infections (HAI) remain a major challenge in neonatal intensive care units (NICU), particularly in resource-limited settings. The combination of high neonatal vulnerability and the rise of multidrug-resistant organisms substantially increases morbidity, mortality, and healthcare costs.

This study aimed to describe the epidemiological, clinical, and bacteriological characteristics of HAI in a neonatal intensive care unit of a developing country, to assess associated morbidity and mortality.

A retrospective analytical study was conducted over three years (November 2020-November 2023) in the Neonatology Department of Hédi Chaker University Hospital, a level III referral center in Tunisia. All neonates hospitalized for ≥48 h with clinically or biologically suspected HAIs confirmed by positive blood culture were included.

Among 4382 hospitalized neonates, 82 cases of HAI were identified. Preterm (85.4%) and low-birth-weight (82.9%) infants were the most affected. The main clinical signs were altered skin color (68.3%) and hemodynamic instability (65.8%). Gram-negative bacilli accounted for 93.9% of all isolates, with Klebsiella pneumoniae being the predominant pathogen (57 cases, 69.5%), showing multidrug resistance in 91.2% of isolates. Empirical therapy most often combined imipenem and amikacin (46.3%). The overall mortality rate was 58.5%, significantly associated with hemodynamic instability and birth weight <1400 g.

HAI remains a serious issue in resource-limited settings, driven by high antimicrobial resistance and specific vulnerability factors. Strengthening infection prevention protocols and multidisciplinary surveillance is crucial to reduce morbidity and mortality.