Etiology of severe invasive infections in young infants in rural settings in sub-Saharan Africa.
Etiology of severe invasive infections in young infants in rural settings in sub-Saharan Africa.
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DOI：
10.1371/journal.pone.0264322
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Halleux CM
中科院分区：
文献类型：
--
作者：
Mduma E;Halidou T;Kaboré B;Walongo T;Lompo P;Museveni J;Gidabayda J;Gratz J;Guga G;Kimathi C;Liu J;Mdoe P;Moshiro R;Petzold M;Singlovic J;Guillerm M;Gomes MF;Houpt ER;Halleux CM
严重侵袭性感染是新生儿死亡的一个主要原因。缺乏病因数据阻碍了在降低死亡率方面取得进展。本研究旨在确定撒哈拉以南非洲幼儿感染的病原体，并描述其抗生素耐药性。2016年9月至2018年4月期间，我们在布基纳法索和坦桑尼亚的两个农村地区实施了一项观察性研究，招募了0-59天大的严重侵袭性感染的幼儿。血液样本进行了血液培养和分子生物学检查。共有634名临床诊断为严重侵袭性感染的婴儿入组，4.2%的婴儿血培养阳性。血培养检出的最常见病原菌为肺炎克雷伯菌和金黄色葡萄球菌，其次为大肠杆菌。革兰氏阴性分离株仅部分对世卫组织推荐的一线社区新生儿败血症治疗敏感。共有18.6%的婴儿至少有一种病原菌PCR阳性，其中大肠杆菌和金黄色葡萄球菌是最常见的细菌。在纳入的婴儿中，60/634（9.5%）死亡。血培养阳性而PCR不阳性与死亡风险相关。对于大多数死亡，血液培养或分子检测都没有发现病原体，因此致病因子仍不清楚。死亡率与低体温、心动过速、呼吸道症状、抽搐、进食困难史、仅在受到刺激或意识水平降低时才运动、腹泻和/或呕吐有关。虽然肺炎克雷伯菌和金黄色葡萄球菌以及大肠杆菌是临床怀疑有严重侵袭性感染的婴儿中最常发现的病原体，但大多数病例仍然没有明确的诊断，因此迫切需要更准确的诊断工具。即使在非洲农村，对一线抗生素的耐药性也是一个日益严峻的挑战。
Serious invasive infections in newborns are a major cause of death. Lack of data on etiological causes hampers progress towards reduction of mortality. This study aimed to identify pathogens responsible for such infections in young infants in sub-Saharan Africa and to describe their antibiotics resistance profile. Between September 2016 and April 2018 we implemented an observational study in two rural sites in Burkina Faso and Tanzania enrolling young infants aged 0–59 days old with serious invasive infection. Blood samples underwent blood culture and molecular biology. In total 634 infants with clinical diagnosis of serious invasive infection were enrolled and 4.2% of the infants had a positive blood culture. The most frequent pathogens identified by blood culture were Klebsiella pneumonia and Staphylococcus aureus, followed by Escherichia coli. Gram-negative isolates were only partially susceptible to first line WHO recommended treatment for neonatal sepsis at community level. A total of 18.6% of the infants were PCR positive for at least one pathogen and Escherichia coli and Staphylococcus aureus were the most common bacteria detected. Among infants enrolled, 60/634 (9.5%) died. Positive blood culture but not positive PCR was associated with risk of death. For most deaths, no pathogen was identified either by blood culture or molecular testing, and hence a causal agent remained unclear. Mortality was associated with low body temperature, tachycardia, respiratory symptoms, convulsions, history of difficult feeding, movement only when stimulated or reduced level of consciousness, diarrhea and/or vomiting. While Klebsiella pneumonia and Staphylococcus aureus, as well as Escherichia coli were pathogens most frequently identified in infants with clinical suspicion of serious invasive infections, most cases remain without definite diagnosis, making more accurate diagnostic tools urgently needed. Antibiotics resistance to first line antibiotics is an increasing challenge even in rural Africa.
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影响因子：
168.9
作者：
O'Brien, Katherine L.;Levine, Orin S.;Mitchell, Joanne L.
通讯作者：
Mitchell, Joanne L.
影响因子：
168.9
作者：
Liu, Li;Oza, Shefali;Hogan, Dan;Chu, Yue;Perin, Jamie;Zhu, Jun;Lawn, Joy E.;Cousens, Simon;Mathers, Colin;Black, Robert E.
通讯作者：
Black, Robert E.
DOI：
10.1016/s0140-6736(18)31127-9
发表时间：
2018-07-14
期刊：
Lancet (London, England)
影响因子：
--
作者：
Saha SK;Schrag SJ;El Arifeen S;Mullany LC;Shahidul Islam M;Shang N;Qazi SA;Zaidi AKM;Bhutta ZA;Bose A;Panigrahi P;Soofi SB;Connor NE;Mitra DK;Isaac R;Winchell JM;Arvay ML;Islam M;Shafiq Y;Nisar I;Baloch B;Kabir F;Ali M;Diaz MH;Satpathy R;Nanda P;Padhi BK;Parida S;Hotwani A;Hasanuzzaman M;Ahmed S;Belal Hossain M;Ariff S;Ahmed I;Ibne Moin SM;Mahmud A;Waller JL;Rafiqullah I;Quaiyum MA;Begum N;Balaji V;Halen J;Nawshad Uddin Ahmed ASM;Weber MW;Hamer DH;Hibberd PL;Sadeq-Ur Rahman Q;Mogan VR;Hossain T;McGee L;Anandan S;Liu A;Panigrahi K;Abraham AM;Baqui AH
通讯作者：
Baqui AH
影响因子：
168.9
作者：
Carlin, John B.;Darmstadt, Gary L.;Bahl, Rajiv
通讯作者：
Bahl, Rajiv
影响因子：
168.9
作者：
Lawn, Joy E.;Blencowe, Hannah;Cousens, Simon N.
通讯作者：
Cousens, Simon N.