Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014-19: a cross-sectional study.
Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014-19: a cross-sectional study.
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DOI：
10.1016/s2214-109x(22)00246-7
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发表时间：
2022-08
影响因子：
34.3
通讯作者：
Govender, Nelesh P.
中科院分区：
文献类型：
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作者：
Mashau, Rudzani C.;Meiring, Susan T.;Dramowski, Angela;Magobo, Rindidzani E.;Quan, Vanessa C.;Perovic, Olga;von Gottberg, Anne;Cohen, Cheryl;Velaphi, Sithembiso;van Schalkwyk, Erika;Govender, Nelesh P.
在撒哈拉以南非洲，几乎没有关于新生儿侵入性感染的人口估计数的报告。我们评估了南非经培养证实的新生儿血流感染和脑膜炎的全国发病风险、病因学和病原体抗菌药物敏感性。我们对2014- 2019年期间在南非256家公共部门卫生机构的新生儿或儿科病房住院的新生儿（<28天）进行了一项横断面研究。从国家病理学数据仓库中提取了2014年1月1日至2019年12月31日的诊断病理学记录。病例定义为14天内至少有一次血液或脑脊液培养阳性的新生儿。发病风险是使用每年登记的活产数量计算的。在已确定的致病病原体中，我们计算了归因于每种病原体的病例比例，以及革兰氏阳性菌和革兰氏阴性菌的抗生素敏感性比率。在43438例阳性培养记录中，有37631例新生儿感染事件，至少分离出一种病原体。 经培养证实的感染的总体发生率风险为每1000例活产6·0（95% CI 6·0-6·1）。晚发型脓毒症（出生后第3-27天）的发病风险为每1000例活产4.9例（4.9 - 5.0），早发型脓毒症（出生后第0-2天）的发病风险为每1000例活产1.1例（1.1 - 1.1）;风险比为4.4（95%CI 4.3 - 4.5）。感染原因因综合征、感染发作时间、设施和省份而异，尽管肺炎克雷伯菌（26%）、鲍曼不动杆菌（13%）和金黄色葡萄球菌（12%）是总体上的主要病原体。在研究期间，革兰氏阴性菌对大多数抗生素的敏感性下降。我们发现晚发性脓毒症的发病率高，各省的差异，肺炎克雷伯菌占优势，革兰氏阴性菌的抗生素敏感性下降。在一个中高收入国家进行的这一全国监测提供了新生儿感染的基线负担，可以据此衡量未来临床和公共卫生干预措施的影响。比尔和梅林达·盖茨基金会。
Few population-level estimates of invasive neonatal infections have been reported from sub-Saharan Africa. We estimated the national incidence risk, aetiology, and pathogen antimicrobial susceptibility for culture-confirmed neonatal bloodstream infections and meningitis in South Africa. We conducted a cross-sectional study of neonates (<28 days of life) admitted to neonatal or paediatric wards of 256 public sector health facilities in South Africa during 2014–19. Diagnostic pathology records from Jan 1, 2014, to Dec 31, 2019, were extracted from a national pathology data warehouse. A case was defined as a neonate with at least one positive blood or cerebrospinal fluid culture during a 14-day period. Incidence risk was calculated using annual numbers of registered livebirths. Among the causative pathogens identified, we calculated the proportion of cases attributed to each of them, as well as the rates of antibiotic susceptibility of Gram-positive and Gram-negative bacteria. Among 43 438 records of positive cultures, there were 37 631 incident cases of neonatal infection with at least one pathogen isolated. The overall incidence risk of culture-confirmed infections was 6·0 per 1000 livebirths (95% CI 6·0–6·1). The incidence risk of late-onset sepsis (days 3–27 of life) was 4·9 per 1000 livebirths (4·9–5·0) and that of early-onset sepsis (days 0–2 of life) was 1·1 per 1000 livebirths (1·1–1·1); risk ratio 4·4 (95% CI 4·3–4·5). The cause of infection differed by syndrome, timing of infection onset, facility, and province, although Klebsiella pneumoniae (26%), Acinetobacter baumannii (13%), and Staphylococcus aureus (12%) were the dominant pathogens overall. Gram-negative bacteria had declining susceptibility to most antibiotics over the study period. We found a high incidence risk of late-onset sepsis with provincial variations, predominance of K pneumoniae, and declining antibiotic susceptibility among Gram-negative bacteria. This national surveillance in an upper-middle-income country provides a baseline burden of neonatal infections against which the impact of future clinical and public health interventions can be measured. Bill & Melinda Gates Foundation.