Epidemiology of Early-onset Bacterial Neonatal Infections in Madagascar. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Ranosiarisoa, Zoly Nantenaina; El Harrif, Sélim; Andrianirina, André Zo; Duron, Sandrine; Simon-Ghediri, Marie-José; Ramparany, Lova; Robinson, Annick Lalaina; Tsifiregna, Rosa; Randrianirina, Frédérique; Ratsima, Elisoa; Raymond, Josette; Imbert, Patrick
• Is Part Of: Pediatric infectious disease journal. Volume 38:Issue 1(2019)
• Publication Date: 2019-01
• Subjects: neonatal infection -- Madagascar -- nosocomial -- multidrug resistance -- neonatal asphyxia; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000001993
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: Little is known about early-onset neonatal bacterial infections (EONBI) in Madagascar. Our aim was to determine their epidemiology to improve their management. Methods: Inborn neonates at risk for EONBI and admitted in the neonatal unit of 2 tertiary hospitals in Antananarivo, Madagascar, were included in a prospective study from April 2012 to March 2013. Using a clinical algorithm, blood culture, gastric fluid culture and C-reactive protein dosage were performed in newborns at high risk of infection, that is, peri partum fever, prematurity <35 weeks' gestation or birth weight <2000 g, or presenting with clinical signs of infection. EONBI was defined as a bacteremia occurring within the first week of life. Results: Among 307 neonates, 75 (24.4%) had an EONBI caused by 1 (n = 59) or 2 (n = 16) bacteria (91 isolates). Gram-negative bacteria were predominant (n = 62, 82.7%), including Enterobacter cloacae (n = 26), Klebsiella pneumoniae (n = 14), Escherichia coli (n = 7) and Proteus mirabilis (n = 2). Group B Streptococcus, Acinetobacter baumanii and Enterococcus sp. represented 3.6%, 8.2% and 12.1% of the isolates, respectively. All E. cloacae and 12/14 (85.7%) K. pneumoniae were extended-spectrum β-lactamase producers. At all, 41/91 (45.1%) bacteria were multidrug-resistant (MDR) and 34/75 (45.3%) newborns had an EONBI caused by an MDR bacteria. Neonatal asphyxia was the only factor associated with multidrug resistance (odds ratio: 4.52; CI: 1.20–16.94; P = 0.025). The EONBI-related mortality (n = 20/75, 26.7%) rose up to 38.2% (n = 13/34) in case of MDR bacteria. Conclusions: The epidemiology of EONBIs in Madagascar is comparable to that found in many low-income countries. Prevention, including improvement of hygiene during resuscitation for neonatal asphyxia, is likely to be more effective in reducing EONBI-related morbidity and mortality than using new antibiotics to counter resistance. Abstract : Supplemental Digital Content is available in the text.