Department of Microbiology, Child Health Research Foundation, Dhaka, Bangladesh
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
BMJ Glob Health. 2022 Nov;7(11). doi: 10.1136/bmjgh-2022-009706.
Risk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying risk factors for infection could lead to improved preventive measures and antibiotic stewardship.
Five sites in Bangladesh, India and Pakistan enrolled mother-child pairs via population-based pregnancy surveillance by community health workers. Medical, sociodemographic and epidemiological risk factor data were collected. Young infants aged 0-59 days with signs of possible serious bacterial infection (pSBI) and age-matched controls provided blood and respiratory specimens that were analysed by blood culture and real-time PCR. These tests were used to build a Bayesian partial latent class model (PLCM) capable of attributing the probable cause of each infant's infection in the ANISA study. The collected risk factors from all mother-child pairs were classified and analysed against the PLCM using bivariate and stepwise logistic multivariable regression modelling to determine risk factors of probable bacterial infection.
Among 63 114 infants born, 14 655 were assessed and 6022 had signs of pSBI; of these, 81% (4859) provided blood samples for culture, 71% (4216) provided blood samples for quantitative PCR (qPCR) and 86% (5209) provided respiratory qPCR samples. Risk factors associated with bacterial-attributed infections included: low (relative risk (RR) 1.73, 95% credible interval (CrI) 1.42 to 2.11) and very low birth weight (RR 5.77, 95% CrI 3.73 to 8.94), male sex (RR 1.27, 95% CrI 1.07 to 1.52), breathing problems at birth (RR 2.50, 95% CrI 1.96 to 3.18), premature rupture of membranes (PROMs) (RR 1.27, 95% CrI 1.03 to 1.58) and being in the lowest three socioeconomic status quintiles (first RR 1.52, 95% CrI 1.07 to 2.16; second RR 1.41, 95% CrI 1.00 to 1.97; third RR 1.42, 95% CrI 1.01 to 1.99).
Distinct risk factors: birth weight, male sex, breathing problems at birth and PROM were significantly associated with the development of bacterial sepsis across South Asian community settings, supporting refined clinical discernment and targeted use of antimicrobials.
在南亚，导致婴儿在生命头 2 个月发生社区获得性细菌感染的危险因素了解甚少。确定感染的危险因素可以导致改进预防措施和抗生素管理。
通过社区卫生工作者进行基于人群的妊娠监测，在孟加拉国、印度和巴基斯坦的 5 个地点招募母婴对。收集医学、社会人口统计学和流行病学危险因素数据。0-59 日龄有疑似严重细菌性感染（pSBI）体征的婴儿和年龄匹配的对照婴儿提供血液和呼吸道标本，由血培养和实时 PCR 进行分析。这些测试用于构建贝叶斯部分潜在类别模型（PLCM），该模型能够归因于 ANISA 研究中每个婴儿感染的可能原因。对所有母婴对收集的危险因素进行分类，并使用双变量和逐步逻辑多变量回归模型对 PLCM 进行分析，以确定可能的细菌性感染的危险因素。
在出生的 63114 名婴儿中，评估了 14655 名婴儿，其中 6022 名有 pSBI 体征；其中，81%（4859 名）提供了血液样本进行培养，71%（4216 名）提供了血液样本进行定量 PCR（qPCR），86%（5209 名）提供了呼吸道 qPCR 样本。与细菌性感染相关的危险因素包括：低体重（相对风险（RR）1.73，95%置信区间（CrI）1.42-2.11）和极低出生体重（RR 5.77，95% CrI 3.73-8.94）、男性（RR 1.27，95% CrI 1.07-1.52）、出生时呼吸问题（RR 2.50，95% CrI 1.96-3.18）、胎膜早破（PROM）（RR 1.27，95% CrI 1.03-1.58）和处于最低三个社会经济地位五分位数（第一 RR 1.52，95% CrI 1.07-2.16；第二 RR 1.41，95% CrI 1.00-1.97；第三 RR 1.42，95% CrI 1.01-1.99）。
在南亚社区环境中，出生体重、男性、出生时呼吸问题和 PROM 等明显不同的危险因素与细菌性败血症的发展显著相关，支持更精细的临床鉴别和针对性使用抗生素。
