Epidemiology of healthcare-associated bloodstream infection in South African neonatal units.

BACKGROUND

Reports of healthcare-associated bloodstream infection (HA-BSI) epidemiology in African neonatal units are limited.

METHODS

We conducted a cross-sectional study (2017-2018) in nine neonatal units in the Western Cape Province, South Africa, including central, regional and district hospitals (416 beds) using laboratory and clinical records. Patient demographics, HA-BSI rates, pathogen spectrum, and hospital outcomes and empiric antibiotic coverage rates were determined.

RESULTS

Over two years, 23,748 neonates were admitted with unit occupancy rates ranging from 79 to 93%. 485 HA-BSI episodes occurred, with median onset at 11 (IQR 7-24) days of life. Most HA-BSI episodes (348; 72%) affected very low birth weight neonates (< 1500 g). The overall HA-BSI rate was 2.0/1000 patient days. The highest HA-BSI rate was observed at the central unit with onsite surgery (3.8/1000 patient days). Crude HA-BSI mortality was 31.8% (154/485) with two-thirds of deaths occurring within three days of BSI onset. Higher mortality was observed for Gram-negative/fungal BSI compared to Gram-positive BSI (RR 1.5; 95%CI 1.1-2.0; p = 0.01) and very preterm neonates (gestation < 32 weeks) versus ≥ 32 weeks (RR 1.5; 95%CI 1.1-2.1; p = 0.01). Mean estimated empiric antibiotic coverage rates varied by unit type: 66-79% for piperacillin-tazobactam plus amikacin, 60-76% for meropenem and 84-92% for meropenem plus vancomycin.

CONCLUSION

Most HA-BSI events affected preterm neonates at the central hospital with onsite surgery. One-third of patients with HA-BSI died, with highest mortality in preterm infants and Gram-negative/fungal BSI. Empiric antibiotic regimens provide moderate coverage of circulating pathogens but require annual review given increasing carbapenem resistance rates.