Davies Hannah G, Kyohere Mary, Tusubira Valerie, Amone Alexander, Wamawobe Amusa, Komugisha Cleophas, Musoke Philippa, Hookham Lauren, Ravji Pooja, Etti Melanie, Nsimire Sendagala Juliet, Shelley Dan R, Farley Caitlin, Voysey Merryn, Spiller Owen B, Peacock Joseph, Sekikubo Musa, Heath Paul T, Le Doare Kirsty
Institute for Infection and Immunity, St George's, University of London, London, UK.
Makerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.
Open Forum Infect Dis. 2025 Mar 10;11(Suppl 3):S157-S164. doi: 10.1093/ofid/ofae629. eCollection 2024 Dec.
Epidemiological evidence about the etiology and antimicrobial resistance of neonatal infections remains limited in low-resource settings. We aimed to describe the etiology of neonatal infections in a prospective observational cohort study conducted at two hospital sites in Kampala, Uganda.
Babies admitted to either unit with risk factors or signs of sepsis, pneumonia, or meningitis had a blood culture, nasopharyngeal swab, and lumbar puncture (if indicated) collected. Basic demographics were collected, and babies were followed up until discharge or death to determine admission outcome. Blood cultures were processed using the BACTEC system and identification confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Cerebrospinal fluid was processed using standard microbiological testing and swabs were processed using the multiplex real-time polymerase chain reaction assay. Antimicrobial susceptibilities of bacterial isolates to World Health Organization-recommended first-line antibiotics (ampicillin or benzylpenicillin and gentamicin) were assessed using e-tests.
A total of 7323 infants with signs or risk factors for sepsis had blood cultures, 2563 had nasopharyngeal swabs, and 23 had lumbar punctures collected. Eleven percent of blood cultures and 8.6% of swabs were positive. Inpatient mortality was 12.1%, with 27.7% case fatality observed among infants with Gram-negative bloodstream infections. (14.8%), spp. (10.3%), and spp. (7.6%), were notable contributors to Gram-negative sepsis, whereas Group B was the predominant Gram-positive pathogen identified (13.5%). Almost 60% of Gram-negative pathogens were ampicillin- and gentamicin-resistant.
Our study demonstrates high levels of antimicrobial resistance and inpatient mortality from neonatal sepsis in the first months of life in Uganda. This underscores the pressing need for revised, context-specific antimicrobial treatment guidelines that account for the evolving landscape of antimicrobial resistance in neonatal sepsis.
在资源匮乏地区，关于新生儿感染的病因及抗菌药物耐药性的流行病学证据仍然有限。我们旨在通过在乌干达坎帕拉的两个医院开展的一项前瞻性观察队列研究，描述新生儿感染的病因。
入住任一科室且有败血症、肺炎或脑膜炎危险因素或体征的婴儿，均采集血培养、鼻咽拭子样本，如有指征则进行腰椎穿刺。收集基本人口统计学数据，并对婴儿进行随访直至出院或死亡，以确定入院结局。血培养采用BACTEC系统进行处理，鉴定通过基质辅助激光解吸电离飞行时间质谱法确认。脑脊液采用标准微生物检测方法进行处理，拭子采用多重实时聚合酶链反应检测法进行处理。使用E-test评估细菌分离株对世界卫生组织推荐的一线抗生素（氨苄西林或苄青霉素和庆大霉素）的药敏情况。
共有7323名有败血症体征或危险因素的婴儿接受了血培养，2563名接受了鼻咽拭子样本采集，23名接受了腰椎穿刺。11%的血培养样本和8.6%的拭子样本呈阳性。住院死亡率为12.1%，革兰氏阴性血流感染婴儿的病死率为27.7%。 （14.8%）、 属（10.3%）和 属（7.6%）是革兰氏阴性败血症的重要致病菌，而B组 是鉴定出的主要革兰氏阳性病原体（13.5%）。近60%的革兰氏阴性病原体对氨苄西林和庆大霉素耐药。
我们的研究表明，在乌干达，新生儿败血症在出生后的头几个月里抗菌药物耐药水平高且住院死亡率高。这凸显了迫切需要修订针对具体情况的抗菌治疗指南，以应对新生儿败血症中不断变化的抗菌药物耐药形势。
