Najjar Nadine, Gobezayehu Abebe Gebremariam, Hopkins Joseph, Biza Heran, Yakubu Habib, Denny Lindsay, Lijalem Mulusew, Endalamaw Lamesgin Alamineh, Ahmed Yakob S, Tadege Taye Zeru, Endalew Mekuanint Wasihun, Tafere Yichalal Endayehu, Debelew Gurmesa Tura, Stone Erin, Moe Christine L, Cranmer John N
Department of Pediatrics, Emory University, Atlanta, Georgia, United States.
Emory Ethiopia, Amhara Regional Office, Bahir Dar, Ethiopia.
Glob Pediatr. 2025 Sep;13:None. doi: 10.1016/j.gpeds.2025.100268.
Neonatal sepsis is a major contributor to neonatal mortality in low- and middle-income countries. Globally, rapid diagnosis and treatment are often a challenge, and standard antibiotic therapy is threatened by antimicrobial resistance (AMR). This study quantifies the predictors of healthcare-associated neonatal sepsis in Amhara, Ethiopia.
This prospective cohort study recruited normal and low birth weight (LBW) neonates from two hospitals. Neonates with suspected healthcare-associated sepsis had blood cultures drawn to identify the organisms and AMR patterns. We used univariable and multivariable logistic regression to determine risk factors for culture-confirmed sepsis. Next, we performed marginal effects analysis to create a clinical tool for prospectively measuring newborn sepsis risk.
Twenty percent of 605 neonates developed healthcare-associated, culture-confirmed sepsis. 44.9% were resistant to first-line empiric therapy, and only 4% of those who failed first-line drugs had sepsis organisms susceptible to second-line drugs. Multivariable logistic regression identified five primary predictors: LBW (aOR 3.4), twin birth (aOR 4.7), maternal history of preterm births (aOR 2.7) or history of LBW births (aOR 2.6), low family income (aOR 1.7), and birth at the general hospital (aOR 2.5). There were significant differences in sepsis and mortality by facility and birthweight.
Neonatal sepsis and AMR pose significant risk to our study population. Due to the high proportion of AMR and likelihood of treatment failure, developing effective facility-based sepsis prevention strategies is an urgent priority for advancing newborn survival in Amhara, Ethiopia and in similar global contexts.
在低收入和中等收入国家，新生儿败血症是新生儿死亡的主要原因。在全球范围内，快速诊断和治疗往往是一项挑战，标准抗生素疗法受到抗菌药物耐药性（AMR）的威胁。本研究对埃塞俄比亚阿姆哈拉地区医疗保健相关新生儿败血症的预测因素进行了量化。
这项前瞻性队列研究从两家医院招募了正常和低出生体重（LBW）的新生儿。疑似医疗保健相关败血症的新生儿进行血培养以确定病原体和AMR模式。我们使用单变量和多变量逻辑回归来确定血培养确诊败血症的危险因素。接下来，我们进行了边际效应分析，以创建一种前瞻性测量新生儿败血症风险的临床工具。
605名新生儿中有20%发生了医疗保健相关、血培养确诊的败血症。44.9%的患儿对一线经验性治疗耐药，一线药物治疗失败的患儿中只有4%的败血症病原体对二线药物敏感。多变量逻辑回归确定了五个主要预测因素：低出生体重（调整后比值比[aOR]3.4）、双胎分娩（aOR 4.7）、母亲早产史（aOR 2.7）或低出生体重儿出生史（aOR 2.6）、家庭收入低（aOR 1.7）以及在综合医院出生（aOR 2.5）。不同医疗机构和出生体重的败血症及死亡率存在显著差异。
新生儿败血症和AMR对我们的研究人群构成了重大风险。由于AMR比例高且治疗失败可能性大，制定有效的基于医疗机构的败血症预防策略是埃塞俄比亚阿姆哈拉地区及类似全球背景下提高新生儿存活率的当务之急。
