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Clinical predictors of bacteraemia in neonates with suspected early-onset sepsis in Malawi: a prospective cohort study

de Baat, Tessa, Lester, Rebecca ORCID:, Ghambi, Lugano, Twabi, Hussein H, Nielsen, Maryke, Gordon, Stephen ORCID:, van Weissenbruch, Mirjam M, Feasey, Nicholas ORCID:, Dube, Queen, Kawaza, Kondwani and Iroh Tam, Pui-Ying ORCID: (2022) 'Clinical predictors of bacteraemia in neonates with suspected early-onset sepsis in Malawi: a prospective cohort study'. Archives of Disease in Childhood, Vol 108, Issue 5, pp. 350-356.

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We studied neonates with suspected early-onset sepsis (EOS, sepsis developing in the first 72 hours after delivery) in Malawi to (1) describe clinical characteristics and microbiological findings, (2) identify which patient characteristics may be associated with pathogen positivity on blood culture, and (3) describe mortality and its potential determinants.

Prospective observational study (May 2018–June 2019).SettingNeonatal ward in Queen Elizabeth Central Hospital, the largest government hospital in Malawi.PatientsAll neonates with suspected EOS in whom a blood culture was obtained.

Out of 4308 neonatal admissions, 1244 (28.9%) had suspected EOS. We included 1149 neonates, of which 109 blood cultures had significant growth (9.5%). The most commonly isolated pathogens wereStaphylococcus aureus,Klebsiella pneumoniae,Enterobacter cloacae,Escherichia coliandAcinetobacter baumanii. Many of the Gram negatives were extended-spectrum beta lactamase-producing Enterobacteriaceae, and these were 40–100% resistant to first-line and second-line antimicrobials. Gestational age (GA) of <32 weeks was associated with pathogen-positive blood cultures (<28 weeks: adjusted OR (AOR) 2.72, 95% CI 1.04 to 7.13; 28–32 weeks: AOR 2.26, 95% CI 1.21 to 4.21; p=0.005). Mortality was 17.6% (202/1149) and associated with low birth weight (<1000 g: AOR 47.57, 95% CI 12.59 to 179.81; 1000–1500 g: AOR 11.31, 95% CI 6.97 to 18.36; 1500–2500 g: AOR 2.20, 95% CI 1.42 to 3.39; p<0.001), low Apgar scores at 5 min (0–3: AOR 18.60, 95% CI 8.81 to 39.27; 4–6: AOR 4.41, 95% CI 2.81 to 6.93; p<0.001), positive maternal venereal disease research laboratory status (AOR 2.53, 95% CI 1.25 to 5.12; p=0.001) and congenital anomalies (AOR 7.37, 95% CI 3.61 to 15.05; p<0.001). Prolonged rupture of membranes was inversely associated with mortality (AOR 0.43, 95% CI 0.19 to 0.98; p 0.007).

In Malawi, EOS was suspected in nearly a third of neonatal admissions and had a high mortality. Ten per cent were culture-confirmed and predicted by low GA. To reduce the impact of suspected neonatal sepsis in least developed countries, improved maternal and antenatal care and development of rapid point of care methods to more accurately guide antimicrobial use could simultaneously improve outcome and reduce antimicrobial resistance.

Item Type: Article
Additional Information: “This article has been accepted for publication in 'Archive of Disease in Childhood', 2022, following peer review, and the Version of Record can be accessed online at” © Authors (or their employer(s)) “ 2022
Subjects: WC Communicable Diseases > WC 20 Research (General)
WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 240 Bacteremia. Sepsis. Toxemias
WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 02 Mar 2023 15:17
Last Modified: 12 Jun 2023 13:44


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