Burden of bacterial resistance among neonatal infections in low income countries: how convincing is the epidemiological evidence?

Huynh, Bich-Tram; Padget, Michael; Garin, Benoit; Herindrainy, Perlinot; Kermorvant-Duchemin, Elsa; Watier, Laurence; Guillemot, Didier; Delarocque-Astagneau, Elisabeth

doi:10.1186/s12879-015-0843-x

Table 2 Neonatal infections in developing countries (2000-May 2014)

From: Burden of bacterial resistance among neonatal infections in low income countries: how convincing is the epidemiological evidence?

Author, country, and study year	Disease type and age	Setting	Neonatal Isolation rate and aetiology*
Sub-Saharan Africa
Blomberg et al. [10]	Bacteremia	urban, hospital recruitment	54 early onset (EOS) isolates ^† : 31 late onset (LOS) isolates:
Tanzania 2001-2002	<7 yrs		Klebsiella spp.	EOS 14 (26%), LOS 7 (23%)
			S. aureus	EOS 6 (11%), LOS 5 (16%)
			E. coli	EOS 6 (11%), LOS 3 (10%)
			Group B Streptococcus	EOS 2 (4%), LOS 1 (3%)
Sigaúque et al. [21]	Bacteremia	rural, hospital recruitment	154 isolates: 16% blood cultures positive
Mozambique 2001-2006	<15 yrs		S. aureus	60 (39%)
			Group B Streptococcus	31 (20%)
			E. coli	9 (6%)
			S. pneumoniae	7 (5%)
Nielsen et al. [17]	Bacteremia	rural, hospital recruitment	23 isolates:
Ghana 2007-2009	<5 yrs		S. aureus	6 (26%)
			Klebsiella spp.	6 (26%)
			Streptococcus spp.	3 (13%)
			E. coli	3 (13%)
			Non-tyhoid Salmonella	2 (9%)
Gray et al. [29]	Group B streptococcus	urban, hospital recruitment	290 isolates: 12% blood cultures positive
Malawi 2004-2005	<90 days		Group B Streptococcus	48 (17%)
Talbert et al. [24]	Neonatal sepsis	rural, hospital recruitment	474 isolates: 9% blood cultures positive (25 infants had 2 bacterial species isolated)
Kenya 2001-2009	<60 days		Klebsiella spp.	57 (13%)
			S. aureus	55 (12%)
			Acinetobacter spp.	48 (11%)
			E. coli	41 (9%)
			Group B Streptococcus	32 (7%)
			86 isolates from CSF samples : 4% CSF cultures positive
			S. pneumoniae	17 (20%)
			Group B Streptococcus	16 (19%)
			Salmonella spp.	10 (12%)
Ojukwu et al. [18]	Neonatal sepsis	urban, hospital recruitment	33 isolates: 24% blood cultures positive
Nigeria 2002-2003	0-28 days		S. aureus	15 (45%)
			E. coli	6 (18%)
			Klebsiella spp.	3 (9%)
			Group B Streptococcus	1 (3%)
Mugalu et al. [15]	Neonatal sepsis	urban, hospital recruitment	110 isolates: 37% blood or CSF cultures positive
Uganda 2002	used WHO guidelines		S. aureus	69 (63%)
			E. coli	17 (15%)
			Group B Streptococcus	7 (6%)
Shitaye et al. [19]	Neonatal sepsis	urban, hospital recruitment	135 isolates: 45% blood cultures positive
Ethiopia 2006-2007	0-28 days		Klebsiella spp.	53 (39%)
			S. aureus	30 (22%)
			Coagulase-negative Staphylococcus	10 (7%)
Mhada et al.	Neonatal sepsis	urban, hospital recruitment	52 early onset (EOS) isolates ^† : 22 late onset (LOS) isolates: 22.4% blood cultures positive
Tanzania 2009-2010	0-28 days		S. aureus	EOS 15 (29%), LOS 12 (55%)
			Klebsiella spp.	EOS 17 (33%), LOS 5 (23%)
			E. coli	EOS 10 (19%), LOS 4 (18%)
			Staphylococcus epidermidis	EOS 6 (12%), LOS 0 (0%)
			Group B Streptococcus	EOS 1 (2%), LOS 0 (0%)
Kiwanuka et al. [13]	Neonatal sepsis	urban, hospital recruitment	19 early onset (EOS) isolates ^† : 7 late onset (LOS) isolates: 33% blood cultures
Uganda 2010	<1 month		S. aureus	EOS 13 (68%), LOS 3 (43%)
			E. coli	EOS 3 (16%), LOS 1 (14%)
			Klebsiella spp.	EOS 1 (5%), LOS 1 (14%)
			Group B Streptococcus	EOS 1 (5%), LOS 0 (0%)
SE Asia
Stoesser et al. [22]	Bacteremia	urban, hospital recruitment	65 isolates:
Cambodia 2007-2011	<16 yrs		Klebsiella spp.	14 (22%)
			S. aureus	9 (14%)
			Enterobacter spp.	4 (6%)
			E. coli	3 (5%)
			Streptococcus pyogenes	3 (5%)
Kruse et al. [30]	Neonatal sepsis	urban, hospital recruitment	399 isolates: 17% blood cultures positive
Vietnam 2009-2010	<28 days		Klebsiella spp.	78 (20%)
			Acinetobacter spp.	58 (15%)
			E. coli	21 (5%)
			Enterobacter spp.	16 (4%)
			S. aureus	11 (3%)
			Morganella spp.	8 (2%)
			Pseudomonas spp.	6 (2%)
			Coagulase-negative Staphylococcus	175 (44%)
India subcontinent
Mir et al. [28]	Omphalitis with sepsis	urban, community recruitment	432 isolates: 64% umbilical cord cultures positive
Pakistan 2004-2007	neonates (<1 month)		S. aureus	225 (52%)^‡
			Streptococcus pyogenes	78 (18%)^‡
			Group B Streptococcus	43 (10%)^‡
Jain et al. [26]	Neonatal sepsis	urban, hospital recruitment	350 isolates: 48% blood cultures positive for bacteria
India 2001-2002	Not defined		Klebsiella spp.	86 (25%)^‡
			Enterobacter spp.	80 (23%)^‡
			E. coli	49 (14%)^‡
Sundaram et al. [23]	Neonatal sepsis	urban, hospital recruitment	527 early onset (EOS) isolates ^§ : 364 late onset (LOS) isolates:
India 1995–1998, 2001-2006	Not defined		S. aureus	EOS 108 (20%), LOS 112 (31%)
			K. pneumoniae	EOS 62 (12%), LOS 49 (14%)
			Non-fermenting gram negative bacilli	EOS 161 (30%), LOS 60 (17%)
			E. coli	EOS 48 (9%), LOS 40 (11%)
Zakariya et al. [25]	Neonatal sepsis	urban, hospital recruitment	50 isolates: 42% blood cultures positive
India 2004-2006	<= 30 days		K. pneumoniae	33 (66%)
			Coagulase-negative Staphylococcus	6 (12%)
			Group B Streptococcus	1 (2%)
Muhammad et al. [16]	Neonatal sepsis	urban, hospital recruitment	130 isolates:
Pakistan 2009-2010	<28 days		S. aureus	35 (27%)
			E. coli	30 (23%)
			Staphylococcus epidermidis	17 (13%)
			Acinetobacter spp.	17 (13%)
			Klebsiella spp.	13 (10%)
			Streptococcus species only found in early onset sepsis (first week)
			Klebseilla species only found in late onset sepsis (after first week to 28 days)
Darmstadt et al. [27]	Neonatal sepsis	rural, community recruitment	29 isolates: 6% blood cultures positive
Bangladesh 2004-2006	<28 days		S. aureus	10 (34%)
			S. pneumoniae	3 (10%)
			Group B Streptococcus	1 (3%)
Gyawali et al. [12]	Neonatal sepsis	urban, hospital recruitment	238 isolates: 15% blood cultures positive
Nepal 2009-2010	first 4 weeks of life		S. aureus	94 (40%)
			Klebsiella spp.	32 (14%)
			Acinetobacter spp.	30 (13%)
			Enterobacter spp.	27 (11%)
			Pseudomonas spp.	21 (9%)
			E. coli	16 (7%)
Shresta et al. [20]	Neonatal sepsis	urban, hospital recruitment	37 isolates: 32% blood cultures positive
Nepal, 2011-2012	not defined		S. aureus	21 (57%)
			K. pneumoniae	8 (22%)
			P. aeruginosa	5 (13%)
Europe
Macharashvili et al. [14]	Neonatal sepsis	urban, hospital recruitment	126 isolates: 67% blood cultures positive
Georgia 2003-2004	8 weeks or younger		K. pneumoniae	36 (29%)
			Enterobacter cloacae	19 (15%)
			S. aureus	15 (12%)
			Group B Streptococcus	6 (5%)

*Percentages calculated when not reported in the article. Pathogens listed in order of relative percentages.
^†Early onset sepsis (EOS) defined as 0–6 days.
^‡Number of isolates calculated from percentages presented in article.
^§Early onset sepsis (EOS) defined as <72 hours, late onset (LOS) defined as >72 hours.

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