Bacteraemia in Malawian neonates and young infants 2002–2007: a retrospective audit

• Published in: BMJ open Vol. 2; no. 3; p. e000906
• Main Authors: Gwee, Amanda, Coghlan, Benjamin, Everett, Dean, Chagoma, Newton, Phiri, Amos, Wilson, Lorna, Molyneux, Elizabeth
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.01.2012; BMJ Group
• Subjects: Age; Antibiotics; Audits; Babies; Bacterial infections; Birth weight; Developing countries; Drug resistance; Health facilities; Laboratories; LDCs; Nosocomial infections; Organisms; Paediatrics; Sepsis; Malawi
• DOI: 10.1136/bmjopen-2012-000906
• ISSN: 2044-6055

ObjectivesTo assess the causes of bacteraemia in young infants and susceptibility to first-line antibiotics (benzylpenicillin plus gentamicin) at the Queen Elizabeth Central Hospital (QECH), Malawi during 2002–2007.DesignRetrospective analysis of demographic and microbiological data using laboratory records.SettingQECH is Malawi's largest hospital with 7000 neonates admitted annually, 9% for septicaemia.PatientsAll infants aged 60 days or less admitted to QECH that had a blood culture taken over the 6-year period.Main outcome measures6754 blood cultures were taken. 3323 organisms were isolated: one-third were pathogens, two-thirds contaminants. Gram-positive organisms (53%) were more common than gram-negatives (47%). Four organisms made up half of all pathogens: Staphylococcus aureus (15.3%), group B streptococci (13.5%), non-typhoidal salmonellae (12.6%) and Escherichia coli (10.5%). Apart from non-typhoidal salmonellae and Streptococcus pneumoniae, most organisms were more common in the first week of life than later. Overall, 28% of isolates during 2002–2007 were resistant to first-line antibiotic, higher than observed during 1996–2001 (22%). Penicillin susceptibility fluctuated while gram-negative resistance to gentamicin increased from 17% to 27% over the study period.ConclusionsIn the QECH, pathogens causing young infant sepsis are an unusual mix of organisms seen in both developed and developing countries. Resistance to first-line antibiotics is higher than observed in most studies. Ongoing monitoring is needed and clinical outcome data would aid interpretation of findings. A high proportion of blood cultures were contaminated with skin flora—improved training and supervision of phlebotomists are needed to improve the utility of taking blood cultures.