493 - Epidemiology and Antimicrobial Resistance Patterns of Neonatal Bloodstream Infections, Northern Tanzania, 2022-2023

Poster Number: 493
Publication Number: 493.268

Background: Neonatal bloodstream infections (BSI) are a leading cause of morbidity and mortality in low- and middle- income countries (LMICs). There are scant data on the epidemiology and associated prevalence of antimicrobial resistance (AMR) of neonatal BSI in Tanzania.

Objective: The objective of this study was to describe the epidemiology of culture-confirmed BSI as well as associated AMR and mortality among infants admitted to a tertiary referral hospital in northern Tanzania.

Design/Methods: We conducted a prospective, observational study of infants admitted to Kilimanjaro Christian Medical Centre (KCMC) from 29 September 2022 to 28 April 2023. KCMC is located in Moshi, Tanzania, has a 79-bed newborn ward, and admits inborn and outborn infants. Infants aged 0-60 days with perinatal risk factors, clinical signs or symptoms of sepsis were eligible for inclusion. Aerobic blood cultures were obtained at enrollment and monitored using an automated microbial detection system. Antimicrobial susceptibility testing was performed using standard phenotypic methods. Vital status was obtained on day 2, 7, and 28 post-enrollment. BSI was defined as blood culture isolation of established neonatal pathogens, including yeast and coagulase-negative Staphylococcus spp. (CoNS). Early-onset BSI was defined as BSI on day of life (DOL) 0-2 and late-onset BSI on DOL 3 or later. Descriptive analysis was preformed to characterize the study population; and associations between variables of interest and odds of BSI were explored using logistic regression.

Results: During the study period, 236 infants were enrolled. Among those enrolled, 106 (45%) infants had a BSI with 58 (55%) classified as early-onset BSI and 48 (45%) classified as late-onset BSI. Of pathogens isolated, 58 (55%) were Gram positive, 40 (37%) were Gram negative and 8 were yeast. The most commonly identified pathogens were CoNS (n = 55, 52%) and Klebsiella pneumoniae (n = 35, 33%). All K. pneumoniae isolates produced extended-spectrum beta-lactamases and were resistant to ampicillin and ceftriaxone (Table 3). All-cause mortality occurred in 13 (22.4%) infants with early-onset BSI and 16 (33.3%) infants with late-onset BSI compared to 30 (23.1%) infants without BSI (p = 0.93; p = 0.10 respectively). Infants requiring respiratory support at enrollment had 1.94-fold (95% CI, 1.14-3.37) increased odds of BSI.

Conclusion(s): In this cohort, neonatal BSI due to bacteria with substantial AMR was common, and BSI was associated with high mortality. Effective preventative, diagnostic, therapeutic interventions are needed to reduce the burden of BSI in hospitalized infants in Tanzania.