Spectrum of organisms and outcome of neonatal infections in HIV-exposed and unexposed newborns at a tertiary care hospital in KwaZulu-Natal.
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Date
2021
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Abstract
The World Health Organisation’s (WHO) recommendation of life-long antiretroviral
prophylaxis to pregnant women who are positive for Human Immunodeficiency Virus (HIV)
has increased HIV-exposed but uninfected infants. These infants are more likely to be born
premature and small for their gestational age. They require prolonged hospitalisation, making
them susceptible to nosocomial infections. The study aimed to determine the organisms causing
infections in these HIV-exposed newborns, their susceptibility profiles, risk factors and
outcome compared to their unexposed counterparts.
Methods:
This prospective descriptive study was conducted at King Edward VIII Hospital in Durban
between January 2014 and December 2019. Laboratory and clinical data of neonates admitted
to the neonatal unit with possible bacterial infection were collected. The organisms and their
susceptibility profiles from blood cultures, cerebrospinal fluid and endotracheal aspirates were
reviewed.
Results:
A total of 276 neonates were included in the final analysis, 50.7% of which were HIV-exposed.
Group B Streptococcus was the predominant organism isolated in the HIV-exposed neonates
in early-onset sepsis while Group B Streptococcus and Klebsiella pneumoniae in the HIVunexposed.
Gram-negative bacilli accounted for 65.8% of the bloodstream organisms causing
late-onset sepsis of which Klebsiella pneumoniae was the most common Gram-negative
pathogen with 61% being extended-spectrum β-lactamase (ESBL) producing and 23%
carbapenemase-producing. Antimicrobial resistance was common in endotracheal aspirates
which included ESBL producing and carbapenemase resistant Klebsiella pneumoniae, ESBL
producing E. coli and multidrug-resistant (MDR). Acinetobacter spp. as well as Gram-positive
bacteria that were resistant to Cloxacillin. HIV-exposure was found to be associated low birth
weight (p <0.001).
Conclusion:
Group B Streptococcus remains the most common pathogen causing early-onset sepsis in both
HIV-exposed and unexposed neonates and is covered by the current empiric antibiotics prescribed in the unit. Resistant gram-negative bacteria caused the majority of the episodes of
late-onset sepsis in both groups. A review of antibiotic treatment for late-onset sepsis and
infection prevention and control policies is warranted.
Description
Masters Degree. University of KwaZulu-Natal, Durban.