Spectrum of organisms and outcome of neonatal infections in HIV-exposed and unexposed newborns at a tertiary care hospital in KwaZulu-Natal.

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.