Incidence and risk factors of neonatal bacterial infections: a community-based cohort from Madagascar (2018–2021)

• Published in: BMC infectious diseases 2023-10, Vol.23 (1), p.1-658, Article 658
• Main Authors: Devred, Ines, Rambliere, Lison, Herindrainy, Perlinot, Andriamarohasina, Lovarivelo, Harimanana, Aina, Randrianirina, Frederique, Ratsima, Elisoa Hariniaina, Hivernaud, Delphine, Kermorvant-Duchemin, Elsa, Andrianirina, Zafitsara Zo, Abdou, Armya Youssouf, Delarocque-Astagneau, Elisabeth, Guillemot, Didier, Crucitti, Tania, Collard, Jean-Marc, Huynh, Bich-Tram
• Format: Article
• Language: English
• Subjects: Aminoglycosides; Amniotic fluid; Amoxicillin; Antibacterial agents; Antibiotic resistance; Antibiotics; Antimicrobial agents; Bacteremia; Bacteria; Bacterial diseases; Bacterial infections; Beta lactamases; Birth weight; Births; Blood; Blood culture; Care and treatment; Children; Complications and side effects; Data collection; Diagnosis; Dosage and administration; Drug resistance; Drug resistance in microorganisms; Enterobacterales; Enterococcus faecium; Gentamicin; Guidelines; Hazard identification; Health care; Infants; Infants (Newborn); Infection; Infections; Investigations; Life Sciences; Low birth weight; Madagascar; Medical examination; Medical research; Medicine, Experimental; Mortality; Mothers; Multidrug resistance; Neonatal; Neonates; Pathogens; Patient outcomes; Pregnancy; Pregnant women; Prevention; Quinolones; Risk factors; Rural areas; Sepsis; Severe Bacterial Infection; Statistical models; Surveillance; Urine; Vancomycin; Womens health; β Lactamase
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-023-08642-w

Few studies on neonatal severe bacterial infection are available in LMICs. Data are needed in these countries to prioritize interventions and decrease neonatal infections which are a primary cause of neonatal mortality. The BIRDY project (Bacterial Infections and Antimicrobial Drug Resistant among Young Children) was initially conducted in Madagascar, Senegal and Cambodia (BIRDY 1, 2012-2018), and continued in Madagascar only (BIRDY 2, 2018-2021). We present here the BIRDY 2 project whose objectives were (1) to estimate the incidence of neonatal severe bacterial infections and compare these findings with those obtained in BIRDY 1, (2) to identify determinants associated with severe bacterial infection and (3) to specify the antibiotic resistance pattern of bacteria in newborns. The BIRDY 2 study was a prospective community-based mother and child cohort, both in urban and semi-rural areas. All pregnant women in the study areas were identified and enrolled. Their newborns were actively and passively followed-up from birth to 3 months. Data on clinical symptoms developed by the children and laboratory results of all clinical samples investigated were collected. A Cox proportional hazards model was performed to identify risk factors associated with possible severe bacterial infection. A total of 53 possible severe bacterial infection and 6 confirmed severe bacterial infection episodes were identified among the 511 neonates followed-up, with more than half occurring in the first 3 days. For the first month period, the incidence of confirmed severe bacterial infection was 11.7 per 1,000 live births indicating a 1.3 -fold decrease compared to BIRDY 1 in Madagascar (p = 0.50) and the incidence of possible severe bacterial infection was 76.3, indicating a 2.6-fold decrease compared to BIRDY 1 in Madagascar (p < 0.001). The 6 severe bacterial infection confirmed by blood culture included 5 Enterobacterales and one Enterococcus faecium. The 5 Enterobacterales were extended-spectrum [beta]-lactamases (ESBL) producers and were resistant to quinolones and gentamicin. Enterococcus faecium was sensitive to vancomycin but resistant to amoxicillin and to gentamicin. These pathogns were classified as multidrug-resistant bacteria and were resistant to antibiotics recommended in WHO guidelines for neonatal sepsis. However, they remained susceptible to carbapenem. Fetid amniotic fluid, need for resuscitation at birth and low birth weight were associated with early onset possibl