{"doi":"10.1186/s12879-024-10219-0","title":"Epidemiology of healthcare-associated bloodstream infection in South African neonatal units","abstract":"BACKGROUND: Reports of healthcare-associated bloodstream infection (HA-BSI) epidemiology in African neonatal units are limited. METHODS: We conducted a cross-sectional study (2017-2018) in nine neonatal units in the Western Cape Province, South Africa, including central, regional and district hospitals (416 beds) using laboratory and clinical records. Patient demographics, HA-BSI rates, pathogen spectrum, and hospital outcomes and empiric antibiotic coverage rates were determined. RESULTS: Over two years, 23,748 neonates were admitted with unit occupancy rates ranging from 79 to 93%. 485 HA-BSI episodes occurred, with median onset at 11 (IQR 7-24) days of life. Most HA-BSI episodes (348; 72%) affected very low birth weight neonates (< 1500 g). The overall HA-BSI rate was 2.0/1000 patient days. The highest HA-BSI rate was observed at the central unit with onsite surgery (3.8/1000 patient days). Crude HA-BSI mortality was 31.8% (154/485) with two-thirds of deaths occurring within three days of BSI onset. Higher mortality was observed for Gram-negative/fungal BSI compared to Gram-positive BSI (RR 1.5; 95%CI 1.1-2.0; p = 0.01) and very preterm neonates (gestation < 32 weeks) versus ≥ 32 weeks (RR 1.5; 95%CI 1.1-2.1; p = 0.01). Mean estimated empiric antibiotic coverage rates varied by unit type: 66-79% for piperacillin-tazobactam plus amikacin, 60-76% for meropenem and 84-92% for meropenem plus vancomycin. CONCLUSION: Most HA-BSI events affected preterm neonates at the central hospital with onsite surgery. One-third of patients with HA-BSI died, with highest mortality in preterm infants and Gram-negative/fungal BSI. Empiric antibiotic regimens provide moderate coverage of circulating pathogens but require annual review given increasing carbapenem resistance rates.","journal":"BMC Infectious Diseases","year":2024,"id":451040,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.6987,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":770093,"name":"Larisse Bolton","orcid":"0000-0001-7879-2173","position":1,"is_corresponding":false},{"id":354231,"name":"Adrie Bekker","orcid":"0000-0003-3836-3432","position":2,"is_corresponding":false},{"id":1271997,"name":"Arnoldus Engelbrecht","orcid":"0009-0003-5740-1745","position":3,"is_corresponding":false},{"id":1272476,"name":"Louisa Erasmus","orcid":null,"position":4,"is_corresponding":false},{"id":930732,"name":"Aaqilah Fataar","orcid":"0000-0003-2280-132X","position":5,"is_corresponding":false},{"id":1272477,"name":"Chandre Geldenhuys","orcid":null,"position":6,"is_corresponding":false},{"id":1272478,"name":"Marlize Kunneke","orcid":null,"position":7,"is_corresponding":false},{"id":1271998,"name":"Damien Roux","orcid":"0000-0002-6103-6416","position":8,"is_corresponding":false},{"id":1272479,"name":"Natasha O’ Connell","orcid":null,"position":9,"is_corresponding":false},{"id":473354,"name":"Kessendri Reddy","orcid":"0000-0002-6701-9764","position":10,"is_corresponding":false},{"id":462035,"name":"Natasha Rhoda","orcid":"0000-0002-9194-5522","position":11,"is_corresponding":false},{"id":1018528,"name":"Lloyd Tooke","orcid":"0000-0001-5905-9996","position":12,"is_corresponding":false},{"id":1272480,"name":"Mark Wates","orcid":null,"position":13,"is_corresponding":false},{"id":1272481,"name":"Thandi Wessels","orcid":null,"position":14,"is_corresponding":false},{"id":231953,"name":"Cari van Schalkwyk","orcid":"0000-0001-5154-1390","position":15,"is_corresponding":false},{"id":589255,"name":"Andrew Whitelaw","orcid":"0000-0001-9070-5247","position":16,"is_corresponding":false},{"id":361867,"name":"Angela Dramowski","orcid":"0000-0002-0161-9791","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":null,"created_at":"2026-07-19T02:02:41.417944Z","pmid":"39593003","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}