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Mduma E, Halidou T, Kaboré B, Walongo T, Lompo P, Museveni J, Gidabayda J, Gratz J, Guga G, Kimathi C, Liu J, Mdoe P, Moshiro R, Petzold M, Singlovic J, Guillerm M, Gomes MF, Houpt ER, Halleux CM. Etiology of severe invasive infections in young infants in rural settings in sub-Saharan Africa. PLoS One 2022; 17:e0264322. [PMID: 35213629 PMCID: PMC8880396 DOI: 10.1371/journal.pone.0264322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Serious invasive infections in newborns are a major cause of death. Lack of data on etiological causes hampers progress towards reduction of mortality. This study aimed to identify pathogens responsible for such infections in young infants in sub-Saharan Africa and to describe their antibiotics resistance profile. METHODS Between September 2016 and April 2018 we implemented an observational study in two rural sites in Burkina Faso and Tanzania enrolling young infants aged 0-59 days old with serious invasive infection. Blood samples underwent blood culture and molecular biology. RESULTS In total 634 infants with clinical diagnosis of serious invasive infection were enrolled and 4.2% of the infants had a positive blood culture. The most frequent pathogens identified by blood culture were Klebsiella pneumonia and Staphylococcus aureus, followed by Escherichia coli. Gram-negative isolates were only partially susceptible to first line WHO recommended treatment for neonatal sepsis at community level. A total of 18.6% of the infants were PCR positive for at least one pathogen and Escherichia coli and Staphylococcus aureus were the most common bacteria detected. Among infants enrolled, 60/634 (9.5%) died. Positive blood culture but not positive PCR was associated with risk of death. For most deaths, no pathogen was identified either by blood culture or molecular testing, and hence a causal agent remained unclear. Mortality was associated with low body temperature, tachycardia, respiratory symptoms, convulsions, history of difficult feeding, movement only when stimulated or reduced level of consciousness, diarrhea and/or vomiting. CONCLUSION While Klebsiella pneumonia and Staphylococcus aureus, as well as Escherichia coli were pathogens most frequently identified in infants with clinical suspicion of serious invasive infections, most cases remain without definite diagnosis, making more accurate diagnostic tools urgently needed. Antibiotics resistance to first line antibiotics is an increasing challenge even in rural Africa.
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Affiliation(s)
- Estomih Mduma
- Haydom Research Center, Haydom Lutheran Hospital, Haydom, United Republic of Tanzania
| | - Tinto Halidou
- Institut de Recherche en Sciences de la Santé (IRSS), Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Berenger Kaboré
- Institut de Recherche en Sciences de la Santé (IRSS), Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Thomas Walongo
- Haydom Research Center, Haydom Lutheran Hospital, Haydom, United Republic of Tanzania
| | - Palpouguini Lompo
- Institut de Recherche en Sciences de la Santé (IRSS), Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Justine Museveni
- Haydom Research Center, Haydom Lutheran Hospital, Haydom, United Republic of Tanzania
| | - Joshua Gidabayda
- Haydom Research Center, Haydom Lutheran Hospital, Haydom, United Republic of Tanzania
| | - Jean Gratz
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, United States of America
| | - Godfrey Guga
- Haydom Research Center, Haydom Lutheran Hospital, Haydom, United Republic of Tanzania
| | - Caroline Kimathi
- Haydom Research Center, Haydom Lutheran Hospital, Haydom, United Republic of Tanzania
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, United States of America
| | - Paschal Mdoe
- Haydom Research Center, Haydom Lutheran Hospital, Haydom, United Republic of Tanzania
| | - Robert Moshiro
- Haydom Research Center, Haydom Lutheran Hospital, Haydom, United Republic of Tanzania
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jan Singlovic
- UNICEF/UNDP/WB/WHO Special Program for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Martine Guillerm
- UNICEF/UNDP/WB/WHO Special Program for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Melba F. Gomes
- UNICEF/UNDP/WB/WHO Special Program for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Eric R. Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, United States of America
| | - Christine M. Halleux
- UNICEF/UNDP/WB/WHO Special Program for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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