Abstract
Severe bacterial infections are a leading cause of death among neonates in low-income countries, which harbor several factors leading to emergence and spread of multidrug-resistant bacteria. Low-income countries should prioritize interventions to decrease neonatal infections; however, data are scarce, specifically from the community. To assess incidence, etiologies, and antimicrobial drug–resistance patterns of neonatal infections, during 2012–2014, we conducted a community-based prospective investigation of 981 newborns in rural and urban areas of Madagascar. The incidence of culture-confirmed severe neonatal infections was high: 17.7 cases/1,000 live births. Most (75%) occurred during the first week of life. The most common (81%) bacteria isolated were gram-negative. The incidence rate for multidrug-resistant neonatal infection was 7.7 cases/1,000 live births. In Madagascar, interventions to improve prevention, early diagnosis, and management of bacterial infections in neonates should be prioritized.
Highlights
Severe bacterial infections are a leading cause of death among neonates in low-income countries, which harbor several factors leading to emergence and spread of multidrug-resistant bacteria
The incidence rates were 17.7 culture-confirmed cases of severe neonatal infection and 13.3 culture-confirmed cases of earlyonset severe neonatal infections per 1,000 live births
The incidence rates for culture-confirmed severe neonatal infections were 14.8/1,000 live births in rural sites and 22.2/1,000 live births in urban sites
Summary
Severe bacterial infections are a leading cause of death among neonates in low-income countries, which harbor several factors leading to emergence and spread of multidrug-resistant bacteria. Each year in low-income countries, 7 million possible (clinical signs with no bacteriological documentation) severe neonatal bacterial infections occur [4,5]. In these countries, multiple factors lead to enhanced emergence and spread of drug-resistant bacteria To assess incidence, etiologies, and antimicrobial drug–resistance patterns of neonatal infections, we conducted a prospective study of a cohort of 981 newborns enrolled at birth in rural and urban communities in Madagascar, one of the poorest countries in the world, where the mortality rate for neonates is high [13]
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