Abstract
BackgroundInfections caused by extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) among hospitalized neonates in sub-Saharan Africa pose significant clinical challenges. Data on prevalence and acquisition of ESBL-E carriage among hospitalized neonates in the region are few, and risk factors for transmission are not clearly defined.MethodsIn a cohort study of consecutive neonatal admissions to Kilifi County Hospital from July 2013 through August 2014, we estimated ESBL-E carriage prevalence on admission using rectal swab cultures and identified risk factors using logistic regression. Using twice-weekly follow-up swabs, we estimated the incidence and identified risk factors for ESBL-E acquisition in hospital using Poisson regression.ResultsThe prevalence of ESBL-E carriage at admission was 10% (59/569). Cesarean delivery, older neonatal age, and smaller household size were significant risk factors. Of the 510 infants admitted without ESBL-E carriage, 238 (55%) acquired carriage during their hospital stay. The incidence of acquisition was 21.4% (95% confidence interval, 19.0%–24.0%) per day. The rate was positively associated with the number of known neonatal ESBL-E carriers and with the total number of neonates on the same ward.ConclusionsCarriage of ESBL-E was common among neonates on admission, and in-hospital acquisition was rapid. The dissemination and selection of ESBL-E appears to be driven by hospital exposures, operative delivery, and neonatal ward patient density. Further attention to infection control, patient crowding, and carriage surveillance is warranted.
Highlights
Infections caused by extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) among hospitalized neonates in sub-Saharan Africa pose significant clinical challenges
Kagia et al During the study period, 1014 neonates were admitted to Kilifi County Hospital (KCH), and the parents/guardians of 597 neonates gave consent for them to participate in the study (Figure 2)
From the 59 neonates with ESBL-E carriage at admission, there were 65 isolates consisting of 31 Klebsiella pneumoniae, 25 Escherichia coli, 8 Enterobacter cloacae, and 1 Klebsiella oxytoca
Summary
In a cohort study of consecutive neonatal admissions to Kilifi County Hospital from July 2013 through August 2014, we estimated ESBL-E carriage prevalence on admission using rectal swab cultures and identified risk factors using logistic regression. Using twice-weekly follow-up swabs, we estimated the incidence and identified risk factors for ESBL-E acquisition in hospital using Poisson regression. Neonatal admissions were eligible for recruitment into the study if they were admitted to the high-dependency unit between 1 July 2013 and 29 August 2014 or to the neonatal rooms in the general pediatric ward between 16 August 2013 and 29 August 2014. The high-dependency unit consists of an Carriage of ESBL Among Admitted Neonates CID 2019:XX (XX XXXX) 1. KCH practices comprehensive obstetric care, as defined by the World Health Organization, with cesarean delivery services available.
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