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Most possible serious bacterial infections have unknown cause in South Asian neonates
An infectious cause could not be pinpointed in 72% of possible serious bacterial infections in neonates in South Asia, suggesting that “substantial proportion” of these episodes may not have been due to infection, according to a study in The Lancet.
“Few data are available for the annual number of [possible serious bacterial infections (pSBIs)] in South Asia, despite the region having the highest number worldwide (3.5 million),” Samir K. Saha, PhD, professor and head of the microbiology department and executive director of the Child Health Research Foundation at the Bangladesh Institute of Child Health, Dhaka Shishu Hospital, and colleagues wrote.
Saha and colleagues noted that more than 500,000 neonatal deaths occur each year as the result of pSBIs, but the causes are unknown.
In the Aetiology of Neonatal Infection in South Asia, or ANISA, study, researchers used population-based pregnancy surveillance at five locations in Bangladesh, India and Pakistan to identify 63,114 babies born at home or in health facilities between 2011 and 2014. Community health workers visited the infants, aged 0 to 59 days, up to 10 times. Those with illness as defined by WHO as pSBI were referred to physicians. The researchers estimated the proportions of specific infectious causes of illness based on blood cultures and molecular testing.
They identified 6,022 pSBIs, including 2,498 early-onset (< 3 days old) episodes and 3,524 episodes in infants aged 3 to 59 days.
The researchers determined causes in only 28% of the pSBI episodes (16% bacterial and 12% viral). Bacterial and viral infections had mean incidences of 13.2 (95% CI, 11.2-15.6) and 10.1 (95% CI, 0.4-11.6) infections per 1,000 livebirths, respectively. Respiratory syncytial virus was the most common pathogen, with 5.4 episodes (95% CI, 4.8-6.3) per 1,000 live births, which was followed by Ureaplasma species, with 2.4 episodes (95% CI, 1.6-3.2) per 1,000 live births.
There were more pSBI episodes attributed to infants who died (46%) than those who survived (27%). Among those who died, the most common pSBI episodes were attributed to bacteria (92%), with Escherichia coli (8.7%) and Ureaplasma species (8.1%) being the most common pathogens.
According to the researchers, 83% of blood cultures were found to be susceptible to penicillin, ampicillin, gentamicin or a combination of the antibiotics.
“Although causal attribution among babies with pSBI in our cohort of over 63,000 livebirths was low (28%), because of the highly sensitive clinical algorithm we used, we found that bacterial causes predominated over viral causes,” the researchers wrote. “Even more importantly, ANISA captured data on pathogens associated with pSBI deaths, indicated that a cause could be attributed to 46% of deaths, among which most (92%) were bacterial.”
In a related commentary, Anna C. Seale, BMBCh, MSc, MRCPCH, MFPH, DPhil, from the London School of Hygiene & Tropical Medicine, and Ramesh Agarwal wrote that “the ANISA study has advanced understanding of neonatal infections and highlighted the limitations of current management strategies. Ways to address these issues must be urgently sought, and it must be remembered that the neonates not seen matter as much as those that are.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.
