Pathogens and antimicrobial resistance in SA neonates – a systematic review and meta-analysis
Tracks
Meeting Room 1.61 - 1.62
| Tuesday, July 1, 2025 |
| 5:00 PM - 5:15 PM |
Overview
Speaker: Prof Vindana Chibabhai
Speaker
Prof Vindana Chibabhai
National Institute for Communicable Diseases (NICD)
Pathogens and antimicrobial resistance in SA neonates – a systematic review and meta- analysis
Abstract
Background
Neonatal sepsis remains a major cause of neonatal deaths in low to –middle income countries. Antimicrobial resistance (AMR)is a global public health threat. Neonatal sepsis is difficult to diagnose. Inappropriate empiric treatment is associated with increased mortality, emphasizing the importance of understanding pathogen profiles and AMR patterns.
Study aim
We aimed to describe bacterial and fungal bloodstream infections at South African(SA) neonatal units determining pathogen prevalence, AMR profiles and mortality rates.
Methodology
We conducted a systematic review with two independent reviewers, including published and gray literature from 2005 to 2022. Meta- analysis was performed using a fixed effects model with inverse variance.
Results
Only 9/1235 studies met inclusion criteria following title, abstract and full text screening(Table 1). There was a higher pooled proportion of Gram negative (57%) compared to Gram positives bacteria (36%) and fungi (7%). Klebsiella pneumoniae was the most prevalent pathogen from Gram negatives (45%), Enterococci from Gram positives (40%) and Candida parapsilosis from fungi (35%)(Table 2). Pooled susceptibility was 35% for ampicillin + gentamicin and for third generation cephalosporins, 77% for piperacillin- tazobactam + amikacin and 82% for fluconazole. Pooled crude mortality was 19% (95% confidence interval 17 – 21%) for seven studies in which mortality was reported.
Conclusion
Neonatal sepsis in SA is characterised by a predominance of Gram negative pathogens listed on the World Health Organisation’s (WHO) bacterial priority pathogens list.Low susceptibility for WHO first and second line empiric therapy demonstrate the importance of up to date region specific surveillance data in neonatal populations.
Neonatal sepsis remains a major cause of neonatal deaths in low to –middle income countries. Antimicrobial resistance (AMR)is a global public health threat. Neonatal sepsis is difficult to diagnose. Inappropriate empiric treatment is associated with increased mortality, emphasizing the importance of understanding pathogen profiles and AMR patterns.
Study aim
We aimed to describe bacterial and fungal bloodstream infections at South African(SA) neonatal units determining pathogen prevalence, AMR profiles and mortality rates.
Methodology
We conducted a systematic review with two independent reviewers, including published and gray literature from 2005 to 2022. Meta- analysis was performed using a fixed effects model with inverse variance.
Results
Only 9/1235 studies met inclusion criteria following title, abstract and full text screening(Table 1). There was a higher pooled proportion of Gram negative (57%) compared to Gram positives bacteria (36%) and fungi (7%). Klebsiella pneumoniae was the most prevalent pathogen from Gram negatives (45%), Enterococci from Gram positives (40%) and Candida parapsilosis from fungi (35%)(Table 2). Pooled susceptibility was 35% for ampicillin + gentamicin and for third generation cephalosporins, 77% for piperacillin- tazobactam + amikacin and 82% for fluconazole. Pooled crude mortality was 19% (95% confidence interval 17 – 21%) for seven studies in which mortality was reported.
Conclusion
Neonatal sepsis in SA is characterised by a predominance of Gram negative pathogens listed on the World Health Organisation’s (WHO) bacterial priority pathogens list.Low susceptibility for WHO first and second line empiric therapy demonstrate the importance of up to date region specific surveillance data in neonatal populations.
Biography
