Epidemiology of early- and late-onset serious bacterial infections in Australian neonates and infants: A retrospective multicentre study

Abstract

Background: There has been little decline in neonatal mortality rates over recent decades, and this is now further challenged by the rising prevalence of antimicrobial resistance (AMR). In Australia, the incidence of neonatal sepsis is low on a global scale, yet there are increasingly frequent outbreaks of multidrug-resistant (MDR) infections in neonatal intensive care units, alongside rising rates of colonisation with MDR bacteria. Methods: We analysed positive blood and cerebrospinal fluid (CSF) cultures collected from infants (aged 0 to 180 days) across five clinical sites in Australia between 2010 and 2019, to determine evolving antimicrobial susceptibility profiles. Results: After excluding presumed contaminants, we analysed 743 pathogenic bacterial isolates cultured from 624 neonates and infants with early (</=72 hours), late (>72 hours to </=28 days), and very late-onset (>28 days to </=180 days) infections. Escherichia coli (37%) and Streptococcus agalactiae (31%) were the primary pathogens responsible for early-onset bloodstream infections, whilst coagulase-negative staphylococci, E. coli and Staphylococcus aureus were responsible for most infections in older neonates and infants. Antimicrobial susceptibility to currently-recommended empiric regimens remains high; however, gram-negative bacteria - including MDR bacteria - were responsible for an increasing proportion of very late-onset infections over the study period (22% in 2010-2014 versus 34% in 2015-2019; p=0.07). Conclusions: Although empiric antimicrobial regimens remain adequate for most pathogens causing infections in neonates and infants in Australia, there is an increasing burden of invasive infections caused by gram-negative bacteria. Ongoing surveillance is necessary to ensure empiric antimicrobial guidelines remain efficacious and appropriate.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding, but Phoebe CM Williams is supported by an NHMRC investigator grant on neonatal sepsis.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee of Sydney Children's Hospital Network gave ethical approval for this work.

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors.

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