Etiology and Antimicrobial Resistance of Culture-Positive Infections in Ugandan Infants: A Cohort Study of 7000 Neonates and Infants - Report - MDSpire

Etiology and Antimicrobial Resistance of Culture-Positive Infections in Ugandan Infants: A Cohort Study of 7000 Neonates and Infants

  • By

  • Hannah G Davies

  • Mary Kyohere

  • Valerie Tusubira

  • Alexander Amone

  • Amusa Wamawobe

  • Cleophas Komugisha

  • Philippa Musoke

  • Lauren Hookham

  • Pooja Ravji

  • Melanie Etti

  • Juliet Nsimire Sendagala

  • Dan R Shelley

  • Caitlin Farley

  • Merryn Voysey

  • Owen B Spiller

  • Joseph Peacock

  • Musa Sekikubo

  • Paul T Heath

  • Kirsty Le Doare

  • PROGRESS Study Author Group

  • Abdelmajid Djennad

  • Agnes Nyamaizi

  • Agnes Ssali

  • Alexander Amone

  • Amusa Wamawobe

  • Annettee Nakimuli

  • Caitlin Farley

  • Carol Nanyunja

  • Christine Najuka

  • Cleophas Komugisha

  • Dan R Shelley

  • Edward A R Portal

  • Ellie Duckworth

  • Emilie Karafillakis

  • Geraldine O’Hara

  • Godfrey Matovu

  • Hannah G Davies

  • Janet Seeley

  • Joseph Peacock

  • Juliet Nsimire Sendagala

  • Katie Cowie

  • Kirsty Le Doare

  • Konstantinos Karampatsas

  • Lauren Hookham

  • Madeleine Cochet

  • Margaret Sewegaba

  • Mary Kyohere

  • Maxensia Owor

  • Melanie Etti

  • Merryn Voysey

  • Moses Musooko

  • Musa Sekikubo

  • Owen B Spiller

  • Patience Atuhaire

  • Paul T Heath

  • Philippa Musoke

  • Phiona Nalubega

  • Pooja Ravji

  • Richard Katungye

  • Ritah Namugumya

  • Rosalin Parks

  • Rose Azuba

  • Sam Kipyeko

  • Simon Beach

  • Stephen Bentley

  • Tim Old

  • Tobius Mutabazi

  • Valerie Tusubira

  • Vicki Chalker

  • March 10, 2025

  • 0 min

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Clinical Report: Etiology and Antimicrobial Resistance in Neonatal Infections in Uganda

Overview

This large prospective cohort study of over 7,000 Ugandan neonates and infants identified key bacterial pathogens causing sepsis and respiratory infections, with high rates of antimicrobial resistance to WHO first-line antibiotics. Inpatient mortality was significant, particularly among infants with Gram-negative bloodstream infections.

Background

Neonatal infections remain a leading cause of mortality globally, especially in sub-Saharan Africa where neonatal death rates are high. Blood culture is the gold standard for diagnosing neonatal sepsis but is often unavailable in low-resource settings, leading to empirical antibiotic use. The WHO recommends ampicillin or benzylpenicillin combined with gentamicin as first-line treatment, but rising antimicrobial resistance threatens treatment efficacy. There is limited epidemiological data on neonatal infection etiology and resistance patterns in many low- and middle-income countries, including Uganda.

Data Highlights

ParameterValue
Number of infants enrolled7323
Blood cultures positive11%
Nasopharyngeal swabs positive8.6%
Inpatient mortality overall12.1%
Case fatality with Gram-negative bloodstream infections27.7%
Common Gram-negative pathogensEscherichia coli (14.8%), Acinetobacter spp. (10.3%), Klebsiella spp. (7.6%)
Predominant Gram-positive pathogenGroup B Streptococcus (13.5%)
Gram-negative pathogens resistant to ampicillin and gentamicin~60%

Key Findings

  • Gram-negative bacteria, notably Escherichia coli, Acinetobacter spp., and Klebsiella spp., are major causes of neonatal sepsis in Uganda.
  • Group B Streptococcus is the leading Gram-positive pathogen identified in neonatal infections.
  • High inpatient mortality rate of 12.1% was observed, with nearly 28% mortality among infants with Gram-negative bloodstream infections.
  • Approximately 60% of Gram-negative isolates showed resistance to WHO-recommended first-line antibiotics (ampicillin and gentamicin).
  • Blood culture positivity rate was 11%, indicating a significant burden of culture-confirmed infections.
  • Nasopharyngeal swabs were positive in 8.6% of cases, supporting the role of respiratory pathogens in infant infections.

Clinical Implications

The high prevalence of antimicrobial resistance among Gram-negative pathogens necessitates urgent revision of empirical antibiotic guidelines for neonatal sepsis in Uganda and similar settings. Clinicians should be aware of the limited efficacy of current first-line antibiotics and consider local resistance patterns when selecting treatment. Enhanced microbiological surveillance and access to diagnostics are critical to guide appropriate therapy and improve outcomes.

Conclusion

This study highlights the significant burden of antimicrobial-resistant neonatal infections in Uganda, underscoring the need for context-specific treatment protocols and strengthened infection control measures to reduce neonatal mortality.

References

  1. PROGRESS Study Supplement -- Investigation of Causes and Antimicrobial Resistance in Culture-Confirmed Infections Among Ugandan Infants

Original Source(s)

Etiology and Antimicrobial Resistance of Culture-Positive Infections in Ugandan Infants: A Cohort Study of 7000 Neonates and Infants

  • by Hannah G Davies, Mary Kyohere, Valerie Tusubira, Alexander Amone, Amusa Wamawobe, Cleophas Komugisha, Philippa Musoke, Lauren Hookham, Pooja Ravji, Melanie Etti, Juliet Nsimire Sendagala, Dan R Shelley, Caitlin Farley, Merryn Voysey, Owen B Spiller, Joseph Peacock, Musa Sekikubo, Paul T Heath, Kirsty Le Doare, PROGRESS Study Author Group, Abdelmajid Djennad, Agnes Nyamaizi, Agnes Ssali, Alexander Amone, Amusa Wamawobe, Annettee Nakimuli, Caitlin Farley, Carol Nanyunja, Christine Najuka, Cleophas Komugisha, Dan R Shelley, Edward A R Portal, Ellie Duckworth, Emilie Karafillakis, Geraldine O’Hara, Godfrey Matovu, Hannah G Davies, Janet Seeley, Joseph Peacock, Juliet Nsimire Sendagala, Katie Cowie, Kirsty Le Doare, Konstantinos Karampatsas, Lauren Hookham, Madeleine Cochet, Margaret Sewegaba, Mary Kyohere, Maxensia Owor, Melanie Etti, Merryn Voysey, Moses Musooko, Musa Sekikubo, Owen B Spiller, Patience Atuhaire, Paul T Heath, Philippa Musoke, Phiona Nalubega, Pooja Ravji, Richard Katungye, Ritah Namugumya, Rosalin Parks, Rose Azuba, Sam Kipyeko, Simon Beach, Stephen Bentley, Tim Old, Tobius Mutabazi, Valerie Tusubira, Vicki Chalker

  • March 10, 2025

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