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

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Clinical Scorecard: Investigation of Causes and Antimicrobial Resistance in Culture-Confirmed Infections Among Ugandan Infants: A Study Involving 7000 Neonates and Infants

At a Glance

CategoryDetail
ConditionNeonatal sepsis, pneumonia, and meningitis
Key MechanismsBacterial and viral infections causing bloodstream and respiratory tract infections; antimicrobial resistance to first-line antibiotics
Target PopulationNeonates and infants admitted with signs or risk factors for sepsis, pneumonia, or meningitis in Uganda
Care SettingTertiary hospitals in low-resource settings (Mulago National Referral Hospital and Kawempe National Referral Hospital, Kampala, Uganda)

Key Highlights

  • 11% of blood cultures and 8.6% of nasopharyngeal swabs were positive for pathogens among infants with suspected infection.
  • High inpatient mortality of 12.1%, with 27.7% case fatality among infants with Gram-negative bloodstream infections.
  • Almost 60% of Gram-negative pathogens showed resistance to WHO-recommended first-line antibiotics (ampicillin and gentamicin).

Guideline-Based Recommendations

Diagnosis

  • Use blood culture as the gold standard for identification of infective organisms in neonatal sepsis where available.
  • Collect nasopharyngeal swabs and cerebrospinal fluid (if indicated) for pathogen identification using PCR and standard microbiological testing.

Management

  • Empiric antibiotic therapy with gentamicin and benzylpenicillin or ampicillin for 7–10 days in neonates with serious bacterial infection.
  • Consider second-generation cephalosporins as second-line treatment in cases of treatment failure or resistance.

Monitoring & Follow-up

  • Monitor antimicrobial susceptibility patterns regularly to inform treatment guidelines.
  • Follow up infants until discharge or death to assess treatment outcomes.

Risks

  • High prevalence of antimicrobial resistance among Gram-negative pathogens reduces effectiveness of first-line antibiotics.
  • Increased mortality associated with Gram-negative bloodstream infections.

Patient & Prescribing Data

Neonates and infants admitted with signs or risk factors for sepsis, pneumonia, or meningitis in two Ugandan tertiary hospitals.

Empiric use of WHO-recommended antibiotics faces challenges due to high resistance rates; revised, context-specific antimicrobial guidelines are urgently needed.

Clinical Best Practices

  • Implement timely collection of blood cultures and other relevant specimens before antibiotic initiation when possible.
  • Use multiplex PCR assays to improve detection of viral and bacterial pathogens in respiratory infections.
  • Adapt antimicrobial treatment protocols based on local antimicrobial resistance surveillance data.
  • Prioritize infection prevention and control measures to reduce neonatal sepsis incidence and mortality.

References

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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