Neonatal Hospital-Acquired Bloodstream Infection in a Single-Centre in Malaysia: Clinical Presentations, Pathogens and Immediate Outcome

Objectives: To determine the epidemiology, clinical characteristics, pathogen, and outcome of hospital-acquired bloodstream infection (HABSI). Methods: This observational, retrospective cohort study of neonates with HABSI between 2013 and 2019 was retrieved from the Infection Surveillance System. The main outcome measure was mortality. Binary logistic regression was used to identify risk factors associated with mortality. Results: There were 278 neonates (27% < 1000gm birth weight and 26% < 29 weeks gestation) with 316 episodes of HABSI documented. The overall incidence of HABSI was 3.79 (95% CI: 3.35 to 4.24) per 1000 admissions and 1.9 per 1000 patients. HABSI was diagnosed at 18.5 days (IQR 11, 36) of hospitalization and 38% presented with severe signs and symptoms of sepsis. The most common pathogens were Klebsiella pneumoniae (29.4%), followed by coagulase-negative staphylococcus (13.9%) and Acinetobacter baumannii (10.1%). Multidrug-resistant (MDR) organisms were noted in 173 (54.7%) with a significant increase over time of extended-spectrum beta-lactamase-producing organisms. Gram-negative resistance to carbapenem was noted in 45% and associated with high mortality. The overall mortality was 25.5% (95% CI:19.6 to 31.5) with no significant changes over time. HABSI due to gram-negative, presented with severe sepsis and prolonged ventilation were associated with poor outcomes. Conclusion: Multidrug resistance is rising and has high mortality in our centre. Factors associated with high mortality were gram-negative organisms, severe sepsis, and prolonged ventilation. Hence, infection and prevention control programs need to be enhanced.