Salmonella Bloodstream Infections in Hospitalized Children with Acute Febrile Illness—Uganda, 2016–2019

Invasive Salmonella infection is a common cause of acute febrile illness (AFI) among children in sub-Saharan Africa; however, diagnosing Salmonella bacteremia is challenging in settings without blood culture. The Uganda AFI surveillance system includes blood culture-based surveillance for etiologies of bloodstream infection (BSIs) in hospitalized febrile children in Uganda. We analyzed demographic, clinical, blood culture, and antimicrobial resistance data from hospitalized children at six sentinel AFI sites from July 2016 to January 2019. A total of 47,261 children were hospitalized. Median age was 2 years (interquartile range, 1–4) and 26,695 (57%) were male. Of 7,203 blood cultures, 242 (3%) yielded bacterial pathogens including Salmonella (N = 67, 28%), Staphylococcus aureus (N = 40, 17%), Escherichia spp. (N = 25, 10%), Enterococcus spp. (N = 18, 7%), and Klebsiella pneumoniae (N = 17, 7%). Children with BSIs had longer median length of hospitalization (5 days versus 4 days), and a higher case-fatality ratio (13% versus 2%) than children without BSI (all P < 0.001). Children with Salmonella BSIs did not differ significantly in length of hospitalization or mortality from children with BSI resulting from other organisms. Serotype and antimicrobial susceptibility results were available for 49 Salmonella isolates, including 35 (71%) non-typhoidal serotypes and 14 Salmonella serotype Typhi (Typhi). Among Typhi isolates, 10 (71%) were multi-drug resistant and 13 (93%) had decreased ciprofloxacin susceptibility. Salmonella strains, particularly non-typhoidal serotypes and drug-resistant Typhi, were the most common cause of BSI. These data can inform regional Salmonella surveillance in East Africa and guide empiric therapy and prevention in Uganda.

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Scrub typhus: a hospital-based study in the northern districts of West Bengal, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192537 ◽

2019 ◽

Vol 7 (6) ◽

pp. 2403

Author(s):

Sanjay Kumar Mallick ◽

Santanu Hazra ◽

Tanmoy Nandi ◽

Arunabha Sarkar

Keyword(s):

Case Fatality Rate ◽

West Bengal ◽

Scrub Typhus ◽

Case Fatality ◽

Febrile Illness ◽

Asia Pacific ◽

Enzyme Linked Immunosorbent Assay ◽

Acute Febrile Illness ◽

Fatality Rate ◽

Serological Tests

Background: Scrub typhus caused by Orientia tsutsugamushi, is a mite-borne zoonotic acute febrile illness. Geographically, it is confined to the Asia-Pacific region and important re-emerging infection in India. Clinical diagnosis of scrub typhus from other acute febrile illness is very difficult due to nonspecific symptoms and the relative absence of eschar in the Indian population. Case fatality rate varies from 30-70% depending on the clinical suspicion, delay in diagnosis and treatment. Antibody-based serological tests are the mainstay of diagnosis. IgM enzyme-linked immunosorbent assay (ELISA) against O. tsutsugamushi is helpful for the diagnosis of scrub typhus within the first week of illness.Methods: The aim of the study was to determine the prevalence of the disease in Northern districts of West Bengal, India using IgM ELISA.Results: Out of 577 serum samples tested 10.05% were positive for IgM antibodies. Majority of cases were below 40 years of age with higher prevalence in female patients. The disease showed a seasonal trend with a peak during the monsoon and later months. The case fatality rate among ELISA positive cases was 32.76%.Conclusions: Significant seropositivity against scrub typhus among cases of acute febrile illness with relatively higher mortality indicates that scrub typhus should be included in the differential diagnosis and confirmed by IgM ELISA.

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Surveillance for Invasive Salmonella Disease in Bamako, Mali, From 2002 to 2018

Clinical Infectious Diseases ◽

10.1093/cid/ciaa482 ◽

2020 ◽

Vol 71 (Supplement_2) ◽

pp. S130-S140

Author(s):

William L Still ◽

Milagritos D Tapia ◽

Sharon M Tennant ◽

Mamadou Sylla ◽

Aliou Touré ◽

...

Keyword(s):

Bacterial Infection ◽

Tertiary Care ◽

Case Fatality ◽

Positive Culture ◽

Bloodstream Infections ◽

Hospitalized Children ◽

Childhood Morbidity ◽

Invasive Bacterial Infection ◽

Microbiological Techniques ◽

Culture Positive

Abstract Background Salmonella enterica bloodstream infections are an important cause of childhood morbidity and mortality, including in Mali. We report 17 years of surveillance for nontyphoidal and typhoidal S. enterica infections among inpatients and outpatients at l’Hôpital Gabriel Touré, the main source of pediatric tertiary care in Bamako, Mali. Methods Between June 2002 and December 2018, a blood culture was collected from 54 748 children aged ≤15 years with fever and/or suspected invasive bacterial infection who provided consent (38 152 inpatients, 16 596 outpatients). Bacterial pathogens were identified using standard microbiological techniques and serovars of S. enterica were determined by PCR and/or agglutination with antisera. Results Nontyphoidal Salmonella (NTS) was identified in 671 enrolled inpatients (1.8% of all enrolled inpatients, 13.8% of enrolled inpatients with a positive culture). S. Enteritidis, the most common NTS serovar, accounted for 38.5% of all NTS isolates (n = 258), followed by S. Typhimurium (31.7%, n = 213). The median (SD) age of children with a culture positive for NTS was 1.8 (3) years. Overall case fatality was 20.9%. An additional 138 inpatients (0.4%) had a positive culture for typhoidal Salmonella. NTS was identified in 11 outpatients (0.07%), while typhoidal Salmonella was found in 49 outpatients (0.3%). The annual incidence of invasive NTS disease decreased over the study period, but case fatality remained high. Conclusions Although incidence decreased, NTS remained a major cause of invasive bacterial infection and mortality among hospitalized children in Bamako, while typhoidal Salmonella was uncommon. Because 87% of NTS belonged to only 4 serovars, a multivalent vaccine may be an effective strategy to reduce the burden and mortality of invasive NTS.

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Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low- and middle-income countries: a systematic review and meta-analysis

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0673-5 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 3

Author(s):

Nina Droz ◽

Yingfen Hsia ◽

Sally Ellis ◽

Angela Dramowski ◽

Mike Sharland ◽

...

Keyword(s):

Systematic Review ◽

Blood Culture ◽

Case Fatality Rate ◽

Bacterial Pathogens ◽

Meta Analysis ◽

Case Fatality ◽

Bloodstream Infections ◽

Fatality Rate ◽

Middle Income ◽

Middle Income Countries

Abstract Background Despite a high mortality rate in childhood, there is limited evidence on the causes and outcomes of paediatric bloodstream infections from low- and middle-income countries (LMICs). We conducted a systematic review and meta-analysis to characterize the bacterial causes of paediatric bloodstream infections in LMICs and their resistance profile. Methods We searched Pubmed and Embase databases between January 1st 1990 and October 30th 2019, combining MeSH and free-text terms for “sepsis” and “low-middle-income countries” in children. Two reviewers screened articles and performed data extraction to identify studies investigating children (1 month-18 years), with at least one blood culture. The main outcomes of interests were the rate of positive blood cultures, the distribution of bacterial pathogens, the resistance patterns and the case-fatality rate. The proportions obtained from each study were pooled using the Freeman-Tukey double arcsine transformation, and a random-effect meta-analysis model was used. Results We identified 2403 eligible studies, 17 were included in the final review including 52,915 children (11 in Africa and 6 in Asia). The overall percentage of positive blood culture was 19.1% [95% CI: 12.0–27.5%]; 15.5% [8.4–24.4%] in Africa and 28.0% [13.2–45.8%] in Asia. A total of 4836 bacterial isolates were included in the studies; 2974 were Gram-negative (63.9% [52.2–74.9]) and 1858 were Gram-positive (35.8% [24.9–47.5]). In Asia, Salmonella typhi (26.2%) was the most commonly isolated pathogen, followed by Staphylococcus aureus (7.7%) whereas in Africa, S. aureus (17.8%) and Streptococcus pneumoniae (16.8%) were predominant followed by Escherichia coli (10.7%). S. aureus was more likely resistant to methicillin in Africa (29.5% vs. 7.9%), whereas E. coli was more frequently resistant to third-generation cephalosporins (31.2% vs. 21.2%), amikacin (29.6% vs. 0%) and ciprofloxacin (36.7% vs. 0%) in Asia. The overall estimate for case-fatality rate among 8 studies was 12.7% [6.6–20.2%]. Underlying conditions, such as malnutrition or HIV infection were assessed as a factor associated with bacteraemia in 4 studies each. Conclusions We observed a marked variation in pathogen distribution and their resistance profiles between Asia and Africa. Very limited data is available on underlying risk factors for bacteraemia, patterns of treatment of multidrug-resistant infections and predictors of adverse outcomes.

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The Establishment and Diversification of Epidemic-Associated Serogroup W Meningococcus in the African Meningitis Belt, 1994 to 2012

mSphere ◽

10.1128/msphere.00201-16 ◽

2016 ◽

Vol 1 (6) ◽

Cited By ~ 23

Author(s):

Adam C. Retchless ◽

Fang Hu ◽

Abdoul-Salam Ouédraogo ◽

Seydou Diarra ◽

Kristen Knipe ◽

...

Keyword(s):

Burkina Faso ◽

Meningococcal Disease ◽

Disease Surveillance ◽

Bloodstream Infections ◽

Rapid Identification ◽

Sub Saharan Africa ◽

Common Cause ◽

Content Type ◽

Meningitis Belt ◽

Sub Saharan

ABSTRACT Meningococcal disease (meningitis and bloodstream infections) threatens millions of people across the meningitis belt of sub-Saharan Africa. A vaccine introduced in 2010 protects against Africa’s then-most common cause of meningococcal disease, N. meningitidis serogroup A. However, other serogroups continue to cause epidemics in the region—including serogroup W. The rapid identification of strains that have been associated with prior outbreaks can improve the assessment of outbreak risk and enable timely preparation of public health responses, including vaccination. Phylogenetic analysis of newly sequenced serogroup W strains isolated from 1994 to 2012 identified two groups of strains linked to large epidemics in Burkina Faso, one being descended from a strain that caused an outbreak during the Hajj pilgrimage in 2000. We find that applying whole-genome sequencing to meningococcal disease surveillance collections improves the discrimination among strains, even within a single nation-wide epidemic, which can be used to better understand pathogen spread. Epidemics of invasive meningococcal disease (IMD) caused by meningococcal serogroup A have been eliminated from the sub-Saharan African so-called “meningitis belt” by the meningococcal A conjugate vaccine (MACV), and yet, other serogroups continue to cause epidemics. Neisseria meningitidis serogroup W remains a major cause of disease in the region, with most isolates belonging to clonal complex 11 (CC11). Here, the genetic variation within and between epidemic-associated strains was assessed by sequencing the genomes of 92 N. meningitidis serogroup W isolates collected between 1994 and 2012 from both sporadic and epidemic IMD cases, 85 being from selected meningitis belt countries. The sequenced isolates belonged to either CC175 (n = 9) or CC11 (n = 83). The CC11 N. meningitidis serogroup W isolates belonged to a single lineage comprising four major phylogenetic subclades. Separate CC11 N. meningitidis serogroup W subclades were associated with the 2002 and 2012 Burkina Faso epidemics. The subclade associated with the 2012 epidemic included isolates found in Burkina Faso and Mali during 2011 and 2012, which descended from a strain very similar to the Hajj (Islamic pilgrimage to Mecca)-related Saudi Arabian outbreak strain from 2000. The phylogeny of isolates from 2012 reflected their geographic origin within Burkina Faso, with isolates from the Malian border region being closely related to the isolates from Mali. Evidence of ongoing evolution, international transmission, and strain replacement stresses the importance of maintaining N. meningitidis surveillance in Africa following the MACV implementation. IMPORTANCE Meningococcal disease (meningitis and bloodstream infections) threatens millions of people across the meningitis belt of sub-Saharan Africa. A vaccine introduced in 2010 protects against Africa’s then-most common cause of meningococcal disease, N. meningitidis serogroup A. However, other serogroups continue to cause epidemics in the region—including serogroup W. The rapid identification of strains that have been associated with prior outbreaks can improve the assessment of outbreak risk and enable timely preparation of public health responses, including vaccination. Phylogenetic analysis of newly sequenced serogroup W strains isolated from 1994 to 2012 identified two groups of strains linked to large epidemics in Burkina Faso, one being descended from a strain that caused an outbreak during the Hajj pilgrimage in 2000. We find that applying whole-genome sequencing to meningococcal disease surveillance collections improves the discrimination among strains, even within a single nation-wide epidemic, which can be used to better understand pathogen spread.

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HOSPITAL-BASED SURVEILLANCE FOR ACUTE FEBRILE ILLNESS IN EGYPT: A FOCUS ON COMMUNITY-ACQUIRED BLOODSTREAM INFECTIONS

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.2005.73.392 ◽

2005 ◽

Vol 73 (2) ◽

pp. 392-399 ◽

Cited By ~ 24

Author(s):

SALMA AFIFI ◽

FRANCIS MAHONEY ◽

HODA MANSOUR ◽

SAID EL OUN ◽

KEN EARHART ◽

...

Keyword(s):

Febrile Illness ◽

Bloodstream Infections ◽

Acute Febrile Illness

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Bloodstream Infections in a Community Hospital: A 25-Year Follow-Up

Infection Control and Hospital Epidemiology ◽

10.1086/502162 ◽

2003 ◽

Vol 24 (12) ◽

pp. 936-941 ◽

Cited By ~ 17

Author(s):

William E. Scheckler ◽

James A. Bobula ◽

Mark B. Beamsley ◽

Scott T. Hadden

Keyword(s):

Blood Culture ◽

Community Hospital ◽

Epidemiologic Study ◽

Case Fatality ◽

Bloodstream Infections ◽

Antibiotic Use ◽

Case Definition ◽

Current Status ◽

Underlying Illness ◽

Definition Of

AbstractObjective:To examine the current status of bloodstream infections (BSIs) in a community hospital as part of a 25-year longitudinal study.Design:Retrospective descriptive epidemiologic study.Setting:Community teaching hospital.Patients:All inpatients in 1998 with a positive blood culture who met the CDC NNIS System case definition of BSI.Methods:Cases were stratified by underlying illness category using case mix adjustment categories (after McCabe) and reviewed for associations among mortality, underlying illness severity, and multiple clinical and laboratory parameters.Results:Of 19,289 patients discharged in 1998,185 had an episode of infection documented by blood culture (96 cases per 10,000 inpatients). BSI was twice as frequent in patients 65 years and older compared with younger patients. BSIs caused or contributed to the deaths of 22 patients for an overall case-fatality rate of 11.9% compared with 20.7% in 1982 (P = .02). Striking decreases were noted for in-hospital patient mortality in 1998 for BSIs with ultimately and rapidly fatal underlying illnesses (P = .02 and P < .10, respectively). Primary bacteremia decreased compared with 1982. Antibiotic use was vigorous, but resistance was modest in both nosocomial and community-acquired organisms and had changed little from 1982 and 1987.Conclusions:Compared with previous studies, case-fatality rates in patients with BSI were substantially lower in rapidly fatal and ultimately fatal underlying illness categories. Antibiotic use was extensive but prompt and appropriate. Microorganism resistance to antibiotics changed little from the 1980s.

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The Epidemiology of Bloodstream Infections and Antimicrobial Susceptibility Patterns: A Nine-Year Retrospective Study at St. Dominic Hospital, Akwatia, Ghana

Journal of Tropical Medicine ◽

10.1155/2019/6750864 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

John Gameli Deku ◽

Mavis Puopelle Dakorah ◽

Sylvester Yao Lokpo ◽

Verner N. Orish ◽

Francis Abeku Ussher ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Blood Culture ◽

Bloodstream Infection ◽

Antimicrobial Susceptibility ◽

Bloodstream Infections ◽

Sub Saharan Africa ◽

Coagulase Negative Staphylococcus ◽

Eastern Region ◽

Sensitivity Testing ◽

Antimicrobial Susceptibility Pattern

Background. Bloodstream infections are among the top causes of morbidity and mortality in people of all ages, especially in immunocompromised patients in sub-Saharan Africa. This study aimed at describing the epidemiology of bloodstream infections and antimicrobial susceptibility pattern over a nine-year period at St. Dominic Hospital, Akwatia, in the Eastern Region of Ghana. Method. This study retrospectively analysed data from 4,489 patients who were referred to the Laboratory Department for blood culture and sensitivity testing from January 2009 to December 2017. Sociodemographic data included age, gender, and patients’ department. Blood culture results were retrieved from archival records in the laboratory. The authorities of St. Dominic Hospital granted approval for the study. Results. The incidence of bloodstream infection over the 9 years was 51.4 positive cultures per 100,000 hospital attendance. Staphylococcus aureus was the leading causative agent of bacteraemia for the first two scalar years (2009–2011 (38.9%) and 2012–2014 (42.2%)) while coagulase-negative staphylococcus (CoNS) (50.5%) was predominant for the last scalar year (2015–2017), followed by Staphylococcus aureus (169/587 (28.8%)). The highest incidence of bloodstream infections was recorded in the wet seasons (months of May (8.9 per 10,000 persons) and October (10.1 per 10,000 persons)). The bacterial isolates demonstrated high resistance to tetracyclines (390/531 (73.4%)), penicillins (1282/1669 (76.8%)), and sulphonamides (450/499 (90.2%)). Conclusion. Bloodstream infection and antimicrobial resistance are high in patients seeking healthcare in Akwatia. This therefore calls for concerted efforts aimed at reducing the incidence in the study area.

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Etiologies of bloodstream infection and antimicrobial resistance: A cross sectional study among patients in a tertiary hospital, Northern Tanzania

East Africa Science ◽

10.24248/easci-d-20-00012 ◽

2021 ◽

Vol 3 (1) ◽

pp. 102-109

Author(s):

Ibrahim Ireneus Mauki ◽

Jesca Deogratias William ◽

Henry Lucas Mlay ◽

Adonira Tajaeli Saro ◽

Samwel Ole Saringe ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Case Fatality ◽

Rapid Test ◽

Bloodstream Infections ◽

Cross Sectional Study ◽

Sub Saharan Africa ◽

Resistance Pattern ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

Background: Bloodstream infections are important causes of morbidity and mortality in people of all age groups, especially in sub-Saharan Africa. In Tanzania, a recent report indicates that case fatality rate of 37% is attributed to bloodstream infections. The aim of this study was to determine the prevalence and factors associated with bloodstream infections as well as to determine resistance pattern of bacterial isolates among patients visiting Kilimanjaro Christian Medical Centre (KCMC). Methods: A cross-sectional study was conducted from April to June 2019 at KCMC. A total of 200 patients were included in the study. Blood samples were collected for culture, malaria rapid test, typhoid and brucella tests. Clinical features, co-morbid conditions and patients' hospitalization data were recorded in the questionnaire. Logistic regression was used to examine the factors associated with bloodstream infections. Predictors of the outcome were considered significant at p<0.05. Results: The prevalence of bloodstream infections was 52(26%). Participants with stomachache had less odds of having bloodstream infections as compared to other patients with symptoms (AOR=0.22, 5.33, 95%CI=0.05-0.97; p=0.04). Of the XX identified isolates Staphylococcus aureus showed the highest rates of resistance for Meropenem 8(88.8%), Cefotaxime 6(66.6%, Amikacin 6(66.6%), Gentamicin 6(66.6%) and Imipenem 6(66.6%). The lowest level of resistance was observed in Ceftriaxone 1(11.1%). Conclusion: Bloodstream infections were highly prevalent in this sample (26%). Staphylococcus spp was the most commonly isolated organism and exhibited a high resistance rate to most antibiotics. This calls for increased and coordinated efforts to improve the identification, treatment and management of bloodstream infections and antimicrobial resistance, thereby improving clinical practice.

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Epidemiology of clinically suspected and laboratory-confirmed bloodstream infections at a South African neonatal unit

The Journal of Infection in Developing Countries ◽

10.3855/jidc.13971 ◽

2021 ◽

Vol 15 (07) ◽

pp. 943-952

Author(s):

Angela Dramowski ◽

Adrie Bekker ◽

Mark Frederic Cotton ◽

Andrew Christopher Whitelaw ◽

Susan Coffin

Keyword(s):

At Risk ◽

Blood Culture ◽

Fungal Pathogens ◽

Case Fatality ◽

Bloodstream Infections ◽

Neonatal Unit ◽

Risk Of Infection ◽

Maternal Risk ◽

Suspected Infection ◽

Healthcare Associated

Introduction: Data from Africa reporting the epidemiology of infection in hospitalised neonates are limited. Methodology: A prospective study with convenience sampling was conducted to characterise neonates investigated with blood culture/s for suspected infection at a 132-bed neonatal unit in Cape Town, South Africa (1 February-31 October 2018). Enrolled neonates were classified as having proven bloodstream infection (BSI) (blood culture-positive with a pathogen) or presumed infection (clinically suspected but blood culture-negative) or as potentially at risk of infection (maternal risk factors at birth). Results: Of 1299 hospitalised neonates with >1 blood culture sampling episode, 712 (55%) were enrolled: 126 (17.7%) had proven BSI; 299 (42%) had presumed infection and 287 (40.3%) were potentially at risk of infection. Neonates with proven BSI had lower birth weight and higher rates of co-existing surgical conditions versus the presumed/potential infection groups (p < 0.001). Median onset of proven BSI versus presumed infection was at 8 (IQR = 5-13) and 1 (IQR = 0-5) days respectively (p < 0.001). Most proven BSI were healthcare-associated (114/126; 90.5%), with Klebsiella pneumoniae (80.6% extended-spectrum β-lactamase producers) and Staphylococcus aureus (66.7% methicillin-resistant) predominating. Mortality from proven BSI (34/126; 27%) was substantially higher than that observed in presumed (8/299; 2.7%) and potential infections (3/287; 1.0%) (p < 0.001). The odds of death from proven BSI was 3-fold higher for Gram-negatives than for Gram-positive/fungal pathogens (OR = 3.23; 95% CI = 1.17-8.92). Conclusions: Proven BSI episodes were predominantly healthcare-associated and associated with a high case fatality rate. Most neonates with presumed infection or at potential risk of infection had favourable 30-day outcomes.

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Epidemiology of Clinically Suspected and Laboratory-Confirmed Bloodstream Infections at A South African Neonatal Unit

10.21203/rs.3.rs-72787/v1 ◽

2020 ◽

Author(s):

Angela Dramowski ◽

A Bekker ◽

M F Cotton ◽

A C Whitelaw ◽

S Coffin

Keyword(s):

At Risk ◽

Blood Culture ◽

Case Fatality ◽

Bloodstream Infections ◽

Neonatal Unit ◽

Risk Of Infection ◽

Cross Sectional ◽

Maternal Risk ◽

Suspected Infection ◽

Healthcare Associated

Abstract Background: Data from Africa reporting the epidemiology of infection in hospitalised neonates are limited. Methods: We conducted a cross-sectional study with convenience sampling to characterise neonates investigated with blood culture/s for suspected infection at a 124-bed neonatal unit in Cape Town, South Africa (1 February-31 October 2018). Enrolled neonates were classified as having proven bloodstream infection (BSI) (blood culture-positive with a pathogen) or presumed infection (clinically suspected but blood culture-negative) or potentially at risk of infection (maternal risk factors at birth). Results: Of 1299 hospitalised neonates with >1 blood culture sampling episode, 712 (55%) were enrolled: 126 (17.7%) had proven BSI; 299 (42%) had presumed infection and 287 (40.3%) were potentially at risk of infection. Neonates with proven BSI had lower birth weight and higher rates of co-existing surgical conditions versus the presumed/potential infection groups (p<0.001). Median onset of proven BSI versus presumed infection was at 8 (IQR 5-13) and 1 (IQR 0-5) days respectively (p<0.001). Most proven BSI were healthcare-associated (114/126; 90.5%), with Klebsiella pneumoniae (80.6% extended-spectrum β-lactamase producers) and Staphylococcus aureus (66.7% methicillin-resistant) predominating. Mortality from proven BSI (34/126; 27%) was substantially higher than that observed in presumed (8/299; 2.7%) and potential infections (3/287; 1.0%) (p<0.001). The odds of death from proven BSI was 3-fold higher for Gram-negatives than for Gram-positive/fungal pathogens (OR 3.23; 95%CI 1.17-8.92). Conclusion: Proven BSI episodes were predominantly healthcare-associated and associated with a high case fatality rate. Most neonates with presumed infection or at potential risk of infection had favourable 30-day outcomes.

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