Pediatrics and neonatology · 2026
Early-onset neonatal sepsis in the Eastern Democratic Republic of the Congo: Microbiology, antimicrobial resistance, and clinical outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
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Ntaganzibwa Joseph Ntagerwa, Nanci Francisca Isia, Zigabe Serge Mushamuka, Kulimushi Eliezer Rhuderhekuguma, Ndinaye Samuel, Bashomeka David Bahati, Bavurhe Grâce Mushagalusa, Shabani Christian Cito, Bwema Joy-Arsène, Cebweru Lucie Nshobole, Birere Elyse Akonkwa, Wabiwa Bel'Ange Assongo, Mwenebitu David Lupande, Battisti Oreste, Van der Linden Dimitri, Kambale Richard Mbusa
Аннотация
BACKGROUND: Early-onset neonatal sepsis (EOS) remains a major cause of neonatal morbidity and mortality in low- and middle-income countries. Data from Central Africa on microbiological patterns, antimicrobial resistance, and diagnostic stewardship are limited.
METHODS: We conducted a retrospective cohort study including neonates ≤72 h of life managed for suspected EOS between January 2021 and September 2025 at a tertiary neonatal intensive care unit in the Eastern Democratic Republic of the Congo. Diagnostic stewardship indicators included blood culture sampling proportion, positivity rate, and contamination rate. Multivariable logistic regression identified independent predictors of in-hospital mortality.
RESULTS: Among 1293 neonates with suspected EOS, blood cultures were performed in 604 (46.7%). The positivity rate for true pathogens was 17.4% (105/604), and 10.1% of cultures were classified as contaminants. Among inborn neonates, the incidence of culture-confirmed EOS was 8.4 per 1000 live births. Gram-negative bacilli accounted for 78.1% of confirmed cases, predominantly Enterobacterales. High resistance to gentamicin and third-generation cephalosporins was documented, with frequent extended-spectrum beta-lactamase production. In the revised multivariable model, low birth weight was independently associated with increased in-hospital mortality (aOR 2.97; 95% CI 1.74-5.09), whereas culture-confirmed EOS was not independently associated with death.
CONCLUSION: EOS in this setting was characterized by Gram-negative predominance, substantial antimicrobial resistance, and important diagnostic stewardship constraints. The high prevalence of multidrug-resistant Enterobacterales raises concerns regarding the adequacy of current WHO-recommended empirical regimens in similar LMIC settings. Low birth weight emerged as the strongest independent predictor of in-hospital mortality. Strengthening microbiological capacity, infection prevention practices, and locally adapted antimicrobial stewardship strategies is essential to improve neonatal outcomes in this setting.
METHODS: We conducted a retrospective cohort study including neonates ≤72 h of life managed for suspected EOS between January 2021 and September 2025 at a tertiary neonatal intensive care unit in the Eastern Democratic Republic of the Congo. Diagnostic stewardship indicators included blood culture sampling proportion, positivity rate, and contamination rate. Multivariable logistic regression identified independent predictors of in-hospital mortality.
RESULTS: Among 1293 neonates with suspected EOS, blood cultures were performed in 604 (46.7%). The positivity rate for true pathogens was 17.4% (105/604), and 10.1% of cultures were classified as contaminants. Among inborn neonates, the incidence of culture-confirmed EOS was 8.4 per 1000 live births. Gram-negative bacilli accounted for 78.1% of confirmed cases, predominantly Enterobacterales. High resistance to gentamicin and third-generation cephalosporins was documented, with frequent extended-spectrum beta-lactamase production. In the revised multivariable model, low birth weight was independently associated with increased in-hospital mortality (aOR 2.97; 95% CI 1.74-5.09), whereas culture-confirmed EOS was not independently associated with death.
CONCLUSION: EOS in this setting was characterized by Gram-negative predominance, substantial antimicrobial resistance, and important diagnostic stewardship constraints. The high prevalence of multidrug-resistant Enterobacterales raises concerns regarding the adequacy of current WHO-recommended empirical regimens in similar LMIC settings. Low birth weight emerged as the strongest independent predictor of in-hospital mortality. Strengthening microbiological capacity, infection prevention practices, and locally adapted antimicrobial stewardship strategies is essential to improve neonatal outcomes in this setting.