Maternal-infant Characteristics of Preterm and Term Neonates With Bloodstream Infections in Lower-tier Hospitals in South Africa: A Cross-sectional Study

Vanessa Quan; Susan Meiring; Rudzani Mashau; Olga Perovic; Rindidzani Magobo; Marshagne Smith; Ruth Mpembe; Anne von Gottberg; Linda de Gouveia; Sibongile Walaza; Cheryl Cohen; Constance Kapongo; Cheryl Mackay; Mphekwa Thomas Mailula; Omphile Mekgoe; Lerato Motjale; Rose Phayane; Angela Dramowski; Nelesh P Govender; for Baby GERMS-SA

doi:10.1097/INF.0000000000005127

Maternal-infant Characteristics of Preterm and Term Neonates With Bloodstream Infections in Lower-tier Hospitals in South Africa: A Cross-sectional Study

Pediatr Infect Dis J. 2026 Jan 7. doi: 10.1097/INF.0000000000005127. Online ahead of print.

Authors

Vanessa Quan¹, Susan Meiring¹, Rudzani Mashau¹, Olga Perovic^{1

2}, Rindidzani Magobo¹, Marshagne Smith¹, Ruth Mpembe¹, Anne von Gottberg^{1

2

3}, Linda de Gouveia¹, Sibongile Walaza¹, Cheryl Cohen^{1

2}, Constance Kapongo⁴, Cheryl Mackay^{5

6

7}, Mphekwa Thomas Mailula⁸, Omphile Mekgoe⁹, Lerato Motjale¹⁰, Rose Phayane¹¹, Angela Dramowski¹², Nelesh P Govender^{1

2

3

13}; for Baby GERMS-SA

Collaborators

Affiliations

¹ From the Division of Public Health Surveillance and Response,the Centre for Heatlhcare-associated Infections, Antimicrobial Resistance and Mycoses, and the Centre for Respiratory Diseases and Meningitis of the National Institute for Communicable Diseases, a division of the National Health Laboratory Service.
² School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg.
³ School of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town.
⁴ Department of Paediatrics and Child Health, Queen Nandi Regional Hospital, Ngwelazane.
⁵ Department of Paediatrics and Child Health, Dora Nginza Hospital, Nelson Mandela Bay, South Africa.
⁶ Neonatology, Child and Adolescent Health Service.
⁷ School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.
⁸ Department of Paediatrics and Child Health, Mankweng Regional Hospital, Mankweng.
⁹ Department of Paediatrics and Child Health, Klerksdorp Regional Hospital, Klerksdorp.
¹⁰ Department of Paediatrics and Child Health, Rob Ferreira Regional Hospital, Nelspruit.
¹¹ Department of Paediatrics and Child Health, Tembisa Provincial Hospital, Johannesburg.
¹² Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
¹³ MRC Centre for Medical Mycology, University of Exeter, Exeter, and Institute of Infection and Immunity, City St George's University of London, London, United Kingdom.

PMID: 41495922
DOI: 10.1097/INF.0000000000005127

Abstract

Background: Bloodstream infections (BSI) are an important cause of neonatal deaths in low- and middle-income countries.

Methods: We conducted a cross-sectional study of culture-confirmed BSI in neonates aged <28 days at 6 lower-tier South African hospitals (October 2019 to September 2020), comparing maternal-infant characteristics between preterm and term babies.

Results: Of 907 BSI episodes, clinical data were available for 676 neonates. Median gestational age was 33 weeks [interquartile ranges (IQR), 29-37 weeks], with 70% (472/676) of neonates born preterm. Preterm neonates had longer median hospital stays than term neonates [19 days (IQR, 9-36) vs. 11 days (IQR, 6-17), P < 0.001], more BSI episodes during days 3-27 of life [72% (343/472) vs. 57% (119/204); P < 0.001] and higher maternal HIV prevalence [38% (177/463) vs. 24% (49/200); P = 0.001]. Fewer mothers of preterm versus term neonates attended antenatal clinic appointments [86% (367/426) vs. 94% (166/176); P = 0.004]. Crude mortality was higher among preterm versus term neonates [31% (146/472) vs. 8.3% (17/204); P < 0.001], with a higher BSI-attributable mortality (defined as death within 3 days of a BSI) [21% (97/472) vs. 5.4% (11/204); P < 0.001]. Preterm neonates had 3.7 times higher adjusted odds of death (1·71-8·14; P = 0.001) than term neonates.

Conclusions: Preterm neonates with a BSI were more likely to die than those who were term. Neonatal units should implement interventions to prevent horizontal transmission of infections among these small, sick neonates. Targeted antenatal and intrapartum interventions are needed to prevent preterm births as a root cause.

Keywords: bacterial infections; fungal infections; middle income country; neonate; preterm; risk factors.