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      Risk factors for mortality in culture-negative neonatal sepsis in Malawi: a propensity score-matched analysis

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          Abstract

          We conducted a propensity score-matched multivariable regression analysis of 1050 culture-negative neonatal sepsis cases in Malawi, where 160 (15.2%) died. Mortality among neonates with culture-negative sepsis was associated with very low birth weight (adjusted OR (AOR) 12.82, 95% CI 1.23 to 137.49), respiratory distress syndrome (AOR 13.20, 95% CI 2.58 to 83.66), a low Apgar score at 1 min (AOR 3.50, 95% CI 1.21 to 10.72) and at 5 min (AOR 4.77, 95% CI 1.94 to 12.50). Addressing maternal and perinatal factors around health and delivery of care is key to improving outcomes in the context of culture-negative sepsis in neonates from low-income country settings like Malawi.

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          Antibiotic resistance-the need for global solutions.

          Ramanan Laxminarayan, Adriano Duse, Chand Wattal … (2013)
          The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Similarities with climate change are evident. Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections. Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken. Here, we describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed. Copyright © 2013 Elsevier Ltd. All rights reserved.
          Article 0 comments Cited 1413 times – based on 0 reviews     Review now
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            Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants.

            Jareen Meinzen-Derr, Ardythe L. Morrow, Kurt R. Schibler … (2011)
            To investigate the outcomes after prolonged empirical antibiotic administration to premature infants in the first week of life, and concluding subsequent late onset sepsis (LOS), necrotizing enterocolitis (NEC), and death. Study infants were ≤ 32 weeks gestational age and ≤ 1500 g birth weight who survived free of sepsis and NEC for 7 days. Multivariable logistic regression was conducted to determine independent relationships between prolonged initial empirical antibiotic therapy (≥ 5 days) and study outcomes that control for birth weight, gestational age, race, prolonged premature rupture of membranes, days on high-frequency ventilation in 7 days, and the amount of breast milk received in the first 14 days of life. Of the 365 premature infants who survived 7 days free of sepsis or NEC, 36% received prolonged initial empirical antibiotics, which was independently associated with subsequent outcomes: LOS (OR, 2.45 [95% CI, 1.28-4.67]) and the combination of LOS, NEC, or death (OR, 2.66 [95% CI, 1.12-6.3]). Prolonged administration of empirical antibiotics to premature infants with sterile cultures in the first week of life is associated with subsequent severe outcomes. Judicious restriction of antibiotic use should be investigated as a strategy to reduce severe outcomes for premature infants. Copyright © 2011 Mosby, Inc. All rights reserved.
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              Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT): a prospective interrupted time-series study.

              Pablo J. Sánchez, Jessica E Pruszynski, Phillip Wozniak … (2016)
              Antibiotics are used frequently in the neonatal intensive care unit. We aimed to inform antibiotic stewardship strategies in a level 3 neonatal intensive care unit by surveillance and assessment of all antibiotic use during a 14-month period, identifying scenarios where antibiotic use can be reduced, and implementing interventions while monitoring safety.
              Article 0 comments Cited 53 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Paediatr Open
                Journal ID (iso-abbrev): BMJ Paediatr Open
                Journal ID (hwp): bmjpo
                Journal ID (publisher-id): bmjpo
                Title: BMJ Paediatrics Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2399-9772
                Publication date Collection: 2024
                Publication date (Electronic): 21 June 2024
                Volume: 8
                Issue: 1
                Electronic Location Identifier: e002664
                Affiliations
                [1 ] Ringgold_560808Malawi-Liverpool-Wellcome Trust Clinical Research Programme , Blantyre, Malawi
                [2 ] Ringgold_37610Kamuzu University of Health Sciences , Blantyre, Southern Region, Malawi
                [3 ] Ringgold_9655Liverpool School of Tropical Medicine , Liverpool, UK
                Author notes
                [Correspondence to ] Dr Pui-Ying Iroh Tam; irohtam@ 123456mlw.mw
                Author information
                http://orcid.org/0000-0002-3682-8892
                Article
                Publisher ID: bmjpo-2024-002664
                DOI: 10.1136/bmjpo-2024-002664
                PMC ID: 11191787
                PubMed ID: 38906562
                SO-VID: f82e422e-b5c9-4c22-b2a2-787fbe3904ae
                Copyright © © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 27 March 2024
                Date accepted : 04 June 2024
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100010269, Wellcome Trust;
                Award ID: 206454
                Categories
                Subject: Original Research Letter
                Subject: 1506
                Custom metadata
                special-feature unlocked

                Keywords: child health,low and middle income countries,neonatology,mortality
                Data availability:
                Keywords: child health, low and middle income countries, neonatology, mortality

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