Pathogens Identified by Minimally Invasive Tissue Sampling in India and Pakistan From Preterm Neonatal Deaths: The PURPOSE Study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

We identified pathogens found in internal organs and placentas of deceased preterm infants cared for in hospitals in India and Pakistan.

Methods

Prospective, observational study conducted in delivery units and neonatal intensive care units. Tissue samples from deceased neonates obtained by minimally invasive tissue sampling and placentas were examined for 73 different pathogens using multiplex polymerase chain reaction (PCR).

Results

Tissue for pathogen PCR was obtained from liver, lung, brain, blood, cerebrospinal fluid, and placentas from 377 deceased preterm infants. Between 17.6% and 34.1% of each type of tissue had at least 1 organism identified. Organism detection was highest in blood (34.1%), followed by lung (31.1%), liver (23.3%), cerebrospinal fluid (22.3%), and brain (17.6%). A total of 49.7% of the deceased infants had at least 1 organism. Acinetobacter baumannii was in 28.4% of the neonates compared with 14.6% for Klebsiella pneumoniae, 11.9% for Escherichia coli/Shigella, and 11.1% for Haemophilus influenzae. Group B streptococcus was identified in only 1.3% of the neonatal deaths. A. baumannii was rarely found in the placenta and was found more commonly in the internal organs of neonates who died later in the neonatal period. The most common organism found in placentas was Ureaplasma urealyticum in 34% of the samples, with no other organism found in >4% of samples.

Conclusions

In organ samples from deceased infants in India and Pakistan, evaluated with multiplex pathogen PCR, A. baumannii was the most commonly identified organism. Group B streptococcus was rarely found. A. baumannii was rarely found in the placentas of these deceased neonates.

Abstract

In organ samples from deceased infants evaluated with multiplex polymerase chain reaction, Acinetobacter baumannii was the most common pathogen. Because A. baumannii was rare in the placentas and increased the longer the infant survived, nosocomial acquisition is likely.

Related collections

Most cited references 28

Record: found
Abstract: found
Article: not found

Acinetobacter baumannii: evolution of a global pathogen

Luísa C.S. Antunes, Paolo Visca, Kevin Towner (2014)

Acinetobacter baumannii is an opportunistic nosocomial pathogen and one of the six most important multidrug-resistant microorganisms in hospitals worldwide. This human pathogen is responsible for a vast array of infections, of which ventilator-associated pneumonia and bloodstream infections are the most common, and mortality rates can reach 35%. Community-acquired infections have also been reported, but few strains have been recovered from environmental sources and infection reservoirs external to the hospital have not been identified. The majority of A. baumannii infections are caused by two main population clones with worldwide distribution. Infection outbreaks are often associated with multidrug resistance, including the recent emergence of strains resistant to all available antibiotics. Nevertheless, A. baumannii virulence traits and pathogenic potential have mostly remained elusive. The recent expansion of A. baumannii sequenced genomes has permitted the development of large-array phylogenomic and phenotypic analyses, which can offer valuable insights into the evolution and adaptation of A. baumannii as a human pathogen. This review summarises these recent advances, with particular focus on A. baumannii evolutionary and genomic aspects, and proposes new avenues of research. © 2013 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.

0 comments Cited 325 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis

Lucia Hug, Monica Alexander, Danzhen You … (2019)

Summary Background Reducing neonatal mortality is an essential part of the third Sustainable Development Goal (SDG), to end preventable child deaths. To achieve this aim will require an understanding of the levels of and trends in neonatal mortality. We therefore aimed to estimate the levels of and trends in neonatal mortality by use of a statistical model that can be used to assess progress in the SDG era. With these estimates of neonatal mortality between 1990 and 2017, we then aimed to assess how different targets for neonatal mortality could affect the burden of neonatal mortality from 2018 to 2030. Methods In this systematic analysis, we used nationally-representative empirical data related to neonatal mortality, including data from vital registration systems, sample registration systems, and household surveys, to estimate country-specific neonatal mortality rates (NMR; the probability of dying during the first 28 days of life) for all countries between 1990 (or the earliest year of available data) and 2017. For our analysis, we used all publicly available data on neonatal mortality from databases compiled annually by the UN Inter-agency Group for Child Mortality Estimation, which were extracted on or before July 31, 2018, for data relating to the period between 1950 and 2017. All nationally representative data were assessed. We used a Bayesian hierarchical penalised B-splines regression model, which allowed for data from different sources to be weighted differently, to account for variable biases and for the uncertainty in NMR to be assessed. The model simultaneously estimated a global association between NMR and under-5 mortality rate and country-specific and time-specific effects, which enabled us to identify countries with an NMR that was higher or lower than expected. Scenario-based projections were made at the county level by use of current levels of and trends in neonatal mortality and historic or annual rates of reduction that would be required to achieve national targets. The main outcome that we assessed was the levels of and trends in neonatal mortality and the global and regional NMRs from 1990 to 2017. Findings Between 1990 and 2017, the global NMR decreased by 51% (90% uncertainty interval [UI] 46–54), from 36·6 deaths per 1000 livebirths (35·5–37·8) in 1990, to 18·0 deaths per 1000 livebirths (17·0–19·9) in 2017. The estimated number of neonatal deaths during the same period decreased from 5·0 million (4·9 million–5·2 million) to 2·5 million (2·4 million–2·8 million). Annual NMRs vary widely across the world, but west and central Africa and south Asia had the highest NMRs in 2017. All regions have reported reductions in NMRs since 1990, and most regions accelerated progress in reducing neonatal mortality in 2000–17 versus 1990–2000. Between 2018 and 2030, we project that 27·8 million children will die in their first month of life if each country maintains its current rate of reduction in NMR. If each country achieves the SDG neonatal mortality target of 12 deaths per 1000 livebirths or fewer by 2030, we project 22·7 million cumulative neonatal deaths by 2030. More than 60 countries need to accelerate their progress to reach the neonatal mortality SDG target by 2030. Interpretation Although substantial progress has been made in reducing neonatal mortality since 1990, increased efforts to improve progress are still needed to achieve the SDG target by 2030. Accelerated improvements are most needed in the regions and countries with high NMR, particularly in sub-Saharan Africa and south Asia. Funding Bill & Melinda Gates Foundation, United States Agency for International Development.

0 comments Cited 304 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Maternal Colonization With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses

Neal J. Russell, Anna C Seale, Megan O’Driscoll … (2017)

Abstract Background Maternal rectovaginal colonization with group B Streptococcus (GBS) is the most common pathway for GBS disease in mother, fetus, and newborn. This article, the second in a series estimating the burden of GBS, aims to determine the prevalence and serotype distribution of GBS colonizing pregnant women worldwide. Methods We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus), organized Chinese language searches, and sought unpublished data from investigator groups. We applied broad inclusion criteria to maximize data inputs, particularly from low- and middle-income contexts, and then applied new meta-analyses to adjust for studies with less-sensitive sampling and laboratory techniques. We undertook meta-analyses to derive pooled estimates of maternal GBS colonization prevalence at national and regional levels. Results The dataset regarding colonization included 390 articles, 85 countries, and a total of 299924 pregnant women. Our adjusted estimate for maternal GBS colonization worldwide was 18% (95% confidence interval [CI], 17%–19%), with regional variation (11%–35%), and lower prevalence in Southern Asia (12.5% [95% CI, 10%–15%]) and Eastern Asia (11% [95% CI, 10%–12%]). Bacterial serotypes I–V account for 98% of identified colonizing GBS isolates worldwide. Serotype III, associated with invasive disease, accounts for 25% (95% CI, 23%–28%), but is less frequent in some South American and Asian countries. Serotypes VI–IX are more common in Asia. Conclusions GBS colonizes pregnant women worldwide, but prevalence and serotype distribution vary, even after adjusting for laboratory methods. Lower GBS maternal colonization prevalence, with less serotype III, may help to explain lower GBS disease incidence in regions such as Asia. High prevalence worldwide, and more serotype data, are relevant to prevention efforts.

0 comments Cited 126 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Najia Karim Ghanchi

Imran Ahmed

Jean Kim

Sheetal Harakuni

Manjunath S Somannavar

Afia Zafar

Shiyam Sunder Tikmani

Sarah Saleem

Shivaprasad S Goudar

Sangappa M Dhaded

Gowdar Guruprasad

S Yogeshkumar

Kay Hwang

Anna Aceituno

Robert M Silver

Elizabeth M McClure:

ORCID: https://orcid.org/0000-0001-8659-5444

Robert L Goldenberg

Journal

Journal ID (nlm-ta): Clin Infect Dis

Journal ID (iso-abbrev): Clin Infect Dis

Journal ID (publisher-id): cid

Title: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America

Publisher: Oxford University Press (US )

ISSN (Print): 1058-4838

ISSN (Electronic): 1537-6591

Publication date Collection: 01 February 2023

Publication date (Electronic): 15 September 2022

Publication date PMC-release: 15 September 2022

Volume: 76

Issue: 3

Pages: e1004-e1011

Affiliations

Department of Pathology & Laboratory Medicine, Aga Khan University , Karachi, Pakistan

Social, Statistical and Environmental Health Sciences, RTI International , Durham, North Carolina, USA

KLE Academy of Higher Education and Research's, J.N. Medical College , Belagavi, Karnataka, India

Department of Pathology & Laboratory Medicine, Aga Khan University , Karachi, Pakistan

Department of Community Health Sciences, Aga Khan University , Karachi, Pakistan

KLE Academy of Higher Education and Research's, J.N. Medical College , Belagavi, Karnataka, India

Department of Pediatrics, Bapuji Educational Association, J.J.M. Medical College , Davangere, Karnataka, India

KLE Academy of Higher Education and Research's, J.N. Medical College , Belagavi, Karnataka, India

Social, Statistical and Environmental Health Sciences, RTI International , Durham, North Carolina, USA

Department of Obstetrics and Gynecology, University of Utah School of Medicine , Salt Lake City, Utah, USA

Social, Statistical and Environmental Health Sciences, RTI International , Durham, North Carolina, USA

Department of Obstetrics and Gynecology, Columbia University , New York, New York, USA

Author notes

Correspondence: E. M. McClure, RTI International 3040 Cornwallis Rd, Durham, NC 27516 ( mcclure@ 123456rti.org ).

Potential conflicts of interest. R. L. G. and R. M. S. report funds to attend meeting in Washington, DC, from RTI International. All other authors report no potential conflicts.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Author information

Elizabeth M McClure https://orcid.org/0000-0001-8659-5444

Article

Publisher ID: ciac747

DOI: 10.1093/cid/ciac747

PMC ID: 9907547

PubMed ID: 36104850

SO-VID: ae27cf0f-46a9-4869-b7b0-a2b2b85c9b22

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Date received : 27 May 2022

Date: 25 August 2022

Date: 11 October 2022

Page count

Pages: 8

Funding

Funded by: Bill & Melinda Gates Foundation, doi 10.13039/100000865;

Comments

Comment on this article

scite_

Cited by 4

See all cited by

Most referenced authors 451

See all reference authors

Pathogens Identified by Minimally Invasive Tissue Sampling in India and Pakistan From Preterm Neonatal Deaths: The PURPOSE Study

Read this article at

Abstract

Background

Methods

Results

Conclusions

Abstract

Related collections

Coronaviruses, COVID-19 and SARS-CoV-2

Most cited references 28

Acinetobacter baumannii: evolution of a global pathogen

National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis

Maternal Colonization With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses

Author and article information

Contributors

Journal

Affiliations

Author notes

Author information

Article

History

Page count

Funding

Categories

Comments

Comment on this article

Similar content 284

Cited by 4

Most referenced authors 451