Newborn infection rates in low-income countries are three-20 times higher than in high-income countries
Representative photo: iStock._ In June, two studies on neonatal infections and drug resistance were published in journal PLOS Medicine. While the first study emphasised the severity and increasing trend of carbapenem-resistant Klebsiella pneumoniae, the second one underscored how antibiotics are becoming ineffective in treating infections.
The latter also highlighted the problems associated with the inappropriate prescription of medicines that deviates from the World Health Organization (WHO) guidelines.
Neonatal mortality is a critical public health indicator for any country. It is defined as the death of newborn within the first 28 days of life. Neonatal mortality rates vary significantly across countries, with low-and middle-income countries (LMIC) contributing to a sizable proportion of deaths.
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Newborn infection rates in low-income countries are three-20 times higher than in high-income countries. Infections contribute to more than half of all neonatal deaths worldwide, making them one of the leading causes.
The prevalence of Klebsiella pneumoniae infections ranges between 4.1 and 6.3 per 1,000 live births, according to a recent study published in PLOS Medicine on June 20, 2023. This infection kills newborns, with case fatalities ranging from 18 per cent to 68 per cent.
Some 128 studies from 30 countries, including 21 LMICs, on 127,583 neonates, were reviewed to better understand the prevalence and clonal diversity of the disease-causing bacteria.
Klebsiella pneumoniae is a bacteria that can cause a variety of infections in humans, including pneumonia, urinary tract infections, bloodstream infections, surgical site infections and other infections.
Infections caused by these pathogens become severe when the pathogen becomes resistant to antimicrobials used to treat them; carbapenem-resistant Klebsiella pneumoniae is a case in point.
Infections caused by carbapenem-resistant Klebsiella pneumoniae pose a significant public health risk as treatment options for such conditions are limited.
Among the 128 studies, bloodstream infection, which frequently leads to sepsis, was identified as the most common type of neonatal carbapenem-resistant Klebsiella pneumoniae infection. If not properly diagnosed and treated, these infections can be fatal.
The pooled global prevalence of carbapenem-resistant Klebsiella pneumoniae infections in hospitalised neonates was high, with a 22.9 per cent pooled mortality, according to the study.
The authors concluded that most neonatal carbapenem-resistant Klebsiella pneumoniae strains are K pneumoniae (sensustricto), with the possibility of other species within the complex.
Pathogens develop antimicrobial resistance due to incorrect antibiotic prescription, among other factors. This issue has been highlighted in a similar study published in PLOS Medicine on June 8, 2023.
Watch video: Antimicrobial-resistant bacteria found in newborn children
The study also focuses on rising antimicrobial resistance, which is affecting neonates and young infants with sepsis in low- and middle-income countries and undermining the effectiveness of WHO-recommended antibiotics.
From 2018-2020, some 3,204 infants aged under 60 days were hospitalised with clinical sepsis in 11 countries, primarily in Asia and Africa.
WHO’s AWaRe classification categorised infants with known antibiotic treatments into five groups.
A total of 17.7 per cent of the infants included in the research tested pathogen positive in blood culture, with 62.9 per cent having primarilyKlebsiella pneumoniae or Acinetobacter spp, which are resistant to WHO-recommended regimens. The two bacteria were resistant to carbapenems in 32.6 per cent and 71.4 per cent of the cases, respectively. These baseline characteristics are highlighted in the figure below, with Klebsiella pneumoniae being the most common infection in these neonates.
Prevalence of pathogens isolated from baseline blood culture. Source: Study.
For the treatment, approximately 25.9 per cent of infants started WHO first-line regimens (access group), 13.8 per cent started WHO second-line cephalosporins (low watch group), 34 per cent started a regimen providing partial extended-spectrum beta-lactamase/pseudomonal coverage (medium watch group), 18 per cent started carbapenem (high watch group), and 1.8 per cent started reserve antibiotic (largely colistin-based).
Authors highlighted that antibiotic regimens used in neonatal sepsis tend to differ from WHO guidelines, and novel empiric regimens are urgently needed in light of antimicrobial resistance.
Furthermore, trials addressing optimal empiric first- and second-line antibiotic treatment strategies in LMIC hospital settings with a high AMR burden are urgently needed.
“The study exposed the glaring reality of antibiotic-resistant infections, especially in hospitals in LMICs, where we are often faced with a shortage of nurses, beds and space,” said Sithembiso Velaphi, head of paediatrics at Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa.
The risk of infections is very high, and most infections are resistant to antibiotics. If an antibiotic doesn’t work, babies often die. This urgently needs to change. We need antibiotics that will cover all bacterial infections, Velaphi added.
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