{
    "abstract": "Epidemiological evidence about the etiology and antimicrobial resistance of neonatal infections remains limited in low-resource settings. We aimed to describe the etiology of neonatal infections in a prospective observational cohort study conducted at two hospital sites in Kampala, Uganda.\nBabies admitted to either unit with risk factors or signs of sepsis, pneumonia, or meningitis had a blood culture, nasopharyngeal swab, and lumbar puncture (if indicated) collected. Basic demographics were collected, and babies were followed up until discharge or death to determine admission outcome. Blood cultures were processed using the BACTEC system and identification confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Cerebrospinal fluid was processed using standard microbiological testing and swabs were processed using the multiplex real-time polymerase chain reaction assay. Antimicrobial susceptibilities of bacterial isolates to World Health Organization-recommended first-line antibiotics (ampicillin or benzylpenicillin and gentamicin) were assessed using e-tests.\nA total of 7323 infants with signs or risk factors for sepsis had blood cultures, 2563 had nasopharyngeal swabs, and 23 had lumbar punctures collected. Eleven percent of blood cultures and 8.6% of swabs were positive. Inpatient mortality was 12.1%, with 27.7% case fatality observed among infants with Gram-negative bloodstream infections. \nOur study demonstrates high levels of antimicrobial resistance and inpatient mortality from neonatal sepsis in the first months of life in Uganda. This underscores the pressing need for revised, context-specific antimicrobial treatment guidelines that account for the evolving landscape of antimicrobial resistance in neonatal sepsis.",
    "authors": [
        {
            "affiliation": "Institute for Infection and Immunity, St George's, University of London, London, UK.\nMakerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.\nDepartment of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.",
            "firstname": "Hannah G",
            "initials": "HG",
            "lastname": "Davies"
        },
        {
            "affiliation": "Institute for Infection and Immunity, St George's, University of London, London, UK.\nMakerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.",
            "firstname": "Mary",
            "initials": "M",
            "lastname": "Kyohere"
        },
        {
            "affiliation": "Makerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.",
            "firstname": "Valerie",
            "initials": "V",
            "lastname": "Tusubira"
        },
        {
            "affiliation": "Makerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.",
            "firstname": "Alexander",
            "initials": "A",
            "lastname": "Amone"
        },
        {
            "affiliation": "Department of Medical Microbiology, Makerere University, Kampala, Uganda.",
            "firstname": "Amusa",
            "initials": "A",
            "lastname": "Wamawobe"
        },
        {
            "affiliation": "Makerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.",
            "firstname": "Cleophas",
            "initials": "C",
            "lastname": "Komugisha"
        },
        {
            "affiliation": "Makerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.",
            "firstname": "Philippa",
            "initials": "P",
            "lastname": "Musoke"
        },
        {
            "affiliation": "Institute for Infection and Immunity, St George's, University of London, London, UK.\nMakerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.\nMedical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.",
            "firstname": "Lauren",
            "initials": "L",
            "lastname": "Hookham"
        },
        {
            "affiliation": "Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.",
            "firstname": "Pooja",
            "initials": "P",
            "lastname": "Ravji"
        },
        {
            "affiliation": "Institute for Infection and Immunity, St George's, University of London, London, UK.\nMakerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.",
            "firstname": "Melanie",
            "initials": "M",
            "lastname": "Etti"
        },
        {
            "affiliation": "Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.",
            "firstname": "Juliet",
            "initials": "J",
            "lastname": "Nsimire Sendagala"
        },
        {
            "affiliation": "Cardiff University School of Medicine, Division of Infection & Immunity, Cardiff, UK.",
            "firstname": "Dan R",
            "initials": "DR",
            "lastname": "Shelley"
        },
        {
            "affiliation": "Cardiff University School of Medicine, Division of Infection & Immunity, Cardiff, UK.",
            "firstname": "Caitlin",
            "initials": "C",
            "lastname": "Farley"
        },
        {
            "affiliation": "Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.",
            "firstname": "Merryn",
            "initials": "M",
            "lastname": "Voysey"
        },
        {
            "affiliation": "Cardiff University School of Medicine, Division of Infection & Immunity, Cardiff, UK.",
            "firstname": "Owen B",
            "initials": "OB",
            "lastname": "Spiller"
        },
        {
            "affiliation": "Institute for Infection and Immunity, St George's, University of London, London, UK.",
            "firstname": "Joseph",
            "initials": "J",
            "lastname": "Peacock"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda.",
            "firstname": "Musa",
            "initials": "M",
            "lastname": "Sekikubo"
        },
        {
            "affiliation": "Institute for Infection and Immunity, St George's, University of London, London, UK.",
            "firstname": "Paul T",
            "initials": "PT",
            "lastname": "Heath"
        },
        {
            "affiliation": "Institute for Infection and Immunity, St George's, University of London, London, UK.\nMakerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.\nMedical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.",
            "firstname": "Kirsty",
            "initials": "K",
            "lastname": "Le Doare"
        },
        {
            "affiliation": null,
            "firstname": null,
            "initials": null,
            "lastname": null
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America.",
    "doi": "10.1093/ofid/ofae629",
    "journal": "Open forum infectious diseases",
    "keywords": [
        "antimicrobial resistance",
        "bloodstream infections",
        "neonatal sepsis",
        "respiratory infections",
        "surveillance"
    ],
    "methods": null,
    "publication_date": "2025-03-12",
    "pubmed_id": "40070704\n34800370\n24006557\n34582466\n37604175\n26603918\n25888320\n33299966\n24131428\n31078660\n32776958\n37289666\n33782558\n36314976\n31552006\n22633519\n31425329\n37436835\n26546372\n28575369\n3231554\n27714962",
    "results": "A total of 7323 infants with signs or risk factors for sepsis had blood cultures, 2563 had nasopharyngeal swabs, and 23 had lumbar punctures collected. Eleven percent of blood cultures and 8.6% of swabs were positive. Inpatient mortality was 12.1%, with 27.7% case fatality observed among infants with Gram-negative bloodstream infections. ",
    "title": "Etiology and Antimicrobial Resistance of Culture-Positive Infections in Ugandan Infants: A Cohort Study of 7000 Neonates and Infants.",
    "xml": "<Element 'PubmedArticle' at 0x78850442ca40>"
}