• Gary L Darmstadt, Samir K Saha, Yoonjoung Choi, Shams El Arifeen, Nawshad Uddin Ahmed, Sanwarul Bari, Syed M Rahman, Ishtiaq Mannan, Derrick Crook, Kaniz Fatima, Peter J Winch, Habibur Rahman Seraji, Nazma Begum, Radwanur Rahman, Maksuda Islam, Anisur Rahman, Robert E Black, Mathuram Santosham, Emma Sacks, Abdullah H Baqui, and Bangladesh Projahnmo-2 (Mirzapur) Study Group.
• Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
• J. Infect. Dis. 2009 Sep 15; 200 (6): 906-15.

BackgroundTo devise treatment strategies for neonatal infections, the population-level incidence and antibiotic susceptibility of pathogens must be defined.MethodsSurveillance for suspected neonatal sepsis was conducted in Mirzapur, Bangladesh, from February 2004 through November 2006. Community health workers assessed neonates on postnatal days 0, 2, 5, and 8 and referred sick neonates to a hospital, where blood was collected for culture from neonates with suspected sepsis. We estimated the incidence and pattern of community-acquired neonatal bacteremia and determined the antibiotic susceptibility profile of pathogens.ResultsThe incidence rate of community-acquired neonatal bacteremia was 3.0 per 1000 person-neonatal periods. Among the 30 pathogens identified, the most common was Staphylococcus aureus (n = 10); half of all isolates were gram positive. Nine were resistant to ampicillin and gentamicin or to ceftiaxone, and 13 were resistant to cotrimoxazole.ConclusionS. aureus was the most common pathogen to cause community-acquired neonatal bacteremia. Nearly 40% of infections were identified on days 0-3, emphasizing the need to address maternal and environmental sources of infection. The combination of parenteral procaine benzyl penicillin and an aminoglycoside is recommended for the first-line treatment of serious community-acquired neonatal infections in rural Bangladesh, which has a moderate level of neonatal mortality. Additional population-based data are needed to further guide national and global strategies.

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