Etiology and Antimicrobial Resistance of Culture-Positive Infections in Ugandan Infants: A Cohort Study of 7000 Neonates and Infants.

Summary

In a prospective cohort of 7,323 Ugandan neonates and infants with suspected sepsis, 11% of blood cultures were positive, inpatient mortality was 12.1%, and case fatality for Gram-negative bloodstream infections reached 27.7%. High resistance to WHO first-line agents underscores the need to revise empiric regimens tailored to local resistance patterns.

Key Findings

• Among 7,323 infants evaluated, 11% of blood cultures and 8.6% of nasopharyngeal swabs were positive.
• Inpatient mortality was 12.1% overall; Gram-negative bloodstream infections had 27.7% case fatality.
• Bacterial isolates showed high resistance to WHO-recommended first-line regimens (ampicillin/penicillin plus gentamicin).

Clinical Implications

Hospitals in similar settings should reassess empiric neonatal sepsis regimens, strengthen microbiology capacity, and implement stewardship aligned with local AMR. Prioritize rapid diagnostics and early escalation for suspected Gram-negative BSI.

Limitations

• Conducted at two sites in Kampala; generalizability to other regions may vary.
• Detailed organism-by-organism resistance profiles and lumbar puncture rates are limited in the abstract.

Future Directions

Implement and evaluate context-specific empiric regimens; expand surveillance to additional sites; integrate genomic epidemiology to track transmission and resistance mechanisms.