Fig 1.
Trends in neonatal hospital-acquired bloodstream infection (HA-BSI) rate, pathogen yield and blood culture contamination rate (2009–2018).
*HA-BSI rate calculated using number of HA-BSI episodes over total inpatient-days multiplied by 1000, from 2009–2018. HA-BSI comparisons made using Poisson regression. Pathogen yield and blood culture contamination rate calculated as number of pathogen-containing and contaminant-containing blood cultures respectively, as a proportion of all blood cultures submitted from 2009–2018; compared using a χ2 test for linear trend. Two-sided p-values were used.
Table 1.
Comparison of key variables in neonatal hospital-acquired bloodstream infection at Tygerberg Hospital from 2009–2018, and comparison between the Period 1 (2009–2013) and Period 2 (2014–2018).
Fig 2.
Phenotypic susceptibility patterns for the most commonly isolated pathogens in neonatal hospital-acquired bloodstream infections, Period 1 (2009–2013) vs Period 2 (2014–2018).
*Phenotypic susceptibility patterns established using the relevant year’s Clinical and Laboratory Standards Institute (CLSI) breakpoints. Isolates classified according to standard definitions for wild-type and acquired resistance, and reported as a proportion of the total number of isolates per species. Two-sided p-values were used. ESBL: extended-spectrum β-lactamase, detected by third-generation cephalosporin resistance; MRSA: methicillin-resistant S. aureus, detected by cefoxitin resistance;3GCR: 3rd-generation cephalosporin resistance in chromosomal ampC beta-lactamase producers; CRE: carbapenem-resistant Enterobacterales, detected by reduced susceptibility to any carbapenem (usually ertapenem), in isolates not known to have chromosomally-mediated mechanisms for reduced susceptibility, XDR: extensively drug resistant, classified using a standard definition [14]. *Including Candida spp. with established fluconazole resistance, C. krusei and C. glabrata, which were the only isolates in which fluconazole resistance was found. No C. auris isolates were detected in this setting during the period of study.