Few population-level estimates of invasive neonatal infections have been reported from sub-Saharan Africa. We estimated the national incidence risk, aetiology, and pathogen antimicrobial susceptibility for culture-confirmed neonatal bloodstream infections and meningitis in South Africa. We conducted a cross-sectional study of neonates (<28 days of life) admitted to neonatal or paediatric wards of 256 public sector health facilities in South Africa during 2014–19. Diagnostic pathology records from Jan 1, 2014, to Dec 31, 2019, were extracted from a national pathology data warehouse. A case was defined as a neonate with at least one positive blood or cerebrospinal fluid culture during a 14-day period. Incidence risk was calculated using annual numbers of registered livebirths. Among the causative pathogens identified, we calculated the proportion of cases attributed to each of them, as well as the rates of antibiotic susceptibility of Gram-positive and Gram-negative bacteria. Among 43 438 records of positive cultures, there were 37 631 incident cases of neonatal infection with at least one pathogen isolated. The overall incidence risk of culture-confirmed infections was 6·0 per 1000 livebirths (95% CI 6·0–6·1). The incidence risk of late-onset sepsis (days 3–27 of life) was 4·9 per 1000 livebirths (4·9–5·0) and that of early-onset sepsis (days 0–2 of life) was 1·1 per 1000 livebirths (1·1–1·1); risk ratio 4·4 (95% CI 4·3–4·5). The cause of infection differed by syndrome, timing of infection onset, facility, and province, although (26%), (13%), and (12%) were the dominant pathogens overall. Gram-negative bacteria had declining susceptibility to most antibiotics over the study period. We found a high incidence risk of late-onset sepsis with provincial variations, predominance of , and declining antibiotic susceptibility among Gram-negative bacteria. This national surveillance in an upper-middle-income country provides a baseline burden of neonatal infections against which the impact of future clinical and public health interventions can be measured. Bill & Melinda Gates Foundation.

中文翻译：

---

2014-19 年南非经培养证实的新生儿血流感染和脑膜炎：一项横断面研究

撒哈拉以南非洲地区很少有人口层面的侵袭性新生儿感染估计报告。我们评估了南非培养确诊的新生儿血流感染和脑膜炎的全国发病风险、病因和病原体抗菌药物敏感性。我们对 2014-19 年南非 256 个公共部门卫生机构的新生儿或儿科病房收治的新生儿（出生后 28 天以下）进行了一项横断面研究。从国家病理数据库中提取2014年1月1日至2019年12月31日的诊断病理记录。病例定义为在 14 天内至少有一次血液或脑脊液培养呈阳性的新生儿。发病风险是根据每年登记的活产数量计算的。在确定的致病病原体中，我们计算了每种病原体的病例比例，以及革兰氏阳性菌和革兰氏阴性菌的抗生素敏感性率。在 43 438 份阳性培养记录中，有 37 631 例新生儿感染病例，至少分离出一种病原体。培养确诊感染的总体发病风险为每 1000 名活产儿 6·0 例（95% CI 6·0–6·1）。晚发性脓毒症（出生后第 3-27 天）的发病风险为每 1000 名活产儿 4·9 例 (4·9–5·0)，早发性脓毒症（出生后第 0-2 天）的发生风险为 1·9每 1000 个活产 1 个 (1·1–1·1)；风险比 4·4 (95% CI 4·3–4·5)。尽管（26%）、（13%）和（12%）总体上是主要病原体，但感染原因因症状、感染发病时间、设施和省份而异。在研究期间，革兰氏阴性细菌对大多数抗生素的敏感性下降。我们发现晚发性败血症的发病风险较高，且各省间存在差异，革兰氏阴性菌占主导地位，且抗生素敏感性下降。这项在中高收入国家进行的国家监测提供了新生儿感染的基线负担，可以根据该负担衡量未来临床和公共卫生干预措施的影响。比尔及梅琳达·盖茨基金会。