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Patient demographics, HA-BSI rates, pathogen spectrum, and hospital outcomes and empiric antibiotic coverage rates were determined.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Over two years, 23,748 neonates were admitted with unit occupancy rates ranging from 79 to 93%. 485 HA-BSI episodes occurred, with median onset at 11 (IQR 7\u201324) days of life. Most HA-BSI episodes (348; 72%) affected very low birth weight neonates (&lt;\u20091500\u00a0g). The overall HA-BSI rate was 2.0\/1000 patient days. The highest HA-BSI rate was observed at the central unit with onsite surgery (3.8\/1000 patient days). Crude HA-BSI mortality was 31.8% (154\/485) with two-thirds of deaths occurring within three days of BSI onset. Higher mortality was observed for Gram-negative\/fungal BSI compared to Gram-positive BSI (RR 1.5; 95%CI 1.1-2.0; <jats:italic>p<\/jats:italic>\u2009=\u20090.01) and very preterm neonates (gestation\u2009&lt;\u200932 weeks) versus \u2265\u200932 weeks (RR 1.5; 95%CI 1.1\u20132.1; <jats:italic>p<\/jats:italic>\u2009=\u20090.01). Mean estimated empiric antibiotic coverage rates varied by unit type: 66\u201379% for piperacillin-tazobactam plus amikacin, 60\u201376% for meropenem and 84\u201392% for meropenem plus vancomycin.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Most HA-BSI events affected preterm neonates at the central hospital with onsite surgery. One-third of patients with HA-BSI died, with highest mortality in preterm infants and Gram-negative\/fungal BSI. Empiric antibiotic regimens provide moderate coverage of circulating pathogens but require annual review given increasing carbapenem resistance rates.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-024-10219-0","type":"journal-article","created":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T18:30:21Z","timestamp":1732645821000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Epidemiology of healthcare-associated bloodstream infection in South African neonatal units"],"prefix":"10.1186","volume":"24","author":[{"given":"Angela","family":"Dramowski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larisse","family":"Bolton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrie","family":"Bekker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnoldus","family":"Engelbrecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa","family":"Erasmus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaqilah","family":"Fataar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandre","family":"Geldenhuys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlize","family":"Kunneke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave Le","family":"Roux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha O\u2019","family":"Connell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kessendri","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Rhoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd","family":"Tooke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Wates","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thandi","family":"Wessels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cari","family":"van Schalkwyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Whitelaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,26]]},"reference":[{"key":"10219_CR1","volume-title":"Levels & trends in Child Mortality: Report 2022, estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation","author":"United Nations Inter-agency Group for Child Mortality Estimation (UN IGME)","year":"2023","unstructured":"United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). 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