{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:46:19Z","timestamp":1792079179873,"version":"4.4.0"},"reference-count":43,"publisher":"American Society of Tropical Medicine and Hygiene","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,15]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Late-onset sepsis (LOS) in neonates is defined as a bloodstream infection occurring after 72 hours of life and is primarily caused by bacterial pathogens, often associated with catheter use and prolonged hospitalization. Despite its clinical and policy relevance, limited data exist on the etiology of neonatal infections in sub-Saharan Africa. This 8-year retrospective study investigated microbial patterns and antibiotic trends of LOS in a South African neonatal unit to inform infection control and antibiotic stewardship strategies. Data from neonates weighing 500 to 2,500 g admitted to the neonatal unit of a public tertiary hospital in Johannesburg (2013\u20132020) were analyzed for culture-confirmed LOS. Microbial prevalence was stratified by birth weight and year, and temporal shifts were assessed using Joinpoint regression. Among 7,468 neonates, 1,454 LOS episodes occurred (194 per 1,000 live births), with males accounting for 51.1%. Gram-positive bacteria predominated (55.4%), mainly coagulase-negative staphylococci (CoNS; 37%), followed by Gram-negative bacteria (44.4%), notably extended-spectrum beta lactamase-producing\n                    <jats:italic>Klebsiella<\/jats:italic>\n                    (13.2%) and\n                    <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                    (12.8%). A marked decline in CoNS incidence was observed in 2016 (annual percentage change: \u221217.6%). Meropenem (35%) and vancomycin (30.5%) were most frequently used, with extreme-low-birth-weight (ELBW) neonates disproportionately affected. Late-onset sepsis remains a persistent challenge, with CoNS as the leading pathogen and increasing multidrug-resistant Gram-negative infections, particularly in ELBW and very-low-birth-weight infants. The observed decline in CoNS may signal improved infection control, whereas reliance on last-line antibiotics underscores an urgent need for enhanced surveillance, prevention, and antimicrobial stewardship.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0419","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:11:18Z","timestamp":1792077078000},"source":"Crossref","is-referenced-by-count":0,"title":["Bacteria Pathogen Distribution in Late-Onset Neonatal Sepsis: Trends from a South African Neonatal Intensive Care Unit"],"prefix":"10.4269","author":[{"given":"Oluseyi","family":"Ajayi","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;"},{"name":"STRONG Group (Specialised Translational Research Oxford Neuromuscular Group), Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanusha","family":"Ramdin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Chirwa","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics Division, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daynia","family":"Ballot","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Newborn Mortality.","year":"2024"},{"issue":"12","key":"b2","series-title":"Lancet Infect Dis","first-page":"1677","article-title":"Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: An international microbiology and drug evaluation prospective substudy (BARNARDS)","volume":"21","author":"Thomson","year":"2021"},{"key":"b3","series-title":"J Infect","first-page":"S24","article-title":"Neonatal sepsis: Progress towards improved outcomes","volume":"6","author":"Shane","year":"2014"},{"issue":"8","key":"b4","series-title":"Lancet Infect Dis","first-page":"731","article-title":"Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: A systematic review and meta-analysis","volume":"14","author":"Seale","year":"2014"},{"key":"b5","series-title":"Neonatology","first-page":"173","article-title":"Prevention and treatment of neonatal infections in facility and community settings of low- and middle-income countries: A descriptive review","volume":"122","author":"Lee Him","year":"2025"},{"issue":"6","key":"b6","series-title":"Pediatr Infect Dis J","first-page":"e207","article-title":"Neonatal sepsis in low- and middle-income countries: Where are we now?","volume":"44","author":"Dramowski","year":"2025"},{"key":"b7","series-title":"Int J Infect Dis","first-page":"125","article-title":"Late-onset neonatal sepsis in Arab states in the Gulf region: Two-year prospective study","volume":"55","author":"Hammoud","year":"2017"},{"key":"b8","series-title":"Int Immunopharmacol","first-page":"109769","article-title":"Clinical and laboratory findings to differentiate late-onset sepsis caused by Gram-negative vs Gram-positive bacteria among perterm neonates: A retrospective cohort study","volume":"116","author":"Zhang","year":"2023"},{"issue":"1","key":"b9","series-title":"Pediatr Infect Dis J","first-page":"e7","article-title":"Incidence, clinical characteristics and risk factors for adverse outcome in neonates with late-onset sepsis","volume":"33","author":"Tsai","year":"2014"},{"issue":"1","key":"b10","series-title":"Pediatrics","first-page":"34","article-title":"Epidemiological, clinical, and microbiological characteristics of late-onset sepsis among very low birth weight infants in Israel: A national survey","volume":"109","author":"Makhoul","year":"2002"},{"issue":"1","key":"b11","series-title":"J Pediatr","first-page":"63","article-title":"Late-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network","volume":"129","author":"Stoll","year":"1996"},{"issue":"8","key":"b12","series-title":"Eur J Pediatr","first-page":"997","article-title":"Current management of late onset neonatal bacterial sepsis in five European countries","volume":"173","author":"Lutsar","year":"2014"},{"issue":"1","key":"b13","series-title":"Pediatr Infect Dis J","first-page":"35","article-title":"Systematic review on the acute cost-of-illness of sepsis and meningitis in neonates and infants","volume":"39","author":"Salman","year":"2020"},{"issue":"3","key":"b14","series-title":"J Family Med Prim Care","first-page":"493","article-title":"Bacteriological profiles and antibiotic susceptibility of neonatal sepsis in a university hospital of Northern India","volume":"12","author":"Siddiqui","year":"2023"},{"key":"b15","article-title":"Low Birth Weight.","year":"2024"},{"issue":"1","key":"b16","series-title":"Arch Dis Child Fetal Neonatal Ed","first-page":"F9","article-title":"Neonatal infections in England: The neonIN surveillance network","volume":"96","author":"Vergnano","year":"2011"},{"issue":"5","key":"b17","series-title":"Expert Rev Anti Infect Ther","first-page":"243","article-title":"Effective antimicrobial therapies needed for treatment of severe infections in African newborns","volume":"23","author":"Iroh Tam","year":"2025"},{"issue":"3","key":"b18","series-title":"Antibiotics","first-page":"554","article-title":"The role of coagulase-negative staphylococci biofilms on late-onset sepsis: Current challenges and emerging diagnostics and therapies","volume":"12","author":"Fran\u00e7a","year":"2023"},{"issue":"1","key":"b19","series-title":"J Afric Neonatal","first-page":"1","article-title":"Epidemiology of bacterial bloodstream infections in very low birth weight neonates at Charlotte Maxeke Johannesburg Academic Hospital","volume":"1","author":"Matlhadisa","year":"2023"},{"issue":"1","key":"b20","series-title":"BMC Pediatr","first-page":"320","article-title":"A review of -multidrug-resistant Enterobacteriaceae in a neonatal unit in Johannesburg, South Africa","volume":"19","author":"Ballot","year":"2019"},{"key":"b21","article-title":"Principles of Epidemiology Second Edition Selected Lessons Lesson 1: Introduction to Epidemiology Lesson 6: Investigating an Outbreak.","author":"Dicker","year":"1992"},{"key":"b22","article-title":"Very Low and Extremely Low Birthweight Infants.","year":"2004"},{"issue":"1","key":"b23","series-title":"J Afric Neonatal","first-page":"7","article-title":"Risk factors and survival for late onset sepsis in very-low-birth-weight infants in a public hospital, Johannesburg, South Africa","volume":"1","author":"Mashile","year":"2023"},{"key":"b24","series-title":"ISRN Pediatr","first-page":"508512","article-title":"Bacterial bloodstream infections in neonates in a developing country","volume":"2012","author":"Ballot","year":"2012"},{"issue":"2","key":"b25","series-title":"J Biomed Inform","first-page":"377","article-title":"Research electronic data capture (REDCap)\u2014A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009"},{"issue":"16","key":"b26","series-title":"Stat Med","first-page":"3102","article-title":"Twenty years since Joinpoint 1.0: Two major enhancements, their justification, and impact","volume":"41","author":"Kim","year":"2022"},{"issue":"5","key":"b27","series-title":"Pediatrics","first-page":"e2023062223","article-title":"Late-onset sepsis in very low birth weight infants","volume":"152","author":"Klinger","year":"2023"},{"issue":"3","key":"b28","series-title":"Arch Dis Child Fetal Neonatal Ed","first-page":"F257","article-title":"Late-onset neonatal sepsis: Recent developments","volume":"100","author":"Dong","year":"2015"},{"issue":"1","key":"b29","series-title":"BMC Infect Dis","first-page":"225","article-title":"Neonatal sepsis in a tertiary unit in South Africa","volume":"21","author":"Pillay","year":"2021"},{"issue":"3","key":"b30","series-title":"J Hosp Infect","first-page":"214","article-title":"Incidence of healthcare-associated infections in high-risk neonates: Results from the German surveillance system for very-low-birthweight infants","volume":"68","author":"Geffers","year":"2008"},{"issue":"3","key":"b31","series-title":"Pediatrics","first-page":"419","article-title":"Nosocomial infection reduction in VLBW infants with a statewide quality-improvement model","volume":"127","author":"Wirtschafter","year":"2011"},{"issue":"5","key":"b32","series-title":"J Infect Public Health","first-page":"825","article-title":"Epidemiology and microbiology of catheter-associated urinary tract infections: A 14-year surveillance study at a tertiary care center in Lebanon","volume":"17","author":"Shmoury","year":"2024"},{"issue":"19","key":"b33","series-title":"JAMA","first-page":"2357","article-title":"Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection","volume":"292","author":"Stoll","year":"2004"},{"issue":"1","key":"b34","series-title":"Antimicrob Resist Infect Control","first-page":"15","article-title":"A mixed-method study on antimicrobial resistance infection drivers in neonatal intensive care units: Pathways, risks, and solutions","volume":"14","author":"Yeshiwas","year":"2025"},{"issue":"8","key":"b35","series-title":"Open Forum Infect Dis","first-page":"ofad362","article-title":"Multidrug-resistant bacterial infections among very low birthweight infants with late-onset sepsis in Johannesburg, South Africa","volume":"10","author":"Licona","year":"2023"},{"issue":"8","key":"b36","series-title":"Lancet Glob Health","first-page":"e1170","article-title":"Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014\u201319: A cross-sectional study","volume":"10","author":"Mashau","year":"2022"},{"issue":"9465","key":"b37","series-title":"Lancet","first-page":"1175","article-title":"Hospital-acquired neonatal infections in developing countries","volume":"365","author":"Zaidi","year":"2005"},{"issue":"4","key":"b38","series-title":"Lancet Infect Dis","first-page":"e51","article-title":"The Lancet Infectious Diseases Commission on antimicrobial resistance: 6 years later","volume":"20","author":"Laxminarayan","year":"2020"},{"issue":"6","key":"b39","series-title":"Semin Perinatol","first-page":"416","article-title":"Neonatal infections in the developing world","volume":"34","author":"Ganatra","year":"2010"},{"issue":"3","key":"b40","series-title":"Expert Rev Anti Infect Ther","first-page":"177","article-title":"Late-onset sepsis caused by Gram-negative bacteria in very low birth weight infants: A systematic review","volume":"17","author":"Dong","year":"2019"},{"key":"b41","series-title":"Early Hum 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