Serious infections remain the leading cause of death in the first year of life. Sepsis in neonatal intensive care units is well described but infants with bacterial infections presenting from the community has not previously been described in New Zealand. Recent studies suggest an increasing incidence of Staphylococcus aureus and Streptococcus pyogenes in New Zealand paediatric populations. It is, therefore, important to understand the unique pattern of infections seen in the infant population in New Zealand as this may impact on empiric management.
A retrospective study (2007-2017) including infants aged 8 to 90 days presenting with clinically significant infection and positive culture from a sterile site. Cases were identified from laboratory database and ICD discharge codes, enabling data collection and analysis.
192 cases were identified from two major hospitals in Auckland. This represented an incidence of invasive bacterial infections of 129/100,000 live births. Escherichia coli (40%) and Streptococcus agalactiae (22%) were the commonest pathogens. Streptococcus pyogenes and Staphylococcus aureus caused 14% and 12% of bacteraemias respectively. Pacific island infants had the highest rates of infection (255/100,000) as did those from deprived backgrounds.
Escherichia coli and Streptococcus agalactiae are the commonest causative organisms in community onset infant sepsis in Auckland.
Rates of invasive bacterial infections in this age group are higher than reported in other industrialised countries (including published data from the USA), with Staphylococcus aureus and Streptococcus pyogenes being the most disproportionate. Our study demonstrates the increased risk of invasive Staphylococcus aureus and Streptococcus pyogenes in New Zealand, even at this early age, and this impacts on empiric antibiotic prescribing and management of infant sepsis in New Zealand. The risk of invasive infection is highest in Pacific and Māori infants and those from deprived backgrounds.
A small number of multi-resistant organisms were present in this age group, prior to antibiotic exposure, illustrating that rising rates of community antimicrobial resistance will need to be considered even when prescribing for infants.
E. Wilson, None
D. R. Lennon, None
R. Webb, None
E. Best, None