Risk factors for community-acquired bacterial infection among young infants in South Asia: a longitudinal cohort study with nested case–control analysis

ObjectiveRisk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying risk factors for infection could lead to improved preventive measures and antibiotic stewardship.MethodsFive sites in Bangladesh, I...

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Published in:BMJ global health Vol. 7; no. 11; p. e009706
Main Authors: Connor, Nicholas E, Islam, Mohammad Shahidul, Mullany, Luke C, Shang, Nong, Bhutta, Zulfiqar A, Zaidi, Anita K M, Soofi, Sajid, Nisar, Imran, Panigrahi, Pinaki, Panigrahi, Kalpana, Satpathy, Radhanath, Bose, Anuradha, Isaac, Rita, Baqui, Abdullah H, Mitra, Dipak K, Sadeq-ur Rahman, Qazi, Hossain, Tanvir, Schrag, Stephanie J, Winchell, Jonas M, Arvay, Melissa L, Diaz, Maureen H, Waller, Jessica L, Weber, Martin W, Hamer, Davidson H, Hibberd, Patricia, Nawshad Uddin Ahmed, A S M, Islam, Maksuda, Hossain, Mohammad Belal, Qazi, Shamim A, El Arifeen, Shams, Darmstadt, Gary L, Saha, Samir K
Format: Journal Article
Language:English
Published: England BMJ Publishing Group Ltd 01.11.2022
BMJ Publishing Group LTD
BMJ Publishing Group
Subjects:
Antibiotics
Antimicrobial agents
Bacteria
Bacterial diseases
Bacterial Infections
Bayes Theorem
Birth weight
Blood
Case-Control Studies
child health
Cohort analysis
Cohort Studies
cohort study
Community-Acquired Infections - complications
Community-Acquired Infections - epidemiology
Female
Humans
India - epidemiology
Infant
Infant, Newborn
Infants
Infections
infections, diseases, disorders, injuries
Longitudinal Studies
Male
Original Research
paediatrics
Pediatrics
Pregnancy
Risk Factors
Socioeconomics
India
South Asia
paediatrics
cohort study
infections, diseases, disorders, injuries
child health
ISSN:2059-7908, 2059-7908
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Abstract ObjectiveRisk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying risk factors for infection could lead to improved preventive measures and antibiotic stewardship.MethodsFive sites in Bangladesh, India and Pakistan enrolled mother–child pairs via population-based pregnancy surveillance by community health workers. Medical, sociodemographic and epidemiological risk factor data were collected. Young infants aged 0–59 days with signs of possible serious bacterial infection (pSBI) and age-matched controls provided blood and respiratory specimens that were analysed by blood culture and real-time PCR. These tests were used to build a Bayesian partial latent class model (PLCM) capable of attributing the probable cause of each infant’s infection in the ANISA study. The collected risk factors from all mother–child pairs were classified and analysed against the PLCM using bivariate and stepwise logistic multivariable regression modelling to determine risk factors of probable bacterial infection.ResultsAmong 63 114 infants born, 14 655 were assessed and 6022 had signs of pSBI; of these, 81% (4859) provided blood samples for culture, 71% (4216) provided blood samples for quantitative PCR (qPCR) and 86% (5209) provided respiratory qPCR samples. Risk factors associated with bacterial-attributed infections included: low (relative risk (RR) 1.73, 95% credible interval (CrI) 1.42 to 2.11) and very low birth weight (RR 5.77, 95% CrI 3.73 to 8.94), male sex (RR 1.27, 95% CrI 1.07 to 1.52), breathing problems at birth (RR 2.50, 95% CrI 1.96 to 3.18), premature rupture of membranes (PROMs) (RR 1.27, 95% CrI 1.03 to 1.58) and being in the lowest three socioeconomic status quintiles (first RR 1.52, 95% CrI 1.07 to 2.16; second RR 1.41, 95% CrI 1.00 to 1.97; third RR 1.42, 95% CrI 1.01 to 1.99).ConclusionDistinct risk factors: birth weight, male sex, breathing problems at birth and PROM were significantly associated with the development of bacterial sepsis across South Asian community settings, supporting refined clinical discernment and targeted use of antimicrobials.
AbstractList Objective Risk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying risk factors for infection could lead to improved preventive measures and antibiotic stewardship.Methods Five sites in Bangladesh, India and Pakistan enrolled mother–child pairs via population-based pregnancy surveillance by community health workers. Medical, sociodemographic and epidemiological risk factor data were collected. Young infants aged 0–59 days with signs of possible serious bacterial infection (pSBI) and age-matched controls provided blood and respiratory specimens that were analysed by blood culture and real-time PCR. These tests were used to build a Bayesian partial latent class model (PLCM) capable of attributing the probable cause of each infant’s infection in the ANISA study. The collected risk factors from all mother–child pairs were classified and analysed against the PLCM using bivariate and stepwise logistic multivariable regression modelling to determine risk factors of probable bacterial infection.Results Among 63 114 infants born, 14 655 were assessed and 6022 had signs of pSBI; of these, 81% (4859) provided blood samples for culture, 71% (4216) provided blood samples for quantitative PCR (qPCR) and 86% (5209) provided respiratory qPCR samples. Risk factors associated with bacterial-attributed infections included: low (relative risk (RR) 1.73, 95% credible interval (CrI) 1.42 to 2.11) and very low birth weight (RR 5.77, 95% CrI 3.73 to 8.94), male sex (RR 1.27, 95% CrI 1.07 to 1.52), breathing problems at birth (RR 2.50, 95% CrI 1.96 to 3.18), premature rupture of membranes (PROMs) (RR 1.27, 95% CrI 1.03 to 1.58) and being in the lowest three socioeconomic status quintiles (first RR 1.52, 95% CrI 1.07 to 2.16; second RR 1.41, 95% CrI 1.00 to 1.97; third RR 1.42, 95% CrI 1.01 to 1.99).Conclusion Distinct risk factors: birth weight, male sex, breathing problems at birth and PROM were significantly associated with the development of bacterial sepsis across South Asian community settings, supporting refined clinical discernment and targeted use of antimicrobials.
Risk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying risk factors for infection could lead to improved preventive measures and antibiotic stewardship. Five sites in Bangladesh, India and Pakistan enrolled mother-child pairs via population-based pregnancy surveillance by community health workers. Medical, sociodemographic and epidemiological risk factor data were collected. Young infants aged 0-59 days with signs of possible serious bacterial infection (pSBI) and age-matched controls provided blood and respiratory specimens that were analysed by blood culture and real-time PCR. These tests were used to build a Bayesian partial latent class model (PLCM) capable of attributing the probable cause of each infant's infection in the ANISA study. The collected risk factors from all mother-child pairs were classified and analysed against the PLCM using bivariate and stepwise logistic multivariable regression modelling to determine risk factors of probable bacterial infection. Among 63 114 infants born, 14 655 were assessed and 6022 had signs of pSBI; of these, 81% (4859) provided blood samples for culture, 71% (4216) provided blood samples for quantitative PCR (qPCR) and 86% (5209) provided respiratory qPCR samples. Risk factors associated with bacterial-attributed infections included: low (relative risk (RR) 1.73, 95% credible interval (CrI) 1.42 to 2.11) and very low birth weight (RR 5.77, 95% CrI 3.73 to 8.94), male sex (RR 1.27, 95% CrI 1.07 to 1.52), breathing problems at birth (RR 2.50, 95% CrI 1.96 to 3.18), premature rupture of membranes (PROMs) (RR 1.27, 95% CrI 1.03 to 1.58) and being in the lowest three socioeconomic status quintiles (first RR 1.52, 95% CrI 1.07 to 2.16; second RR 1.41, 95% CrI 1.00 to 1.97; third RR 1.42, 95% CrI 1.01 to 1.99). Distinct risk factors: birth weight, male sex, breathing problems at birth and PROM were significantly associated with the development of bacterial sepsis across South Asian community settings, supporting refined clinical discernment and targeted use of antimicrobials.
ObjectiveRisk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying risk factors for infection could lead to improved preventive measures and antibiotic stewardship.MethodsFive sites in Bangladesh, India and Pakistan enrolled mother–child pairs via population-based pregnancy surveillance by community health workers. Medical, sociodemographic and epidemiological risk factor data were collected. Young infants aged 0–59 days with signs of possible serious bacterial infection (pSBI) and age-matched controls provided blood and respiratory specimens that were analysed by blood culture and real-time PCR. These tests were used to build a Bayesian partial latent class model (PLCM) capable of attributing the probable cause of each infant’s infection in the ANISA study. The collected risk factors from all mother–child pairs were classified and analysed against the PLCM using bivariate and stepwise logistic multivariable regression modelling to determine risk factors of probable bacterial infection.ResultsAmong 63 114 infants born, 14 655 were assessed and 6022 had signs of pSBI; of these, 81% (4859) provided blood samples for culture, 71% (4216) provided blood samples for quantitative PCR (qPCR) and 86% (5209) provided respiratory qPCR samples. Risk factors associated with bacterial-attributed infections included: low (relative risk (RR) 1.73, 95% credible interval (CrI) 1.42 to 2.11) and very low birth weight (RR 5.77, 95% CrI 3.73 to 8.94), male sex (RR 1.27, 95% CrI 1.07 to 1.52), breathing problems at birth (RR 2.50, 95% CrI 1.96 to 3.18), premature rupture of membranes (PROMs) (RR 1.27, 95% CrI 1.03 to 1.58) and being in the lowest three socioeconomic status quintiles (first RR 1.52, 95% CrI 1.07 to 2.16; second RR 1.41, 95% CrI 1.00 to 1.97; third RR 1.42, 95% CrI 1.01 to 1.99).ConclusionDistinct risk factors: birth weight, male sex, breathing problems at birth and PROM were significantly associated with the development of bacterial sepsis across South Asian community settings, supporting refined clinical discernment and targeted use of antimicrobials.
Risk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying risk factors for infection could lead to improved preventive measures and antibiotic stewardship.OBJECTIVERisk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying risk factors for infection could lead to improved preventive measures and antibiotic stewardship.Five sites in Bangladesh, India and Pakistan enrolled mother-child pairs via population-based pregnancy surveillance by community health workers. Medical, sociodemographic and epidemiological risk factor data were collected. Young infants aged 0-59 days with signs of possible serious bacterial infection (pSBI) and age-matched controls provided blood and respiratory specimens that were analysed by blood culture and real-time PCR. These tests were used to build a Bayesian partial latent class model (PLCM) capable of attributing the probable cause of each infant's infection in the ANISA study. The collected risk factors from all mother-child pairs were classified and analysed against the PLCM using bivariate and stepwise logistic multivariable regression modelling to determine risk factors of probable bacterial infection.METHODSFive sites in Bangladesh, India and Pakistan enrolled mother-child pairs via population-based pregnancy surveillance by community health workers. Medical, sociodemographic and epidemiological risk factor data were collected. Young infants aged 0-59 days with signs of possible serious bacterial infection (pSBI) and age-matched controls provided blood and respiratory specimens that were analysed by blood culture and real-time PCR. These tests were used to build a Bayesian partial latent class model (PLCM) capable of attributing the probable cause of each infant's infection in the ANISA study. The collected risk factors from all mother-child pairs were classified and analysed against the PLCM using bivariate and stepwise logistic multivariable regression modelling to determine risk factors of probable bacterial infection.Among 63 114 infants born, 14 655 were assessed and 6022 had signs of pSBI; of these, 81% (4859) provided blood samples for culture, 71% (4216) provided blood samples for quantitative PCR (qPCR) and 86% (5209) provided respiratory qPCR samples. Risk factors associated with bacterial-attributed infections included: low (relative risk (RR) 1.73, 95% credible interval (CrI) 1.42 to 2.11) and very low birth weight (RR 5.77, 95% CrI 3.73 to 8.94), male sex (RR 1.27, 95% CrI 1.07 to 1.52), breathing problems at birth (RR 2.50, 95% CrI 1.96 to 3.18), premature rupture of membranes (PROMs) (RR 1.27, 95% CrI 1.03 to 1.58) and being in the lowest three socioeconomic status quintiles (first RR 1.52, 95% CrI 1.07 to 2.16; second RR 1.41, 95% CrI 1.00 to 1.97; third RR 1.42, 95% CrI 1.01 to 1.99).RESULTSAmong 63 114 infants born, 14 655 were assessed and 6022 had signs of pSBI; of these, 81% (4859) provided blood samples for culture, 71% (4216) provided blood samples for quantitative PCR (qPCR) and 86% (5209) provided respiratory qPCR samples. Risk factors associated with bacterial-attributed infections included: low (relative risk (RR) 1.73, 95% credible interval (CrI) 1.42 to 2.11) and very low birth weight (RR 5.77, 95% CrI 3.73 to 8.94), male sex (RR 1.27, 95% CrI 1.07 to 1.52), breathing problems at birth (RR 2.50, 95% CrI 1.96 to 3.18), premature rupture of membranes (PROMs) (RR 1.27, 95% CrI 1.03 to 1.58) and being in the lowest three socioeconomic status quintiles (first RR 1.52, 95% CrI 1.07 to 2.16; second RR 1.41, 95% CrI 1.00 to 1.97; third RR 1.42, 95% CrI 1.01 to 1.99).Distinct risk factors: birth weight, male sex, breathing problems at birth and PROM were significantly associated with the development of bacterial sepsis across South Asian community settings, supporting refined clinical discernment and targeted use of antimicrobials.CONCLUSIONDistinct risk factors: birth weight, male sex, breathing problems at birth and PROM were significantly associated with the development of bacterial sepsis across South Asian community settings, supporting refined clinical discernment and targeted use of antimicrobials.
Author Diaz, Maureen H
Hossain, Tanvir
Waller, Jessica L
Soofi, Sajid
Isaac, Rita
Baqui, Abdullah H
Winchell, Jonas M
Mullany, Luke C
Weber, Martin W
Qazi, Shamim A
Arvay, Melissa L
Connor, Nicholas E
Saha, Samir K
Islam, Maksuda
Darmstadt, Gary L
El Arifeen, Shams
Shang, Nong
Nisar, Imran
Sadeq-ur Rahman, Qazi
Bose, Anuradha
Panigrahi, Pinaki
Hibberd, Patricia
Nawshad Uddin Ahmed, A S M
Bhutta, Zulfiqar A
Schrag, Stephanie J
Hossain, Mohammad Belal
Panigrahi, Kalpana
Zaidi, Anita K M
Mitra, Dipak K
Islam, Mohammad Shahidul
Satpathy, Radhanath
Hamer, Davidson H
AuthorAffiliation 8 Department of Pediatrics , Georgetown University Medical Center , Washington , DC , USA
5 Centre for Global Child Health , The Hospital for Sick Children , Toronto , Ontario , Canada
15 Section of Infectious Diseases, Department of Medicine , Boston University School of Medicine , Boston , Massachusetts , USA
3 Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
1 Department of Microbiology , Child Health Research Foundation , Dhaka , Bangladesh
11 Department of Public Health , North South University , Dhaka , Bangladesh
6 Institute for Global Health and Development , The Aga Khan University , Karachi , Pakistan
17 Department of Pediatrics , Stanford University School of Medicine , Stanford , California , USA
10 Christian Medical College , Vellore , India
12 International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka , Bangladesh
7 Department of Pediatrics and Child Health , The Aga Khan University , Karachi , Pakistan
9
AuthorAffiliation_xml – name: 14 Department of Global Health , Boston University School of Public Health , Boston , Massachusetts , USA
– name: 1 Department of Microbiology , Child Health Research Foundation , Dhaka , Bangladesh
– name: 17 Department of Pediatrics , Stanford University School of Medicine , Stanford , California , USA
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– name: 9 AIPH University , Bhubaneswar , India
– name: 5 Centre for Global Child Health , The Hospital for Sick Children , Toronto , Ontario , Canada
– name: 13 Child and Adolescent Health and Development Division , WHO Regional Office for Europe , Copenhagen , Denmark
– name: 16 Consultant and Researcher , (Retired WHO staff) , Geneva , Switzerland
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– name: 6 Institute for Global Health and Development , The Aga Khan University , Karachi , Pakistan
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– name: 12 International Centre for Diarrhoeal Disease Research, Bangladesh , Dhaka , Bangladesh
– name: 3 Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
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  organization: Department of Microbiology, Child Health Research Foundation, Dhaka, Bangladesh
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  givenname: Imran
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  surname: Nisar
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  organization: Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
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  givenname: Pinaki
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  organization: Department of Pediatrics, Georgetown University Medical Center, Washington, DC, USA
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  organization: AIPH University, Bhubaneswar, India
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  organization: AIPH University, Bhubaneswar, India
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  organization: Christian Medical College, Vellore, India
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  organization: Christian Medical College, Vellore, India
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  organization: Department of Public Health, North South University, Dhaka, Bangladesh
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  organization: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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  surname: Schrag
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  organization: Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  organization: Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  givenname: Melissa L
  surname: Arvay
  fullname: Arvay, Melissa L
  organization: Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  givenname: Maureen H
  surname: Diaz
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  organization: Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  surname: Waller
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  organization: Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  givenname: Martin W
  surname: Weber
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  organization: Child and Adolescent Health and Development Division, WHO Regional Office for Europe, Copenhagen, Denmark
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  givenname: A S M
  surname: Nawshad Uddin Ahmed
  fullname: Nawshad Uddin Ahmed, A S M
  organization: Department of Microbiology, Child Health Research Foundation, Dhaka, Bangladesh
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  givenname: Maksuda
  surname: Islam
  fullname: Islam, Maksuda
  organization: Department of Microbiology, Child Health Research Foundation, Dhaka, Bangladesh
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  surname: Hossain
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  organization: Department of Microbiology, Child Health Research Foundation, Dhaka, Bangladesh
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  surname: Qazi
  fullname: Qazi, Shamim A
  organization: Consultant and Researcher, (Retired WHO staff), Geneva, Switzerland
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  givenname: Shams
  surname: El Arifeen
  fullname: El Arifeen, Shams
  organization: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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  givenname: Gary L
  orcidid: 0000-0002-7522-5824
  surname: Darmstadt
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  organization: Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
– sequence: 32
  givenname: Samir K
  surname: Saha
  fullname: Saha, Samir K
  organization: Department of Microbiology, Child Health Research Foundation, Dhaka, Bangladesh
BackLink https://www.ncbi.nlm.nih.gov/pubmed/36319031$$D View this record in MEDLINE/PubMed
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CitedBy_id crossref_primary_10_1016_j_clp_2024_10_003
crossref_primary_10_1007_s00203_024_04107_z
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Issue 11
Keywords paediatrics
cohort study
infections, diseases, disorders, injuries
child health
Language English
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Snippet ObjectiveRisk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia....
Risk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying...
ObjectiveRisk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia....
Objective Risk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia....
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StartPage e009706
SubjectTerms Antibiotics
Antimicrobial agents
Bacteria
Bacterial diseases
Bacterial Infections
Bayes Theorem
Birth weight
Blood
Case-Control Studies
child health
Cohort analysis
Cohort Studies
cohort study
Community-Acquired Infections - complications
Community-Acquired Infections - epidemiology
Female
Humans
India - epidemiology
Infant
Infant, Newborn
Infants
Infections
infections, diseases, disorders, injuries
Longitudinal Studies
Male
Original Research
paediatrics
Pediatrics
Pregnancy
Risk Factors
Socioeconomics
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Title Risk factors for community-acquired bacterial infection among young infants in South Asia: a longitudinal cohort study with nested case–control analysis
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