Evidence map›Paper›PMID 40020700›Full record

ArticleThe Lancet. Microbe2025

Pathogen aetiology and risk factors for death among neonates with bloodstream infections at lower-tier South African hospitals: a cross-sectional study.

Susan Meiring, Vanessa Quan, Rudzani Mashau, Olga Perovic, Rindidzani Magobo, Marshagne Smith, Ruth Mpembe, Anne von Gottberg, Linda de Gouveia, Sibongile Walaza and 10 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Microbe, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Article
  2. Article
  3. Genomic Characterization ofOpen forum infectious diseases · 2026
    Article
  4. Article
  5. Article
  6. Review
  7. Threat and Control ofFoods (Basel, Switzerland) · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Susan MeiringNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa. Electronic address: susanme@nicd.ac.za.
Vanessa QuanNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
Rudzani MashauNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
Olga PerovicNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Rindidzani MagoboNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
Marshagne SmithNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
Ruth MpembeNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
Anne von GottbergNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Linda de GouveiaNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
Sibongile WalazaNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
Cheryl CohenNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Constance KapongoDepartment of Paediatrics and Child Health, Queen Nandi Regional Hospital, Ngwelazane, South Africa.
Cheryl MackayDepartment of Paediatrics and Child Health, Dora Nginza Hospital, Nelson Mandela Bay, South Africa.
Mphekwa Thomas MailulaDepartment of Paediatrics and Child Health, Mankweng Regional Hospital, Mankweng, South Africa.
Omphile MekgoeDepartment of Paediatrics and Child Health, Klerksdorp Regional Hospital, Klerksdorp, South Africa.
Lerato MotjaleDepartment of Paediatrics and Child Health, Rob Ferreira Regional Hospital, Nelspruit, South Africa.
Rose PhayaneDepartment of Paediatrics and Child Health, Tembisa Provincial Hospital, Johannesburg, South Africa.
Angela DramowskiDepartment of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Nelesh P GovenderNational Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK.
Baby GERMS-SA

Funding

Bill & Melinda Gates Foundation INV-008112Gates Foundation INV008112
6 · The paper itself

Abstract

backgroundInfections are among the top causes of neonatal mortality, particularly in low-income and middle-income countries. We aimed to describe the clinical characteristics of neonates diagnosed with culture-confirmed bloodstream infections at six lower-tier hospitals in South Africa.

methodsWe did a cross-sectional study of culture-confirmed bloodstream infections among neonates (aged 0-27 days) at six lower-tier hospitals in South Africa. Clinical, demographic, and pathogen data from sick, hospitalised neonates were analysed and bloodstream infections were categorised as early-onset sepsis (EOS; 0-2 days of life) or late-onset sepsis (LOS; 3-27 days of life). Incidence of bloodstream infection and crude in-hospital mortality in neonates with bloodstream infection were calculated and factors associated with death were analysed using multivariable logistic regression models.

findingsFrom Oct 1, 2019 to Sept 30, 2020, we identified 907 neonatal bloodstream infection episodes. Incidence was 6·4 cases per 1000 patient-days. Most neonates were preterm (median gestation 33 weeks [IQR 29-37]), with 30·5% (n=277) of bloodstream infections classified as EOS and 69·5% (n=630) as LOS. Gram-negative pathogens dominated (63·2% [n=573]), including Klebsiella pneumoniae (25·7% [n=233]) and Acinetobacter baumannii (19·2% [n=174]). Crude in-hospital mortality in neonates with bloodstream infection was 25·5% (n=231), accounting for 21·4% (231 of 1078 cases) of all in-hospital neonatal deaths. Increased all-cause mortality was associated with Gram-negative bloodstream infection (vs Gram-positive pathogens, adjusted odds ratio 3·70 [95% CI 1·46-9·39]; p=0·0059), inborn LOS (vs EOS, 2·42 [1·11-5·29];  p=0·027), preterm birth (5·00 [2·16-11·59]; p=0·0002), and neonatal intensive care unit admission (3·26 [1·51-7·03]; p=0·0026).

interpretationHospitalised, preterm neonates who developed Gram-negative bloodstream infections had high in-hospital mortality. Many small vulnerable newborns require prolonged stays in lower-tier hospitals and acquire life-threatening bloodstream infection; appropriate resources are needed at this level of care to prevent infections and save lives.

fundingBill & Melinda Gates Foundation.

Indexed as

BacteremiaNeonatal SepsisSepsisCross-Sectional StudiesFemaleHospital MortalityHospitalsHumansIncidenceInfantInfant, NewbornMaleRisk FactorsSouth Africa

Identifiers

PMID40020700
PMCPMC12062197

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.