Catheter‑related bloodstream infections and risk factors in infants hospitalized in neonatal intensive care units at Mogadishu, Somalia: two years of experience.

backgroundCatheter-related bloodstream infections (CRBSIs) are among the most common healthcare-associated infections in neonates and contribute substantially to morbidity and mortality. This study aimed to determine the incidence of CRBSIs and to examine the risk factors, clinical characteristics, and microbial profiles of CRBSIs, with emphasis on catheter type and birth weight classification.

methodsA retrospective observational study was conducted at the neonatal intensive care unit (NICU) of the Mogadishu-Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital. Medical records of neonates admitted between January 2022 and December 2024 were reviewed. Of 1,781 neonates admitted, 300 met the inclusion criteria according to the 2009 Infectious Diseases Society of America (IDSA) guidelines for CRBSI diagnosis, which include paired blood cultures, catheter tip cultures, or differential time to positivity. Statistical analyses were performed using SPSS version 23, including Spearman's correlation and multivariable logistic regression to identify independent risk factors.

resultsDuring the study period, 1,781 neonates were admitted to the NICU, of whom 300 developed CRBSIs, corresponding to an incidence of 16.8%. Of these, 60% were male and 40% female. The majority (53%) were born between 36 and 42 weeks of gestation, while 29.3% had birth weights > 2,500 g. Significant associations were observed between prognosis and parameters including birth weight, gestational age, catheter type, C-reactive protein (CRP) levels, and culture sample type (p < 0.005). Analysis of culture results showed that Klebsiella spp. was the most frequently isolated pathogen, followed by E. coli and Candida spp. A significant correlation was identified between cathetertype and isolate type (p = 0.008). Furthermore, the highest frequency of Gram-negative isolates was observed among preterm gestational age groups (p = 0.002). Regarding antimicrobial resistance, Gram-negative isolates exhibited high resistance to ceftriaxone, ceftazidime, ampicillin-sulbactam, amoxicillin-clavulanate, and trimethoprim-sulfamethoxazole. Gram-positive isolates, including MRSA and MRCNS, showed substantial resistance to clindamycin, erythromycin, and trimethoprim-sulfamethoxazole.

conclusionAmong neonates in Mogadishu, low birth weight, preterm gestational age, catheter type, and elevated CRP levels were significantly associated with CRBSI prognosis. The high prevalence of antibiotic resistance among both Gram-negative and Gram-positive pathogens underscores the urgent need for strengthened antimicrobial stewardship and infection control measures in neonatal intensive care units.