HIV Exposure and Neonatal Sepsis: A Descriptive Etiological Study

Atuhaire, Patience

; Kyohere, Mary; Tusubira, Valerie

; Davies, Hannah G

; Musoke, Philippa; Sekikubo, Musa

; Wamawobe, Amusa

; Peacock, Joseph

; Le Doare, Kirsty

; Djennad, Abdelmajid; +48 more...Nyamaizi, Agnes; Ssali, Agnes; Amone, Alexander; Wamawobe, Amusa; Nakimuli, Annettee; Farley, Caitlin; Nanyunja, Carol; Najuka, Christine; Komugisha, Cleophas; Shelley, Dan R; Portal, Edward AR; Duckworth, Ellie; Karafillakis, Emilie; O’Hara, Geraldine; Matovu, Godfrey; Davies, Hannah G; Seeley, Janet; Peacock, Joseph; Sendagala, Juliet Nsimire; Cowie, Katie; Doare, Kirsty Le; Karampatsas, Konstantinos; Hookham, Lauren; Cochet, Madeleine; Sewegaba, Margaret; Kyohere, Mary; Owor, Maxensia; Etti, Melanie; Voysey, Merryn; Musooko, Moses; Sekikubo, Musa; Spiller, Owen B; Atuhaire, Patience; Heath, Paul T; Musoke, Philippa; Nalubega, Phiona; Ravji, Pooja; Katungye, Richard; Namugumya, Ritah; Parks, Rosalin; Azuba, Rose; Kipyeko, Sam; Beach, Simon; Bentley, Stephen; Old, Tim; Mutabazi, Tobius; Tusubira, Valerie; and Chalker, Vicki (2025) HIV Exposure and Neonatal Sepsis: A Descriptive Etiological Study. Open forum infectious diseases, 11 (S3). S187-S192. ISSN 2328-8957 DOI: 10.1093/ofid/ofae642

Copy

Background: Low- and middle-income countries lack data on culture-confirmed sepsis in HIV-exposed infants, despite the reported heightened risk of infectious morbidity. This study describes culture-confirmed sepsis and antibiotic resistance patterns among HIV-exposed children in a large etiological cohort study in Kampala, Uganda.

Methods: This was a prospective birth cohort study based at 2 Ugandan sites, as part of the Progressing Group B Streptococcal Vaccines (PROGRESS) study. Any infant with risk factors, signs, or symptoms of infection presenting before 3 months of age had a blood culture and nasopharyngeal swab taken to determine the etiology of neonatal and young infant sepsis.

Results: Among 4492 blood cultures, 460 were obtained from HIV-exposed infants. Nine infants (1.9%) had positive blood cultures. The most frequently isolated organisms were Escherichia coli, group B Streptococcus, and Streptococcus viridans, and these organisms demonstrated resistance to the common antibiotics (aminoglycosides, penicillins, and cephalosporins) used for management of suspected sepsis. A higher proportion of the exposed babies died vs HIV-unexposed (15.8 vs 11.2; P = .005). Nasopharyngeal swabs were collected from 114 infants, with 7.9% positive for at least one virus or bacterium.

Conclusions: Future work is needed to investigate why mortality among HIV-exposed infants persists despite maternal antiretroviral treatment. Antimicrobial resistance is an increasing concern in this setting.