HIV Exposure and Neonatal Sepsis: A Descriptive Etiological Study

Atuhaire, P

; Kyohere, M; Tusubira, V

; Davies, HG

; Musoke, P; Sekikubo, M

; Wamawobe, A

; Peacock, J

; Le Doare, K

; Djennad, A; +48 more...Nyamaizi, A; Ssali, A; Amone, A; Wamawobe, A; Nakimuli, A; Farley, C; Nanyunja, C; Najuka, C; Komugisha, C; Shelley, DR; Portal, EA; Duckworth, E; Karafillakis, E; O’Hara, G; Matovu, G; Davies, HG; Seeley, J; Peacock, J; Sendagala, JN; Cowie, K; Doare, KL; Karampatsas, K; Hookham, L; Cochet, M; Sewegaba, M; Kyohere, M; Owor, M; Etti, M; Voysey, M; Musooko, M; Sekikubo, M; Spiller, OB; Atuhaire, P; Heath, PT; Musoke, P; Nalubega, P; Ravji, P; Katungye, R; Namugumya, R; Parks, R; Azuba, R; Kipyeko, S; Beach, S; Bentley, S; Old, T; Mutabazi, T; Tusubira, V; Chalker, V and (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

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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.