Serious community-acquired neonatal infections in rural southeast Asia (Bohol Island, Philippines)

Objective: To determine the bacterial etiology, clinical presentation and risk factors for outcome of serious community-acquired infections in young infants. Study Design: Infants younger than 60 days, admitted for severe pneumonia or suspected sepsis/meningitis were prospectively evaluated using complete blood count, blood culture, chest radiograph, cerebrospinal fluid (CSF) culture in suspected meningitis. chi(2) or Fisher's exact test and stepwise logistic regression were used for analysis. Results: Thirty-four of 767 enrolled infants had a positive blood or CSF culture. Gram-negative bacteria were more frequent than Gram positive: overall ( P = 0.004), in those below 7 days of age ( P = 0.002) and among home deliveries ( P = 0.012). Case fatality rates were higher among infants below 1 week old ( OR 4.14, P< 0.001), those with dense ( OR 2.92, P< 0.001) or diffuse radiographic infiltrates ( OR 2.79, P = 0.003). Conclusions: Gram-negative enteric bacteria are the predominant causes of community-acquired infections in Filipino infants below 2 months old. Age below 7 days and radiographic pneumonia predicted death.