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Pathogens identified by minimally invasive tissue sampling in India and Pakistan from preterm neonatal deaths
The PURPOSe study
Ghanchi, N. K., Ahmed, I., Kim, J., Harakuni, S., Somannavar, M. S., Zafar, A., Tikmani, S. S., Saleem, S., Goudar, S. S., Dhaded, S. M., Guruprasad, G., Yogeshkumar, S., Hwang, K., Aceituno, A., Silver, R. M., McClure, E. M., & Goldenberg, R. L. (2023). Pathogens identified by minimally invasive tissue sampling in India and Pakistan from preterm neonatal deaths: The PURPOSe study. Clinical Infectious Diseases, 76(3), E1004-E1011. https://doi.org/10.1093/cid/ciac747
BACKGROUND: We identified pathogens found in internal organs and placentas of deceased preterm infants cared for in hospitals in India and Pakistan.
METHODS: Prospective, observational study conducted in delivery units and NICUs. Tissue samples from deceased neonates obtained by minimally invasive tissue sampling (MITS) and placentas were examined for 73 different pathogens using multiplex PCR.
RESULTS: Tissue for pathogen PCR was obtained from liver, lung, brain, blood, cerebrospinal fluid (CSF) and placentas from 377 deceased preterm infants. Between 17.6% and 34.1% of each type of tissue had at least one organism identified. Organism detection was highest in blood (34.1%), followed by lung (31.1%), liver (23.3%), CSF (22.3%) and brain (17.6%). 49.7% of the deceased infants had at least one organism. Acinetobacter baumannii was in 28.4% of the neonates compared to 14.6% for Klebsiella pneumoniae, 11.9% for E. coli/Shigella, and 11.1% for Haemophilus influenzae. Group B Streptococcus (GBS) was identified in only 1.3% of the neonatal deaths. A. baumannii was rarely found in the placenta and was found more commonly in the internal organs of neonates who died later in the neonatal period. The most common organism found in placentas was Ureaplasma urealyticum in 34% of the samples, with no other organism found in ≥ 4% of samples.
CONCLUSIONS: In organ samples from deceased infants in India and Pakistan, evaluated with multiplex pathogen PCR, A. baumannii was the most commonly identified organism. GBS was rarely found. A. baumannii was rarely found in the placentas of these deceased neonates.
