Clinical and laboratory parameters associated with bloodstream infections among neonates admitted to a tertiary hospital in Tanzania: a hospital-based cross-sectional study

Abstract

Background Timely diagnosis and effective management are critical for improving outcomes in neonatal bloodstream infections (BSIs), particularly in resource-limited settings. This study aimed to determine clinical signs and laboratory markers associated with BSIs among neonates at Tertiary hospital in Mwanza, Tanzania. Methods A hospital-based cross-sectional study was conducted, among neonates treated for suspected BSI from January 2023 to June 2024. Clinical signs of sepsis were systematically documented. Blood samples were collected for culture, serial C-reactive protein (CRP), and complete blood count at admission, 24 h, and 72 h. Data were analyzed using R software version 4.4. Results A total of 327 neonates with suspected BSI were enrolled, with a median age of 1 day [interquartile range (IQR): 1–5 days]. The case-fatality rate was 9.2% (30/327). BSIs were confirmed in 53/327 (16.2%) neonates. Among confirmed cases, 39/53 (73.5%) were caused by Gram-negative bacteria, predominantly Klebsiella pneumoniae and Acinetobacter spp. Neonates with confirmed BSI had a significantly longer mean hospital stay than those with culture-negative sepsis (10.1 ± 8.0 days vs. 6.6 ± 6.6 days; p < 0.001). Elevated CRP was an independent predictor of BSI ( p < 0.001). Conclusion BSIs remain a significant cause of neonatal morbidity and mortality in this setting. Gram-negative organisms predominated and were associated with worse outcomes. A combination of clinical features, early warning signs, and CRP may aid in the early identification of neonates at high risk of BSIs and support timely initiation of appropriate management in resource limited settings.