Patterns of early-life microbial exposure and infection risk in hospital-born neonates in a tertiary hospital setting in Ghana

BACKGROUND: Hospital environments serve as reservoirs of diverse airborne microorganisms, including fungi and multidrug-resistant bacteria, which pose serious risks to neonatal health. Although vernix caseosa provides initial protection against these microorganisms, neonates remain vulnerable to healthcare-associated infections due to their immature immune system and fragile protective barriers. METHODS: A longitudinal study involving 59 neonates was conducted at the maternity ward of the University of Cape Coast Hospital from October to December 2023. A total of 845 swab samples were collected from indoor air, high-touch surfaces, neonatal skin and the palms of the neonates' mothers and nurses. Samples were cultured on Sabouraud Dextrose Agar, Nutrient Agar, and MacConkey Agar and incubated for bacterial and fungal growth. Fungal isolates were identified using phenotypic methods, while bacterial isolates were identified using Gram staining and standard biochemical tests. Data were analyzed using SPSS version 27.0, and the chi-square test was employed to assess the association between early microbial colonization and post-discharge neonatal infections, with statistical significance set at p < 0.05. RESULTS: Staphylococcus epidermidis was the most prevalent isolate recovered from indoor air and neonatal skin, accounting for 19.1% (60/314) and 34.9% (29/83), respectively, while Aspergillus niger (15.1%, 31/205) was the predominant isolate recovered from high-touch surfaces in the maternity ward. Initial bacterial colonization of the skin was observed in 79.7% (47/59) of neonates after birth. Out of these, 11 (23.4%) developed infections during follow-up, with skin infections accounting for the majority of cases (72.7%, 8/11). However, bacterial colonization after birth was not statistically associated with bacterial infections after discharge (p = 0.06). CONCLUSION: Considering the high levels of bacterial and fungal contamination recovered from indoor air and high-touch surfaces within the maternity ward, neonates may be exposed to potentially pathogenic microorganisms, highlighting the importance of infection prevention and environmental hygiene measures.