RESUMO
Group B Streptococcus, a common commensal in the gut of humans and in the lower genital tract in women, remains an important cause of neonatal mortality and morbidity. The incidence of early onset disease has fallen markedly in countries that test women for carriage at 35-37 weeks of pregnancy and then offer intrapartum prophylaxis with penicillin during labour. Countries that do not test, but instead employ a risk factor approach, have not seen a similar fall. There are concerns about the effect on the neonatal microbiome of widespread use of antibiotic prophylaxis during labour, but so far the effects seem minor and temporary. Vaccination against GBS would be acceptable to most women and GBS vaccines are in the early stages of development. Tweetable abstract: Group B Strep is a key cause of infection, death and disability in young babies. Antibiotics given in labour remain the mainstay of prevention, until a vaccine is available.
Assuntos
Complicações Infecciosas na Gravidez , Infecções Estreptocócicas , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Mães , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/prevenção & controle , Streptococcus agalactiaeRESUMO
AIM: Vancomycin is used as a second line antibiotic in the treatment of late onset neonatal infection for its activity against coagulase negative staphylococci. Vancomycin infusions are prepared within a ward setting for administration to neonates. Differences in preparation techniques on the ward have previously been recognised as a potential source of variation in vancomycin concentrations, as compared to concentrations in pre-made preparations. This study analyses a consecutive series of vancomycin syringes prepared in a ward for administration to neonates, to determine how accurate the concentration of each preparation was compared to the expected concentration. METHOD: Vancomycin concentrations were determined by UV analysis (λ=280â nm) with a UV spectrophotometer (Jenway Genova Plus). A calibration curve for vancomycin was created (R2=0.9996) by manufacturing a series of solutions of vancomycin hydrochloride in glucose 5% w/v.Samples of vancomycin from syringes from which doses were administered to neonates were then analysed to assess their concentration. For each syringe, mean vancomycin concentration±standard deviation was calculated (n=3).Reasonable errors in preparations were calculated based on errors in each step of the preparation process. Theoretical error was calculated based on apparatus used, and experimental error was recorded based on a simulated process. Two preparation methods were compared; the method complying with that described in the local formulary, 1 and an alternative method reported by the nurses preparing the dose. RESULTS: Analysis of results showed that concentration of the vancomycin syringes prepared ranged from 0.85 to 8.24â mg/mL. The expected concentration was 4.17â mg/ml.Theoretical error in preparation of vancomycin doses was lower with the formulary-compliant method1 versus an alternative method, as were variations in in vancomycin concentration.Depending on the type of error (theoretical or experimental) and method by which vancomycin syringes were prepared (formulary1 or alternative method), the percentage of syringes with vancomycin concentration outside of the specified ranges varied from 20%-43%. This is higher compared to the findings of the Department of Health2, where it was found that 19.2% of morphine infusions prepared by nurses in the neonatal intensive care unit were outside British Pharmacopoeia concentration limits. CONCLUSION: Preparation of vancomycin doses should follow the formulary method1 to minimise variation in concentration of the final product. Alternatively, pre-made syringes may be preferred as an alternative to ward-made syringes as this removes individualised preparation as a source of error.
RESUMO
Antibiotics are increasingly prescribed in the peripartum period, for both maternal and fetal indications. Their effective use can be life-saving, however, injudicious use drives antibiotic resistance and contributes to the development of abnormal faecal flora and subsequent immune dysregulation. Neonatal units are a high risk area for the selection and transmission of multi-resistant organisms. Very few new antibiotics with activity against Gram-negative bacteria are under development, and no significantly new Gram-negative antibiotics will be available in the next decade. This review seeks to summarise current practice, and suggests restrictive antibiotic strategies based on epidemiological data from recently published UK neonatal infection surveillance studies.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Prescrições de Medicamentos/normas , Berçários Hospitalares , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Infecções Bacterianas/epidemiologia , Infecção Hospitalar/epidemiologia , Esquema de Medicação , Monitoramento de Medicamentos/métodos , Humanos , Recém-Nascido , Sepse/tratamento farmacológico , Sepse/epidemiologiaRESUMO
INTRODUCTION: Neonatal infection is an important cause of morbidity and mortality. Neonatal infection surveillance networks are necessary for defining the epidemiology of infections and monitoring changes over time. DESIGN: Prospective multicentre surveillance using a web-based database. SETTING: 12 English neonatal units. PARTICIPANTS: Newborns admitted in 2006-2008, with positive blood, cerebrospinal fluid or urine culture and treated with antibiotics for at least 5 days. OUTCOME MEASURE: Incidence, age at infection, pathogens and antibiotic resistance profiles. RESULTS: With the inclusion of coagulase negative Staphylococci (CoNS), the incidence of all neonatal infection was 8/1000 live births and 71/1000 neonatal admissions (2007-2008). The majority of infections occurred in premature (<37 weeks) and low birthweight (<2500 g) infants (82% and 81%, respectively). The incidence of early onset sepsis (EOS; ≤48 h of age) was 0.9/1000 live births and 9/1000 neonatal admissions, and group B Streptococcus (58%) and Escherichia coli (18%) were the most common organisms. The incidence of late onset sepsis (LOS; >48 h of age) was 3/1000 live births and 29/1000 neonatal admissions (7/1000 live births and 61/1000 admissions including CoNS) and the most common organisms were CoNS (54%), Enterobacteriaceae (21%) and Staphylococcus aureus (18%, 11% of which were methicillin resistant S aureus). Fungi accounted for 9% of LOS (72% Candida albicans). The majority of pathogens causing EOS (95%) and LOS (84%) were susceptible to commonly used empiric first line antibiotic combinations of penicillin/gentamicin and flucloxacillin/gentamicin, respectively (excluding CoNS). CONCLUSIONS: The authors have established NeonIN in England and defined the current epidemiology of neonatal infections. These data can be used for benchmarking among units, international comparisons and as a platform for interventional studies.
Assuntos
Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Sepse/epidemiologia , Idade de Início , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Resistência Microbiana a Medicamentos , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/microbiologia , Masculino , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Vigilância da População , Sepse/tratamento farmacológico , Sepse/microbiologiaRESUMO
We present the longest known surviving case of a male infant with a mosaic complete trisomy 1q. Born at 39 weeks of gestation with respiratory distress, his weight was 3,330 g (25th centile); he had micrognathia, a posterior cleft of palate, abnormal ears and left thumb, syndactyly, and an absent corpus callosum. Initial blood karyotype was normal (46,XY). He died at age 5 months. Autopsy suggested aspiration as the primary cause of death and confirmed the antemortem findings of an absent corpus callosum and atrial septal defect. It also identified some central nervous system, cardiac, gastrointestinal, and lung anomalies not previously recognized. Cytogenetic analysis of skin fibroblasts obtained at autopsy showed a de novo unbalanced translocation between chromosomes 1 and 22: 46,XY,+1,der(1;22)(q10;q10)[25]/46,XY[65] in the cells examined. The previously reported cases had a similar phenotype with birth weight above the 50th centile for gestational age, small mouth, micrognathia, abnormal ears, abnormal fingers, microphthalmia, and hydrocephalus. The present case and a review of the literature delineates the phenotype in trisomy 1q, and reinforces the critical importance of effective communication between specialists, and obtaining permission for autopsy and skin biopsy, in the pursuit of a diagnosis.
Assuntos
Cromossomos Humanos Par 1/genética , Mosaicismo , Trissomia/genética , Encéfalo/patologia , Bandeamento Cromossômico , Cromossomos Humanos Par 22/genética , Evolução Fatal , Humanos , Lactente , Recém-Nascido , Masculino , Metáfase , Análise de Sobrevida , SindactiliaRESUMO
Estimates of incidence of early-onset group B streptococcal (EOGBS) infection are based on blood or cerebrospinal fluid culture-proven cases, which can be falsely negative and hence underestimate the true burden of disease. Probable EOGBS infection can be defined as colonisation by group B streptococci accompanied by features of clinical sepsis. Data collected prospectively in the UK over 1 year for neonates who required a septic screen in the first 72 h of life indicated a combined rate of definite and probable EOGBS infection of 3.6 per 1000 livebirths. This estimate indicates a much greater disease burden in the UK than that suggested by figures of culture-proven sepsis, and lends support to the need for prevention strategies.