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2.
Mymensingh Med J ; 29(4): 784-792, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116078

RESUMO

This cross-sectional descriptive study was conducted at the neonatal intensive care unit (NICU) in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2017 to December 2017 to determine antimicrobial sensitivity pattern in neonatal sepsis. Ninety four neonates (0-28 days) who were admitted in NICU with suspected sepsis were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained and then septic screening along with blood culture and antimicrobial sensitivity was done. All data were compiled, tabulated and then analyzed by SPSS version 21.0. Among 94 cases, 68(72.3%) were preterm and 26(23.4%) were term. There was male predominance and male female ratio was 1.9:1. Most of the patient admitted within 72 hours of birth. Most (84%) had low birth weight (<2500gm). Pre-mature onset of labour, pre-mature rupture of membrane >18 hours, vaginal route of delivery, instrumental resuscitation, pre-lacteal feeding, bottle feeding were the major perinatal risk factors in this study. Early onset sepsis (76.6%) was most prevalent in this study. Blood culture yielded positive growth in 20(21.3%) cases. Among them, Klebsiella was found in 7(35%). E. coli in 6(30%), Acinetobacter was in 3(15%), Staphylococcus aureus in 2(10%) cases. Pseudomonas and Enterobacter were found in rest 2(10%) of the cases. Gram negative bacteria were found in 18(90%) cases. Klebsiella was sensitive to Imipenem (85.7%), Colistin (85.7%) and Ciprofloxacin (77.5%). Sensitivity of E. coli was Imipenem (100%), Colistin (100%), Amikacin (66.7%), Ciprofloxacin (66.7%), Netilmicin (66.7%) and Gentamicin (50%). Acinatobecter had sensitivity to Netilmicin, Colistin, Imipenem (100%). Staphylococcus was 100% sensitive to Imipenem, Netilmicin and Vancomycin. Pseudomonas was found sensitive to Imipenem (100%), Amikacin (100%), Netilmicin (100%) and Colistin (100%). Enterobacter was found highly sensitive to Ciprofloxacin, Colistin and Imipenem. Almost all organisms were resistant to Ampicillin, Gentamicin, Cefotaxime and Ceftazidime. Based on result it is concluded that Klebsiella pneumoniae and Escherichia coli are the leading cause of neonatal sepsis in this study and most of them resistant to multiple antibiotics. Organisms found more sensitive to Imipenem, Colistin, Ciprofloxacin and Netilmicin.


Assuntos
Anti-Infecciosos , Sepse Neonatal , Sepse , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bangladesh/epidemiologia , Estudos Transversais , Escherichia coli , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Testes de Sensibilidade Microbiana , Sepse Neonatal/diagnóstico , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Gravidez , Sepse/diagnóstico , Sepse/tratamento farmacológico , Sepse/epidemiologia
3.
BMC Infect Dis ; 20(1): 682, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32942989

RESUMO

BACKGROUND: Enterobacter cloacae species is responsible for nosocomial outbreaks in vulnerable patients in neonatal intensive care units (NICU). The environment can constitute the reservoir and source of infection in NICUs. Herein we report the impact of preventive measures implemented after an Enterobacter cloacae outbreak inside a NICU. METHODS: This retrospective study was conducted in one level 3 NICU in Lyon, France, over a 6 year-period (2012-2018). After an outbreak of Enterobacter cloacae infections in hospitalized neonates in 2013, several measures were implemented including intensive biocleaning and education of medical staff. Clinical and microbiological characteristics of infected patients and evolution of colonization/infection with Enterobacter spp. in this NICU were retrieved. Moreover, whole genome sequencing was performed on 6 outbreak strains. RESULTS: Enterobacter spp. was isolated in 469 patients and 30 patients developed an infection including 2 meningitis and 12 fatal cases. Preventive measures and education of medical staff were not associated with a significant decrease in patient colonisation but led to a persistent decreased use of cephalosporin in the NICU. Infection strains were genetically diverse, supporting the hypothesis of multiple hygiene defects rather than the diffusion of a single clone. CONCLUSIONS: Grouped cases of infections inside one setting are not necessarily related to a single-clone outbreak and could reveal other environmental and organisational problematics. The fight against implementation and transmission of Enterobacter spp. in NICUs remains a major challenge.


Assuntos
Enterobacter cloacae/patogenicidade , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/prevenção & controle , Controle de Infecções/métodos , Surtos de Doenças/prevenção & controle , Enterobacter cloacae/genética , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/microbiologia , Fezes/microbiologia , Feminino , França , Humanos , Higiene , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Sepse Neonatal/epidemiologia , Sepse Neonatal/microbiologia , Estudos Retrospectivos , Sequenciamento Completo do Genoma
4.
Am J Trop Med Hyg ; 103(4): 1397-1404, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32783799

RESUMO

Recurrent enteric infections and micronutrient deficiencies, including deficiencies in the tryptophan-kynurenine-niacin pathway, have been associated with environmental enteric dysfunction, potentially contributing to poor child growth and development. We are conducting a randomized, placebo-controlled, 2 × 2 factorial interventional trial in a rural population in Haydom, Tanzania, to determine the effect of 1) antimicrobials (azithromycin and nitazoxanide) and/or 2) nicotinamide, a niacin vitamer, on attained length at 18 months. Mother/infant dyads were enrolled within 14 days of the infant's birth from September 2017 to September 2018, with the follow-up to be completed in February 2020. Here, we describe the baseline characteristics of the study cohort, risk factors for low enrollment weight, and neonatal adverse events (AEs). Risk factors for a low enrollment weight included being a firstborn child (-0.54 difference in weight-for-age z-score [WAZ] versus other children, 95% CI: -0.71, -0.37), lower socioeconomic status (-0.28, 95% CI: -0.43, -0.12 difference in WAZ), and birth during the preharvest season (November to March) (-0.22, 95% CI: -0.33, -0.11 difference in WAZ). The most common neonatal serious AEs were respiratory tract infections and neonatal sepsis (2.2 and 1.4 events per 100 child-months, respectively). The study cohort represents a high-risk population for whom interventions to improve child growth and development are urgently needed. Further analyses are needed to understand the persistent impacts of seasonal malnutrition and the interactions between seasonality, socioeconomic status, and the study interventions.


Assuntos
Saúde da Criança/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Azitromicina/uso terapêutico , Peso Corporal , Transtornos da Nutrição Infantil , Pré-Escolar , Estudos de Coortes , Intervenção Médica Precoce , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mães , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Niacinamida/uso terapêutico , Pobreza , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , População Rural , Estações do Ano , Tanzânia/epidemiologia , Tiazóis/uso terapêutico , Adulto Jovem
5.
PLoS One ; 15(8): e0237085, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776958

RESUMO

BACKGROUND: Sepsis is the third most common cause of death among neonates, with about 225,000 newborns dying every year globally. Data concerning the microbial etiology of neonatal sepsis and antimicrobial resistance profiles of its causative agents are necessary to inform targeted and effective treatment and prevention strategies. OBJECTIVE: To determine the proportion of newborns with symptoms and signs of sepsis who had a positive blood culture, its bacterial etiology, the antimicrobial resistance patterns as well as the factors associated with culture-positivity and case fatality at Mulago national referral hospital in Uganda. METHODS: We conducted a cross-sectional study among 359 neonates with symptoms and signs of sepsis who presented to the pediatric emergency care unit of Mulago national referral hospital from mid-January to end of December 2018. We performed blood culture and antimicrobial susceptibility testing, and conducted polymerase chain reaction to identify methicillin-resistant Staphylococcus aureus (MRSA) isolates. We used multivariable logistic regression to estimate the association between potential risk factors and culture-positive neonatal sepsis. FINDINGS: Of the 359 neonates recruited, 46 (12.8%; 95% CI 9.5%, 16.7%) had a positive blood culture. The predominant isolated bacteria were Staphylococcus aureus in 29 (63.0%), Escherichia coli in seven (15.2%), and Klebsiella pneumoniae in five (10.9%). Of the 46 pathogens, 73.9% were resistant to ampicillin, 23.9% to gentamicin and 8.7% to ceftriaxone. We isolated MRSA from the blood specimens of 19 (5.3%) of the 359 neonates, while 3 (0.8%) grew extended spectrum beta lactamase producers. The case fatality risk among neonates with neonatal sepsis was 9.5% (95% CI: 6.6%, 13.0%). Cesarean section delivery was strongly associated with culture-positive sepsis (adjusted odds ratio 3.45, 95% CI: 1.2, 10.1). CONCLUSION: One in eight neonates with clinical signs of sepsis grew a likely causative bacterial pathogen. S. aureus was the main pathogen isolated and a third of these isolates were MRSA. A significant proportion of the isolated bacterial pathogens were resistant to the first and second line antibiotics used for the treatment of neonatal sepsis. There is need to revisit the current treatment guidelines for neonatal sepsis.


Assuntos
Sepse Neonatal/epidemiologia , Infecções Estafilocócicas/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Sepse Neonatal/etiologia , Sepse Neonatal/microbiologia , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Uganda
6.
Am J Obstet Gynecol ; 223(5): 739.e1-739.e13, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32780999

RESUMO

BACKGROUND: Despite expectant management, preeclampsia remote from term usually results in preterm delivery. Antithrombin, which displays antiinflammatory and anticoagulant properties, may have a therapeutic role in treating preterm preeclampsia, a disorder characterized by endothelial dysfunction, inflammation, and activation of the coagulation system. OBJECTIVE: This randomized, placebo-controlled clinical trial aimed to evaluate whether intravenous recombinant human antithrombin could prolong gestation and therefore improve maternal and fetal outcomes. STUDY DESIGN: We performed a double-blind, placebo-controlled trial at 23 hospitals. Women were eligible if they had a singleton pregnancy, early-onset or superimposed preeclampsia at 23 0/7 to 30 0/7 weeks' gestation, and planned expectant management. In addition to standard therapy, patients were randomized to receive either recombinant human antithrombin 250 mg loading dose followed by a continuous infusion of 2000 mg per 24 hours or an identical saline infusion until delivery. The primary outcome was days gained from randomization until delivery. The secondary outcome was composite neonatal morbidity score. A total of 120 women were randomized. RESULTS: There was no difference in median gestational age at enrollment (27.3 weeks' gestation for the recombinant human antithrombin group [range, 23.1-30.0] and 27.6 weeks' gestation for the placebo group [range, 23.0-30.0]; P=.67). There were no differences in median increase in days gained (5.0 in the recombinant human antithrombin group [range, 0-75] and 6.0 for the placebo group [range, 0-85]; P=.95). There were no differences between groups in composite neonatal morbidity scores or in maternal complications. No safety issues related to recombinant human antithrombin were noted in this study, despite the achievement of supraphysiological antithrombin concentrations. CONCLUSION: The administration of recombinant human antithrombin in preterm preeclampsia neither prolonged pregnancy nor improved neonatal or maternal outcomes.


Assuntos
Proteínas Antitrombina/uso terapêutico , Cesárea/estatística & dados numéricos , Idade Gestacional , Pré-Eclâmpsia/tratamento farmacológico , Administração Intravenosa , Adolescente , Adulto , Parto Obstétrico/estatística & dados numéricos , Método Duplo-Cego , Feminino , Sofrimento Fetal/epidemiologia , Humanos , Doenças do Prematuro/epidemiologia , Recém-Nascido Pequeno para a Idade Gestacional , Pessoa de Meia-Idade , Sepse Neonatal/epidemiologia , Mortalidade Perinatal , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/fisiopatologia , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Proteínas Recombinantes , Adulto Jovem
7.
S Afr Med J ; 110(5): 360-363, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657717

RESUMO

Despite a substantial decline in childhood mortality rates in South Africa (SA), progress in neonatal mortality reduction has been much slower. Severe bacterial infections remain a leading cause of neonatal morbidity and a direct cause of 13.1% of neonatal deaths among babies >1 kg. The incidence of hospital-acquired infections, antimicrobial resistance and outbreaks of infections in SA neonatal units is substantial, and is possibly higher than the currently available estimates. The SA Neonatal Sepsis Task Force was launched in Port Elizabeth, SA, on 13 September 2019 to provide technical advice and guidance on surveillance for neonatal sepsis, infection prevention, case management, antimicrobial stewardship and containment of neonatal unit outbreaks.


Assuntos
Comitês Consultivos , Gestão de Antimicrobianos , Unidades de Terapia Intensiva Neonatal , Sepse Neonatal/epidemiologia , Sepse Neonatal/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Resistência Microbiana a Medicamentos , Humanos , Recém-Nascido , Controle de Infecções , Vigilância da População , África do Sul/epidemiologia
9.
PLoS One ; 15(6): e0234472, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579580

RESUMO

BACKGROUND: Despite remarkable progress in the reduction of death in under-five children, neonatal mortality has shown little or no concomitant reduction globally. It is also one of the most common causes of neonatal death in Ethiopia. Little is known on predictors of neonatal sepsis. Risk based screening and commencement of treatment appreciably reduces neonatal death and illness. Therefore, the main aim of this study was to identify predictors of neonatal sepsis in public referral hospitals of Northwest Ethiopia. METHODS: Institutional based unmatched case-control study was conducted among a total of 231 neonates in Debre Markos and Felege Hiwot referral hospitals from March 2018- April 2018. Neonates who fulfill the preseted criteria for sepsis were considered as cases and neonates diagnosed with other medical reasons except sepsis were controls. For each case, two consecutive controls were selected by simple random sampling method. Data were collected using structured pretested questionnaire through a face to face interview with index mothers and by reviewing neonatal record using checklist. The collected data were entered into Epi data version 3.1 and exported to STATA/ SE software version 14. Binary and multivariable logistic regression analyses were employed. Statistical significance was declared at P<0.05. RESULT: Multivariable logistic regression analysis showed that, duration of rupture of membrane ≥ 18hours was significantly associated with sepsis (AOR = 10.4, 95%CI = 2.3-46.5). The other independent predictors of neonatal sepsis were number of maternal antenatal care service ≤3 (AOR = 4.4, 95%CI = 1.7-11.5), meconium stained amniotic fluid (AOR = 3.9, 95%CI = 1.5-9.8), urinary tract infection during pregnancy (AOR = 10.8, 95% CI = 3.4-33.9), intranatal fever (AOR = 3.2, 95% CI = 1.1-9.5), first minute APGAR score <7 (AOR = 3.2, 95% CI = 1.3-7.7), resuscitation at birth (AOR = 5.4, 95% CI = 1.9-15.5), nasogastric tube insertion (AOR = 3.7, 95% CI = 1.4-10.2). CONCLUSION: Neonatal invasive procedures, ANC follow up during pregnancy, different conditions during birth like meconium stained amniotic fluid, low APGAR score and resuscitation at birth were the independent predictors of neonatal sepsis.


Assuntos
Mortalidade Infantil , Sepse Neonatal/epidemiologia , Parto , Morte Perinatal/etiologia , Cuidado Pré-Natal , Adulto , Líquido Amniótico , Índice de Apgar , Estudos de Casos e Controles , Etiópia , Feminino , Hospitais Públicos , Humanos , Lactente , Recém-Nascido , Mães , Gravidez , Infecções Urinárias/complicações , Adulto Jovem
10.
PLoS One ; 15(5): e0232406, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365073

RESUMO

BACKGROUND: High global neonatal deaths have triggered efforts to improve facility-based care. However, the outcomes achievable at different levels of care are unclear. This study compared morbidity and mortality patterns of newborns admitted to a regional and a district hospital in Ghana to determine outcome, risk and modifiable factors associated with mortality. OBJECTIVE: This study compared morbidity and mortality patterns of newborns admitted to a regional and a district hospital in Ghana to determine outcome, risk and modifiable factors associated with mortality. METHODS: A cross-sectional study involving a records-review over one year at the Upper West Regional Hospital, and three years at St Joseph's District Hospital, Jirapa was carried out. Age, sex, gestational age, weight, duration of admission, diagnosis, among others were examined. The data were analysed and statistical inference made. RESULTS: Altogether, 2004 newborns were examined, comprising 1,241(62%) from St Joseph's District Hospital and 763(38%) from Upper West Regional Hospital. The proportion of neonatal deaths was similar, 8.94% (St Joseph's District Hospital) and 8.91% (Upper West Regional Hospital). Prematurity, neonatal sepsis, birth asphyxia, low birth weight, neonatal jaundice and pneumonia contributed the most to mortality and suspected infections including malaria accounted for almost half (45.5%). Mortality was significantly associated with duration of stay of 48 hours, being premature, and being younger than 3 days. CONCLUSION: Majority of the mortality among the neonates admitted was due to preventable causes. Better stabilization and further studies on the epidemiology of sepsis, prematurity, low birth weight, including the contribution of malaria to these and outcome of transferred neonates are needed.


Assuntos
Hospitalização , Mortalidade Infantil , Asfixia Neonatal/epidemiologia , Asfixia Neonatal/mortalidade , Estudos Transversais , Feminino , Gana/epidemiologia , Mortalidade Hospitalar , Hospitais de Distrito , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Sepse Neonatal/epidemiologia , Sepse Neonatal/mortalidade , Admissão do Paciente
11.
Clin Lab ; 66(1)2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32013354

RESUMO

BACKGROUND: Considering the physiological changes in serum procalcitonin (PCT) levels in newborns due to age, we recently established an age-specific percentile-based reference curve for serum PCT level. The present study aimed to determine the best cutoff percentile line using this reference curve for the differentiation between infected and colonized preterm infants. METHODS: A total of 52 preterm infants with positive bacterial culture (9 with bacterial infection, 43 with colonization) were enrolled within the study period. The 97.5th, 95.0th, 92.5th, 90.0th, 80.0th, 70.0th, 60.0th, and 50.0th percentile lines were drawn in the reference curve. PCT levels in infected or colonized infants were used, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The best cutoff percentile line was determined in the receiver operating characteristic curve analysis. RESULTS: Of the 52 preterm infants, 9 were infected (5 and 4 infants with an onset of < 7 days and ≥ 7 days after birth, respectively), whereas 43 were colonized (6 and 37 infants with an onset of < 7 days and ≥ 7 days after birth, respectively). The best cutoff percentile lines were the 90.0th percentile (sensitivity, 0.800; specificity, 0.833; PPV, 0.800; NPV, 0.833) and 97.5th percentile (sensitivity, 1.00; specificity, 0.973; PPV, 0.800; NPV, 1.00) in infants with an onset of < 7 days and ≥ 7 days after birth, respectively. CONCLUSIONS: The age-specific percentile-based reference curve for serum PCT level is clinically applicable as a new tool for diagnosing infections in preterm infants with positive culture results, particularly at ≥ 7 days after birth.


Assuntos
Infecções Bacterianas/diagnóstico , Recém-Nascido Prematuro , Pró-Calcitonina/sangue , Fatores Etários , Infecções Bacterianas/epidemiologia , Biomarcadores/sangue , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Sepse Neonatal/diagnóstico , Sepse Neonatal/epidemiologia , Valor Preditivo dos Testes , Valores de Referência , Estudos Retrospectivos
12.
JAMA Netw Open ; 3(2): e1921124, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32049298

RESUMO

Importance: High levels of antimicrobial resistance in neonatal bloodstream isolates are being reported globally, including in Asia. Local hospital antibiogram data may include too few isolates to meaningfully examine the expected coverage of antibiotic regimens. Objective: To assess the coverage offered by 3 antibiotic regimens for empirical treatment of neonatal sepsis in Asian countries. Design, Setting, and Participants: A decision analytical model was used to estimate coverage of 3 prespecified antibiotic regimens according to a weighted-incidence syndromic combination antibiogram. Relevant data to parameterize the models were identified from a systematic search of Ovid MEDLINE and Embase. Data from Asian countries published from 2014 onward were of interest. Only data on blood culture isolates from neonates with sepsis, bloodstream infection, or bacteremia reported from the relevant setting were included. Data analysis was performed from April 2019 to July 2019. Exposures: The prespecified regimens of interest were aminopenicillin-gentamicin, third-generation cephalosporins (cefotaxime or ceftriaxone), and meropenem. The relative incidence of different bacteria and their antimicrobial susceptibility to antibiotics relevant for determining expected concordance with these regimens were extracted. Main Outcomes and Measures: Coverage was calculated on the basis of a decision-tree model incorporating relative bacterial incidence and antimicrobial susceptibility of relevant isolates. Data on 7 bacteria most commonly reported in the included studies were used for estimating coverage, which was reported at the country level. Results: Data from 48 studies reporting on 10 countries and 8376 isolates were used. Individual countries reported 51 (Vietnam) to 6284 (India) isolates. Coverage varied considerably between countries. Meropenem was generally estimated to provide the highest coverage, ranging from 64.0% (95% credible interval [CrI], 62.6%-65.4%) in India to 90.6% (95% CrI, 86.2%-94.4%) in Cambodia, followed by aminopenicillin-gentamicin (from 35.9% [95% CrI, 27.7%-44.0%] in Indonesia to 81.0% [95% CrI, 71.1%-89.7%] in Laos) and cefotaxime or ceftriaxone (from 17.9% [95% CrI, 11.7%-24.7%] in Indonesia to 75.0% [95% CrI, 64.8%-84.1%] in Laos). Aminopenicillin-gentamicin coverage was lower than that of meropenem in all countries except Laos (81.0%; 95% CrI, 71.1%-89.7%) and Nepal (74.3%; 95% CrI, 70.3%-78.2%), where 95% CrIs for aminopenicillin-gentamicin and meropenem were overlapping. Third-generation cephalosporin coverage was lowest of the 3 regimens in all countries. The coverage difference between aminopenicillin-gentamicin and meropenem for countries with nonoverlapping 95% CrIs ranged from -15.9% in China to -52.9% in Indonesia. Conclusions and Relevance: This study's findings suggest that noncarbapenem antibiotic regimens may provide limited coverage for empirical treatment of neonatal sepsis in many Asian countries. Alternative regimens must be studied to limit carbapenem consumption.


Assuntos
Antibacterianos , Farmacorresistência Bacteriana , Sepse Neonatal , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Ásia/epidemiologia , Bactérias/efeitos dos fármacos , Tomada de Decisão Clínica , Árvores de Decisões , Quimioterapia Combinada , Gentamicinas/farmacologia , Gentamicinas/uso terapêutico , Humanos , Incidência , Recém-Nascido , Testes de Sensibilidade Microbiana , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Sepse Neonatal/microbiologia , beta-Lactamas/farmacologia , beta-Lactamas/uso terapêutico
14.
BMC Infect Dis ; 20(1): 151, 2020 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-32070296

RESUMO

BACKGROUND: Early diagnosis of neonatal sepsis is essential to prevent severe complications and avoid unnecessary use of antibiotics. The mortality of neonatal sepsis is over 18%in many countries. This study aimed to develop a predictive model for the diagnosis of bacterial late-onset neonatal sepsis. METHODS: A case-control study was conducted at Queen Sirikit National Institute of Child Health, Bangkok, Thailand. Data were derived from the medical records of 52 sepsis cases and 156 non-sepsis controls. Only proven bacterial neonatal sepsis cases were included in the sepsis group. The non-sepsis group consisted of neonates without any infection. Potential predictors consisted of risk factors, clinical conditions, laboratory data, and treatment modalities. The model was developed based on multiple logistic regression analysis. RESULTS: The incidence of late proven neonatal sepsis was 1.46%. The model had 6 significant variables: poor feeding, abnormal heart rate (outside the range 100-180 x/min), abnormal temperature (outside the range 36o-37.9 °C), abnormal oxygen saturation, abnormal leucocytes (according to Manroe's criteria by age), and abnormal pH (outside the range 7.27-7.45). The area below the Receiver Operating Characteristics (ROC) curve was 95.5%. The score had a sensitivity of 88.5% and specificity of 90.4%. CONCLUSION: A predictive model and a scoring system were developed for proven bacterial late-onset neonatal sepsis. This simpler tool is expected to somewhat replace microbiological culture, especially in resource-limited settings.


Assuntos
Sepse Neonatal/diagnóstico , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Feminino , Frequência Cardíaca , Humanos , Incidência , Recém-Nascido , Masculino , Modelos Biológicos , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Sepse Neonatal/microbiologia , Curva ROC , Fatores de Risco , Sensibilidade e Especificidade , Centros de Atenção Terciária/estatística & dados numéricos , Tailândia/epidemiologia
15.
Niger J Clin Pract ; 23(1): 71-78, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31929210

RESUMO

Background: Neonatal hyperglycemia (NNH) like hypoglycemia is a dangerous metabolic disorder often associated with adverse consequences, if undetected and untreated. This study was set out to determine the prevalence, risk factors, and outcomes of babies with the point of admission hyperglycaemia at the Wesley Guild Hospital (WGH), Ilesa. Methods: The study was descriptive and cross-sectional, involving 300 consecutively recruited neonates admitted into the special care baby unit (SCBU) of the hospital. All subjects had blood glucose done at the point of admission using Accu-Chek Active® glucometer (Roche Diagnostics GmbH, Germany). Hyperglycemia was defined as blood glucose ≥7.0 mmol/L. Factors associated with NNH were determined using univariate and multivariate analyses. Results: Of the 300 subjects (Male: Female 1.5:1), there were 74 (24.7%) preterms, 35 (11.7%) small-for-gestational age and 85 (28.3%) low-birth-weight babies. Eighteen (6.0%) babies had hyperglycemia. Parental low socioeconomic class, maternal lack of antenatal care (ANC), vaginal delivery, grand multiparity, outborn status, respiratory distress, probable sepsis, and neonatal anemia at presentation were associated with NNH (P < 0.05). Respiratory distress (OR = 3.800, 95% CI = 1.122-12.873, P = 0.032), and probable sepsis (OR = 4.090, 95% CI = 1.206-13.872, P = 0.024) were independent predictors of hyperglycemia. Hyperglycemia was significantly associated with mortality. (38.9% vs. 11.0%; P = 0.001). Conclusion: Neonatal hyperglycemia was detected in 6.0% of neonatal admission at the WGH, Ilesa and it was associated with increased mortality. Hyperglycemia should be suspected and promptly managed at the point of admission of ill newborns particularly those with respiratory distress and signs of sepsis.


Assuntos
Hospitalização/estatística & dados numéricos , Hiperglicemia/epidemiologia , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Sepse Neonatal/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Estudos Transversais , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/mortalidade , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Sepse Neonatal/epidemiologia , Sepse Neonatal/mortalidade , Nigéria/epidemiologia , Gravidez , Prevalência , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Fatores de Risco
16.
PLoS One ; 15(1): e0227570, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978069

RESUMO

BACKGROUND: Neonatal sepsis is accounted for 30-50% of annual neonatal deaths in developing countries. We performed a systematic review and meta-analysis study to evaluate the national prevalence and identification of the etiological pathogens of neonatal sepsis in Iran. METHODS: A comprehensive literature search was done on the national and international databases for studies published between 2000 and 2019. The DerSimonian and Laird random-effects model was used to calculate pooled prevalence estimates, with 95% confidence intervals (CIs). Subgroup analyses and meta-regressions regarding the gender, type of sepsis and time during were also performed. Data were extracted, analyzed, and presented according to PRISMA guideline. RESULTS: Of 944 publications identified, 22 studies containing 14,683 neonates met the eligibility criteria. The pooled national prevalence of sepsis in Iran was 15.98% (95%CI, 11.96-20.46%; 1,367/14,683). Prevalence rate in boys (20.42%; 95%CI, 9.03-34.8%) was slightly higher than girls (18.5%; 95%CI, 7.4-32.8). A decreasing trend in prevalence of neonatal sepsis was found in recent years, although not statistically significant (c = -0.005; P value = 0.4). The most prevalent causative bacterial pathogens were Enterobacter spp. (23.04%), followed by Klebsiella pneumoniae (17.54%), coagulase-negative Staphylococci (14.06%), Escherichia coli (13.92%), Pseudomonas aeruginosa (12.67%), and Staphylococcus aureus (11.48%). CONCLUSION: Our findings showed a high prevalence of neonatal sepsis in suspected neonates, suggesting the need to implement preventive measures, routine assessment, and close monitoring of neonates. Also, Enterobacter spp. and Klebsiella pneumoniae were identified as the principal bacterial pathogens responsible for neonatal septicemia in Iran.


Assuntos
Sepse Neonatal/epidemiologia , Sepse Neonatal/microbiologia , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Prevalência
17.
J Trop Pediatr ; 66(3): 257-266, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31539064

RESUMO

OBJECTIVE: To assess the predictors of early onset neonatal sepsis (EONS) among neonates in Dodoma Tanzania. METHODS: A hospital-based case-control study of randomly selected 105 cases and 217 controls in three hospitals in Dodoma region. Cases were neonates diagnosed with neonatal sepsis. Controls were matched to the cases by mother's age and parity at a ratio of 1 case to 2 controls. A semi-structured questionnaire was used to collect data on the potential mother, neonate and interventional predictors of EONS. Both descriptive and inferential statistical analysis were employed to test for independent association. RESULTS: Most (92.5%) of neonates were born at term (≥37 weeks) and 84% had normal birth weight of ≥3 kg. After adjusting for confounders, the maternal factors which showed significant association with EONS were maternal history of chorioamnionitis [adjusted odds ratios (AOR) = 1.910, p = 0.042, 95% confidence interval (CI): 1.0223.56], HIV status (AOR = 2.909, p = 0.012, 95% CI: 1.020-8.296), prolonged rupture of membrane (AOR = 2.857, p = 0.014, 95% CI: 1.233-6.619) and multiple digital vaginal examinations during labor (AOR = 5.178, p = 0.026, 95% CI: 1.220-21.986). The neonatal history of perinatal asphyxia was observed to have a significant association with EONS (AOR = 6.781, p = 0.006, 95% CI: 1.725-26.652). CONCLUSION: Both maternal and neonatal predictors had significant contribution to EONS. Results shed light on critical factors for consideration to prevent this disease and poor outcomes.


Assuntos
Sepse Neonatal/diagnóstico , Adulto , Idade de Início , Peso ao Nascer , Estudos de Casos e Controles , Corioamnionite/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Masculino , Idade Materna , Mães , Sepse Neonatal/epidemiologia , Parto , Gravidez , Tanzânia/epidemiologia
18.
Arch Dis Child Fetal Neonatal Ed ; 105(2): 118-122, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31296696

RESUMO

OBJECTIVE: To compare management recommendations of the National Institute for Health and Care Excellence (NICE) guidelines with the Kaiser Permanente sepsis risk calculator (SRC) for risk of early onset neonatal sepsis (EONS). DESIGN: Multicentre prospective observational projection study. SETTING: Eight maternity hospitals in Wales, UK. PATIENTS: All live births ≥34 weeks gestation over a 3-month period (February-April 2018). METHODS: Demographics, maternal and infant risk factors, infant's clinical status, antibiotic usage and blood culture results from first 72 hours of birth were collected. Infants were managed using NICE recommendations and decisions compared with that projected by SRC. MAIN OUTCOME MEASURE: Proportion of infants recommended for antibiotics on either tool. RESULTS: Of 4992 eligible infants, complete data were available for 3593 (71.9%). Of these, 576 (16%) were started on antibiotics as per NICE recommendations compared with 156 (4.3%) projected by the SRC, a relative reduction of 74%. Of the 426 infants avoiding antibiotics, SRC assigned 314 (54.6%) to normal care only. There were seven positive blood cultures-three infants were recommended antibiotics by both, three were not identified in the asymptomatic stage by either; one was a contaminant. No EONS-related readmission was reported. CONCLUSION: The judicious adoption of SRC in UK clinical practice for screening and management of EONS could potentially reduce interventions and antibiotic usage in three out of four term or near-term infants and promote earlier discharge from hospital in >50%. We did not identify any EONS case missed by SRC when compared with NICE. These results have significant implications for healthcare resources.


Assuntos
Antibacterianos/uso terapêutico , Maternidades/estatística & dados numéricos , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Antibacterianos/efeitos adversos , Hemocultura , Feminino , Idade Gestacional , Nível de Saúde , Humanos , Recém-Nascido , Masculino , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos , Medicina Estatal , País de Gales/epidemiologia
19.
J Perinatol ; 40(2): 337-343, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31700089

RESUMO

OBJECTIVE: We aimed to identify differences in morbidity and mortality between inborn versus outborn extremely low birth weight (ELBW) infants admitted to the Texas Children's Hospital neonatal intensive care unit (NICU). STUDY DESIGN: Vermont Oxford Network data were analyzed between January 2014 and December 2017. Inborn versus outborn outcomes were compared. RESULT: Of 533 ELBW infants, 402 were inborn, and 131 were outborn. Gestational age and birth weight (BW) were similar. After adjusting outcomes to control for maternal steroids, maternal hypertension, maternal prenatal care, and temperature below 36 °C at admission, no outcomes were significantly different except inborn patients had decreased odds of late onset sepsis (adjusted odds ratio = 0.606, 95% confidence interval: 0.377-0.973, p = 0.038). CONCLUSION: In this study, outborn ELBW patients had increased odds of late onset sepsis compared with inborn ELBW patients after controlling for covariates that differed significantly between these two cohorts.


Assuntos
Entorno do Parto , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Doenças do Prematuro/epidemiologia , Sepse Neonatal/epidemiologia , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária , Texas/epidemiologia
20.
Eur J Clin Microbiol Infect Dis ; 39(3): 583-591, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31773363

RESUMO

Neonatal sepsis is a great challenge for clinicians and infection control practitioners, especially in facilities with limited resources. Carbapenem-resistant Klebsiella pneumoniae (CRKP) is rapidly increasing and carriages a major threat to neonates. We aimed to examine phenotypes causing neonatal late onset sepsis (NLOS) in comparison with neonatal early onset sepsis (NEOS) with further investigations of genotypes, and genetic relatedness of CRKP in neonatal late-onset sepsis. Our study included 88 neonates diagnosed with sepsis: 58 with (NLOS) and 30 with (NEOS) from November 2015 to April 2016, at neonatal intensive care unit (NICU) of Cairo University Hospital. K. pneumoniae was the most common encountered pathogen in the NLOS group (37.9%) with a mean sepsis score of 6.39 when compared to the NEOS group (p < 0.05). In Klebsiella group, C-reactive protein and interleukin-6 levels were significantly high (p ˂ 0.001) and 56.5% of the isolates were meropenem resistant. The most prevalent carbapenemase gene was OXA-48 which was identified in 14/23 (60.8%) followed by NDM-1 which was identified in 12/23 (52.2%) as detected by multiplex PCR. Coexistence of both carbapenemases was found in 52.2% (12/23). The blaKPC, blaIMP, and blaVIM genes were not harbored in the isolates. By investigating the genetic relatedness of CRKP by pulsed-field gel electrophoresis, 23 isolates of K. pneumoniae revealed various pulsed-field gel electrophoresis (PFGE) patterns, demonstrating that the isolates were non-clonal. Awareness of the existing phenotypes and genotypes is important for proper treatment and infection control practices.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Variação Genética , Unidades de Terapia Intensiva Neonatal , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/genética , Sepse Neonatal/epidemiologia , Sepse Neonatal/microbiologia , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Enterobacteriáceas Resistentes a Carbapenêmicos/classificação , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Estudos Transversais , Egito/epidemiologia , Humanos , Recém-Nascido , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/classificação , Testes de Sensibilidade Microbiana , Sepse Neonatal/tratamento farmacológico , Prognóstico , Vigilância em Saúde Pública , Resultado do Tratamento
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