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1.
Clin Infect Dis ; 69(8): 1360-1367, 2019 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30596901

RESUMO

BACKGROUND: Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-based births become more common, the proportion of neonatal deaths due to hospital-onset sepsis has increased. METHODS: We conducted a prospective cohort study in a neonatal intensive care unit in Zambia where we implemented a multifaceted infection prevention and control (IPC) bundle consisting of IPC training, text message reminders, alcohol hand rub, enhanced environmental cleaning, and weekly bathing of babies ≥1.5 kg with 2% chlorhexidine gluconate. Hospital-associated sepsis, bloodstream infection (BSI), and mortality (>3 days after admission) outcome data were collected for 6 months prior to and 11 months after bundle implementation. RESULTS: Most enrolled neonates had a birth weight ≥1.5 kg (2131/2669 [79.8%]). Hospital-associated mortality was lower during the intervention than baseline period (18.0% vs 23.6%, respectively). Total mortality was lower in the intervention than prior periods. Half of enrolled neonates (50.4%) had suspected sepsis; 40.8% of cultures were positive. Most positive blood cultures yielded a pathogen (409/549 [74.5%]), predominantly Klebsiella pneumoniae (289/409 [70.1%]). The monthly rate and incidence density rate of suspected sepsis were lower in the intervention period for all birth weight categories, except babies weighing <1.0 kg. The rate of BSI with pathogen was also lower in the intervention than baseline period. CONCLUSIONS: A simple IPC bundle can reduce sepsis and death in neonates hospitalized in high-risk, low-resource settings. Further research is needed to validate these findings in similar settings and to identify optimal implementation strategies for improvement and sustainability. CLINICAL TRIALS REGISTRATION: NCT02386592.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Bacteriemia/prevenção & controle , Clorexidina/análogos & derivados , Controle de Infecções , Sepse/prevenção & controle , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Peso ao Nascer , Clorexidina/administração & dosagem , Estudos de Coortes , Mortalidade Hospitalar , Hospitais , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Controle de Infecções/métodos , Unidades de Terapia Intensiva Neonatal , Morte Perinatal/prevenção & controle , Estudos Prospectivos , Sepse/epidemiologia , Sepse/microbiologia , Sepse/mortalidade , Zâmbia/epidemiologia
2.
MMWR Morb Mortal Wkly Rep ; 67(19): 556-559, 2018 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-29771877

RESUMO

On October 6, 2017, an outbreak of cholera was declared in Zambia after laboratory confirmation of Vibrio cholerae O1, biotype El Tor, serotype Ogawa, from stool specimens from two patients with acute watery diarrhea. The two patients had gone to a clinic in Lusaka, the capital city, on October 4. Cholera cases increased rapidly, from several hundred cases in early December 2017 to approximately 2,000 by early January 2018 (Figure). In collaboration with partners, the Zambia Ministry of Health (MoH) launched a multifaceted public health response that included increased chlorination of the Lusaka municipal water supply, provision of emergency water supplies, water quality monitoring and testing, enhanced surveillance, epidemiologic investigations, a cholera vaccination campaign, aggressive case management and health care worker training, and laboratory testing of clinical samples. In late December 2017, a number of water-related preventive actions were initiated, including increasing chlorine levels throughout the city's water distribution system and placing emergency tanks of chlorinated water in the most affected neighborhoods; cholera cases declined sharply in January 2018. During January 10-February 14, 2018, approximately 2 million doses of oral cholera vaccine were administered to Lusaka residents aged ≥1 year. However, in mid-March, heavy flooding and widespread water shortages occurred, leading to a resurgence of cholera. As of May 12, 2018, the outbreak had affected seven of the 10 provinces in Zambia, with 5,905 suspected cases and a case fatality rate (CFR) of 1.9%. Among the suspected cases, 5,414 (91.7%), including 98 deaths (CFR = 1.8%), occurred in Lusaka residents.


Assuntos
Cólera/epidemiologia , Epidemias , Cólera/prevenção & controle , Vacinas contra Cólera/administração & dosagem , Epidemias/prevenção & controle , Fezes/microbiologia , Feminino , Humanos , Masculino , Prática de Saúde Pública , Vibrio cholerae/isolamento & purificação , Zâmbia/epidemiologia
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