Emergence of multidrug-resistant gram-negative organisms in a neonatal unit and the therapeutic implications

Musoke, Rachel

doi:10.1093/tropej/46.2.86

Cited by 61 publications

(52 citation statements)

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“…The nearest comparisons are with studies related to care of newborns in specially designated areas i.e newborn units. The differences that arise between infants in a new born unit and those in a general ward stem from; (i) lack of personel specialised in the care of newborns in the general wards (ii) lack of specialised equipment in the general wards (1). Maternal attributes: In this study, maternal attributes such as marital status, parity, antenatal clinic attendance, mode or place of delivery had no influence on the mortality.…”

Section: Discussionmentioning

confidence: 65%

“…The inadequency of supportive care as shown in this study was responsible for a substantial amount of the mortality. Musoke and Revathi researching in the same hospital also found that lack of supportive care for neonates contributed significantly to morbidity and mortality (1). The impact of this poor supportive care is bound to be magnified in a non-specialised area such as the general wards.…”

Section: Discussionmentioning

confidence: 96%

“…Several studies have been done in the new born unit to determine the morbidity and mortality of new borns in the unit but none have been done for the general wards (1)(2)(3).This study therefore has no precedent to which comparisons can be made except for those studies from the new born unit.…”

Section: Introductionmentioning

confidence: 99%

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Morbidity and mortality of neonates admitted in general paediatric wards at Kenyatta National Hospital

Simiyu

2004

E Af Med Jrnl

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Background: Neonatal morbidity and mortality is high in developing countries. Facilities for specific neonatal care are limited in Kenya with no neonatal intensive care unit in the public health institutions. The new born unit at Kenyatta National Hospital (KNH) cannot accommodate all neonates so a number of these are admitted to the general paediatric wards. Objectives: To establish the morbidity and mortality of neonates admitted to the general wards at KNH and to review the medical interventions applied in the management and make recommendations that will improve on this. Design: A retrospective study. Setting: Kenyatta National Hospital general paediatric wards-Nairobi, Kenya. Subjects: All babies who were admitted to the general paediatric wards at KNH from January to December 2000. Results: A total of 308 records of neonates admitted to the general paediatric wards at KNH in the year of study were found and retrieved. The mortality was 315/1000 neonates admitted. Of the 308 admissions, 33.4% were low birth weight (LBW), 5% being very low birth weight (VLBW). The common diagnoses at admission or discharge were suspected sepsis 71% (confirmed sepsis 8.4%), jaundice 35%, pneumonia 32%, omphalitis 28%, dehydration 14%, apnoec attacks 13%, and hypothermia 6%. Eighty nine (29%) of the infants were not investigated at all. The mean duration of stay was nine days for those who lived to discharge and four days for those who died. Of those who died, 49% died within 24 hours of admission. The frequently cited cause of death was suspected sepsis, pneumonia, dehydration and hypothermia. There were only six admissions to the general purpose intensive care unit referred from the wards. The independent predictors of mortality were low birth weight, apnoec attacks, hypothermia and dehydration(p<0.05). Conclusion: The mortality rate for neonates admitted to the general paediatric wards is high with almost half the deaths occurring in the first twenty four hours of admission. While the wards are doing commendable work, they need support by improving laboratory back up for improved diagnostic ability and to improve supportive care such as maintenance of fluid electrolyte balance, temperature regulation and access to intensive care facilities.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 96%

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Morbidity and mortality of neonates admitted in general paediatric wards at Kenyatta National Hospital

Simiyu

2004

E Af Med Jrnl

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“…18,19 Increased drug resistances have developed by these organisms over the last two decades and become a major problem to manage of neonatal sepsis. 20,21 Besides, frequent used of group B Streptococcus (GBS) as ethological agent of neonatal sepsis in developed countries, being responsible for high morbidity and death rates. 22 Recent advances in molecular biology have contributed to the tremendous progress in understanding the pathophysiology of sepsis.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of hypoglycemic status and causative factors in neonatal sepsis

Islam

Aklima

Yesmin

et al. 2017

Int J Contemp Pediatr

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Background: Very few studies have been reported on hypoglycemic status, hematological parameters and causative organisms of neonatal sepsis in different regions of Bangladesh. Hence, present study was conducted in the Chittagong city of Bangladesh.Methods: The study was conducted on 106 neonates (0 to 28 days of age) in Chattagam Maa-Shishu O General Hospital, Bangladesh. The questionnaire was developed to get relevant information of the neonates. Blood from neonates were subjected to routine investigations like blood glucose, CRP, hematological parameters, blood culture and bacterial identification.Results: Among 106 neonates with sepsis, 68 presented early onset neonatal sepsis (EONS) and 38 presented late onset neonatal sepsis (LONS). Fifty-one neonates had low birth weight (2500 g or less), 18 had very low birth weight (1500 g or less) and 22 were preterm. The most prevalent clinical features were reluctant to feed (56), hyperthermia (31) and hypotonia (22). Thirty-three neonates had neutropenia (<54%) and 62 had higher neutrophil count (>62%). Biochemical analysis showed 52 had higher C-reactive protein levels. Investigation of hypoglycemic status revealed that there were different types of neonatal sepsis, i.e. 77 neonates were hypoglycemic (<45 gm/dl), and among them EONS and LONS were 59 and 18, respectively. Thirty-three neonates had positive blood culture for bacteria. Among them, Klebsiella spp. accounted for 10 of the total isolates followed by Acinetobacter spp. 8. The Gram-positive and negative bacteria were found in 7 and 26, respectively.Conclusions: Hypoglycemia was associated with neonatal sepsis as an exacerbating factor.

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“…According to World health organization this growing problem of antibiotic resistance was announced the theme for the year 2011 as "Antibiotic Resistance tomorrow". 1,7,8 Mechanisms by which antibiotic resistance develop:…”

Section: Introductionmentioning

confidence: 99%