Hospital-acquired neonatal infections in developing countries

Zaidi, Anita K. M.; Huskins, W. Charles; Thaver, Durrane; Bhutta, Zulfiqar Ahmed; Abbas, Zohair; Goldmann, Donald A.

doi:10.1016/s0140-6736(05)71881-x

Cited by 623 publications

(640 citation statements)

References 112 publications

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“…83 We included both inborn and outborn babies but all studies had to include contact with a hospital that could undertake laboratory investigations for common bacterial pathogens such as group B streptococcus. These studies are biased towards patients with severe disease, 84,85 and more babies with group B streptococcal infection could have been included in these studies than those in the total population, thereby infl ating our incidence estimate. Families who attend hospitals also have better access to health care and higher socioeconomic status than do those who do not attend hospitals.…”

Section: Discussionmentioning

confidence: 99%

Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis

Edmond¹,

Kortsalioudaki²,

Scott³

et al. 2012

The Lancet

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SummaryBackground Despite widespread use of intrapartum antibiotic prophylaxis, group B streptococcus remains a leading cause of morbidity and mortality in infants in Europe, the Americas, and Australia. However, estimates of disease burden in many countries outside of these regions is not available. We aimed to examine the current global burden of invasive disease and the serotype distribution of group B streptococcus isolates.

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Section: Discussionmentioning

confidence: 99%

Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis

Edmond¹,

Kortsalioudaki²,

Scott³

et al. 2012

The Lancet

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513

456

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“…Risk factors of sepsis are amenable to low-cost, low-technology interventions. 17 In view of sepsis being a major cause of death in neonatal period and amenable to simple interventions, incorporation of these principles in neonatal care model in limited-resource hospital settings carries a potential of a significant immediate gain in neonatal survival. A recent study conducted in eastern India demonstrated a decline in NMR of the served district by creating a facility-based care and extensive training of referring doctors at primary and secondary levels.…”

Section: Discussionmentioning

confidence: 99%

Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India

Agarwal

Acharya

et al. 2006

J Perinatol

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Objective: To evaluate impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India.Study design: Before-and-after intervention trial setting: limited resource teaching hospital; Design: Before and after study.Interventions: A package of simple interventions was evolved. The interventions included: rational admissions and early discharge, entrusting mothers in care-giving, enforcing asepsis routines, aggressive enteral feeding, abandoning unnecessary interventions, protocol-based management, rational antibiotics and training and empowerment of nurses.Statistical methods: The categorical and continuous variables were compared with w 2 and two-tailed tests, respectively.Results: Neonatal mortality rate declined significantly during the intervention period as compared to control period (20.3 versus 29.3 per 1000 live births; relative risk 0.69, 95% confidence interval (CI) 0.57 to 0.85). Most significant decline occurred in sepsis-related deaths. The survival of neonates with birth weight 1000 to 1499 improved over two folds (56.7% versus 24.5%, P<0.01). There was a significant decline in antibiotics use (635/878, 72.3% versus 299/897, 23.2%; P ¼ 0.00). The duration of stay in neonatal unit was decreased by a mean of 1.5 day (95% CI 0.9 to 2.8 days) after interventions.Conclusions: Simple interventions can result in a significant decline in neonatal mortality in hospitals with limited resources. This package is likely to be effective in hospitals with a high proportion of the sepsis deaths.

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“…Bloodstream infections (BSIs) are the most common healthcareassociated infection in neonates [3][4] . Very limited information is available from developing countries on infection rates per hospital-days or device-days including Brazilian units 5 . Incidence density rates per healthcare-associated infection in few studies [6][7] were higher than those observed in most studies in the United States or Europe 8 .…”

Section: Reduction Of Catheter-associated Bloodstream Infections Thromentioning

confidence: 99%

Reduction of catheter-associated bloodstream infections through procedures in newborn babies admitted in a university hospital intensive care unit in Brazil

Resende

Brito

et al. 2011

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: Catheter-associated bloodstream infection (CA-BSI) is the most common nosocomial infection in neonatal intensive care units. There is evidence that care bundles to reduce CA-BSI are effective in the adult literature. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. METHODS: An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. RESULTS: A total of sixty-seven (26.7%) CA-BSIs were observed. There were 46 (32%) episodes of culture-proven sepsis in group preintervention (24.1 per 1,000 catheter days [CVC days]). Neonates in the group after implementation of the intervention had 21 (19.6%) episodes of CA-BSI (14.9 per 1,000 CVC days). The incidence of CA-BSI decreased significantly after the intervention from the group preintervention and postintervention (32% to 19.6%, 24.1 per 1,000 CVC days to 14.9 per 1,000 CVC days, p=0.04). In the multiple logistic regression analysis, the use of more than 3 antibiotics and length of stay >8 days were independent risk factors for BSI. CONCLUSIONS: A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.

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Hospital-acquired neonatal infections in developing countries

Cited by 623 publications

References 112 publications

Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis

Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis

Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India

Reduction of catheter-associated bloodstream infections through procedures in newborn babies admitted in a university hospital intensive care unit in Brazil

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