Neonatal nosocomial bloodstream infections at a referral hospital in a middle-income country: burden, pathogens, antimicrobial resistance and mortality

Dramowski, Angela; Madide, A.; Bekker, Adrie

doi:10.1179/2046905515y.0000000029

Cited by 67 publications

(81 citation statements)

References 18 publications

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“…This result is inconstant with many previous results [17]- [19] that reported Staphylococci as the most common cause of neonatal sepsis. However, many studies agreed with our result [20] [21]. This may be due to environmental differences and differences in the supportive care and infection control practices between different centers.…”

Section: Discussionsupporting

confidence: 81%

<i>MBL2</i> Gene Polymorphism and the Association with Neonatal Sepsis in Egyptian Neonates, a Case Control Study

Mashaly¹,

El-Sabbagh²,

El-Kazzaz³

et al. 2016

OJI

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Mannose binding lectin (MBL) is an important component of innate immunity particularly in neonates whose adaptive immunity is not fully developed. Polymorphism in MBL2 gene promoter and exon1 determines MBL serum level and function. The aim of this study was to investigate the frequency of different MBL2 genotypes in neonatal sepsis among patients of neonatal intensive care unit (NICU). Two hundred and forty-five neonates were enrolled in this study (127 infected and 118 uninfected controls). Multiplex PCR and double amplification refractory mutation system (dARMS) were used for typing of MBL2 exon1 and promoter respectively. Klebsiella species were the most frequently isolated organisms (22.8%). There is no statistical significance difference in the distribution of different expression genotypes between infected group and controls (P = 0.11). However, prevalence of low MBL2 expression genotypes (XA/O and O/O) was higher in infected patients compared to control group (patients 25.2% and controls 15.3%). Low and medium MBL2 expression genotypes were mostly associated with Gram-negative bacterial infections (18.9% and 22.8%) respectively. A statistically significant association of Gram-negative bacterial infections with low MBL2 expression genotypes was found (P = 0.02). Higher frequency of AB and BB genotypes was observed (31.5% and 7.9%) in patients group compared to control, but without statistical significant difference.

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Section: Discussionsupporting

confidence: 81%

<i>MBL2</i> Gene Polymorphism and the Association with Neonatal Sepsis in Egyptian Neonates, a Case Control Study

Mashaly¹,

El-Sabbagh²,

El-Kazzaz³

et al. 2016

OJI

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“…Literature describing neonatal HAI is extremely limited, reporting healthcare-associated bloodstream infection (HA-BSI) only; an HA-BSI incidence of 4/1 000 and 14/1 000 patient days was reported from two tertiary hospitals -in Cape Town and Johannesburg, respectively. [12,13] Among paediatric inpatients in Cape Town, HA-BSI rates of 1.6/1 000 patient days were recorded, with excess mortality attributable to hospital-v. community-acquired BSI (25% v. 16%). [14] In 1987, prospective surveillance of two paediatric wards at Chris Hani Baragwanath Hospital, Johannesburg established an HAI prevalence of 14.3%, with a predominance of gastrointestinal and respiratory tract infections.…”

Section: In Practicementioning

confidence: 99%

A framework for preventing healthcare-associated infection in neonates and children in South Africa

2017

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Healthcare-associated infection (HAI) is a frequent and serious complication affecting 4 -8% of hospitalised children and neonates in high-income countries. The burden of HAI in South African (SA) paediatric and neonatal wards is substantial but underappreciated, owing to a lack of HAI surveillance and reporting. Maternal and child health and infection prevention are priority areas for healthcare quality improvement in the National Core Standards programme. Despite increasing recognition in SA, infection prevention efforts targeting hospitalised children and neonates are hampered by health system, institutional and individual patient factors. To ensure safe healthcare delivery to children, a co-ordinated HAI prevention strategy should promote development of infection prevention norms and policies, education, patient safety advocacy, healthcare infrastructure, surveillance and research. We present a framework for SA to develop and expand HAI prevention in hospitalised neonates and children.

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“…Staphylococcus aureus remains one of the principal causes of HAI in children (8)(9)(10)(11). In S. aureus, the smr gene and the qacA/B gene complex have been associated with elevated MICs and minimum bactericidal concentrations (MBCs) of CHG. A number of investigators have discovered an increase in the incidence of organisms bearing these genes following widespread use of CHG in hospital units (12)(13)(14) and, more rarely, following exposure to CHG outside the hospital setting (15,16).…”

mentioning

confidence: 99%

Impact of Health Care Exposure on Genotypic Antiseptic Tolerance in Staphylococcus aureus Infections in a Pediatric Population

McNeil

Hultén

Mason

et al. 2017

Antimicrob Agents Chemother

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Staphylococcus aureus possessing either the smr gene or the qacA/B genes is associated with decreased susceptibility to chlorhexidine gluconate (CHG) and other antiseptics. Previous studies of antiseptic-tolerant staphylococci have focused largely on high-risk populations, and the exact role of health care exposure in the acquisition of these organisms is unclear. We sought to describe the risk factors and features of infection caused by antiseptic-tolerant S. aureus in a general pediatric population. Isolates were selected from an ongoing S. aureus surveillance study. Every third sequential isolate in the year 2014 was selected for inclusion. All isolates underwent PCR for the genes qacA/B and smr. Medical records were reviewed. Five hundred six isolates were included in the study, with 377 (74.3%) being community acquired. One hundred (19.8%) isolates were smr positive and 79 (15.6%) qacA/B positive. In univariable analyses, the presence of either gene was associated with underlying medical conditions, nosocomial acquisition, recent hospitalization, central venous lines, and CHG exposure. In multivariable analyses, only differences between patients with chronic medical conditions (odds ratio [OR] ϭ 1.72; 95% confidence interval [CI], 1.22 to 2.64) and nosocomial acquisition (OR ϭ 2.48; 95% CI, 1.16 to 8.17) remained statistically significant. Among patients without risk factors, 27.9% had infection with an antiseptic-tolerant isolate. smr-or qacA/B-positive S. aureus isolates are common in children and are independently associated with nosocomial acquisition and underlying medical conditions. These findings imply a role for the health care environment in acquisition of these organisms. However, genotypic antiseptic tolerance was seen in Ͼ25% of healthy children with an S. aureus infection, indicating that these organism are prevalent in the community as well.

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Neonatal nosocomial bloodstream infections at a referral hospital in a middle-income country: burden, pathogens, antimicrobial resistance and mortality

Abstract: The burden of nosocomial neonatal BSI at this middle-income country referral neonatal unit is substantial and remained unchanged over the study period, although attributable mortality declined significantly. Nosocomial BSI pathogens exhibited high levels of antimicrobial resistance.

Cited by 67 publications

References 18 publications

<i>MBL2</i> Gene Polymorphism and the Association with Neonatal Sepsis in Egyptian Neonates, a Case Control Study

<i>MBL2</i> Gene Polymorphism and the Association with Neonatal Sepsis in Egyptian Neonates, a Case Control Study

A framework for preventing healthcare-associated infection in neonates and children in South Africa

Impact of Health Care Exposure on Genotypic Antiseptic Tolerance in Staphylococcus aureus Infections in a Pediatric Population

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Neonatal nosocomial bloodstream infections at a referral hospital in a middle-income country: burden, pathogens, antimicrobial resistance and mortality

Abstract: The burden of nosocomial neonatal BSI at this middle-income country referral neonatal unit is substantial and remained unchanged over the study period, although attributable mortality declined significantly. Nosocomial BSI pathogens exhibited high levels of antimicrobial resistance.

Cited by 67 publications

References 18 publications

&lt;i&gt;MBL2&lt;/i&gt; Gene Polymorphism and the Association with Neonatal Sepsis in Egyptian Neonates, a Case Control Study

&lt;i&gt;MBL2&lt;/i&gt; Gene Polymorphism and the Association with Neonatal Sepsis in Egyptian Neonates, a Case Control Study

A framework for preventing healthcare-associated infection in neonates and children in South Africa

Impact of Health Care Exposure on Genotypic Antiseptic Tolerance in Staphylococcus aureus Infections in a Pediatric Population

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Resources

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<i>MBL2</i> Gene Polymorphism and the Association with Neonatal Sepsis in Egyptian Neonates, a Case Control Study

<i>MBL2</i> Gene Polymorphism and the Association with Neonatal Sepsis in Egyptian Neonates, a Case Control Study