Resumo
Introduction: Due to immaturity of neonatal immune function, prolonged hospitalisation, invasive procedures and inadequate infection control measures, healthcare-associated infections (HAI) remain a perennial problem in neonatal units globally and impact negatively on outcome. It is essential to quantify the burden and assess the risk factors in order to address this problem.
Objectives: To determine the prevalence, bacterial aetiology of and risk factors for HAI in the neonatal unit of the University College Hospital, Ibadan, Nigeria.
Materials and methods: Fifty-six out of the 435 neonates admitted who developed symptoms or signs of neonatal sepsis after 48 hours of admission or symptom free interval had their clinical history and physical examination recorded. Blood, urine and where indicated, cerebrospinal fluid (CSF) samples were taken for culture and sensitivity before antibiotic therapy.
Results: The incidence of HAI was 4.1% (18 babies) of neonatal admissions, 4.4/1000 patient days (72.2% of infections was septicaemia). There were 7 Gram positive isolates [all Methicillin Resistant Staphylococcus aureus (MRSA)] and 11 Gram negative isolates. The blood culture isolates were MRSA (6), Klebsiella pneumoniae (3), Hafnia alvei (2) and one each of Stenotrophomas maltophilia and Escherichia coli. The two cerebrospinal fluid isolates were Chryseobacterium meningosepticum and Klebsiella ozaenae, other isolates were Escherichia coli - abscess aspirate, MRSA and Escherichia coliurethral catheter tips. MRSA demonstrated 33.3% and 50.0% susceptibility to gentamycin and vancomycin respectively. The Gram negatives demonstrated 81.8%, 45.6% and 90.1% susceptibility to ceftazidime, ciprofloxacin and meropenem respectively. The case fatality rate was 38.9% (7 babies).
Conclusion: MRSA and Klebsiella pneumoniae are the common causes of HAI in the neonatal unit and are associated with high mortality.
Keywords: Healthcare Associated Infections; Neonatal Septicaemia; Bacterial pathogens
Résumé
Introduction: En raison de l’immaturité de la fonction immunitaire néonatale, d’une hospitalisation prolongée, de procédures invasives et de mesures inadéquates de contrôle des infections, les infections nosocomiales demeurent un problème chronique dans les unités néonatales et ont un impact négatif sur les résultats. Il est essentiel de quantifier la charge et d’évaluer les facteurs de risque afin de résoudre ce problème.
Objectifs: Déterminer la prévalence, l’étiologie bactérienne et les facteurs de risque d’infection nosocomiale dans l’unité néonatale du Collège Hospitalier l’Universitaire, Ibadan, Nigeria.
Matériel et méthodes: Cinquante-six des 435 nouveau-nés admis qui ont développé des symptômes ou des signes de septicémie néonatale après 48 heures d’admission ou un intervalle sans symptômes ont eu leurs antécédents cliniques et un examen physique recordé. Du sang, l’urine et dans le cas échéant, des échantillons de liquide céphalo-rachidien (LCR) ont été prélevés pour la culture et la sensibilité avant l’antibiothérapie.
Résultats: L’incidence des infections nosocomiales était de 4,1% (18 bébés) d’admissions néonatales, 4,4 / 1000 jours-patients (72,2% des infections étaient des septicémies). Il y avait 7 isolats Gram positifs [tous Staphylococcus aureus résistants à la méthicilline (SARM)] et 11 isolats Gram négatifs. Les isolats de culture de sang étaient SARM (6), Klebsiella pneumoniae (3), Hafnia alvei (2) et un chacun des sténotrophomes maltophilie et Escherichia coli. Les deux isolats de liquide céphalorachidien étaient Chryseobacterium meningosepticum et Klebsiella ozaenae, autres isolats Escherichia coli - aspiration d’abcès, SARM et extrémités de cathéter urétrale Escherichia coli. SARM a démontré une sensibilité de 33,3% et 50,0% à la gentamycine et à la vancomycine respectivement. Les Gram négatifs ont montré une sensibilité de 81,8% ; 45,6% et 90,1% à la ceftazidime, à la ciprofloxacine et au méropénème respectivement. Le taux de létalité était de 38,9% (7 bébés).
Conclusion: SARM et Klebsiella pneumoniae sont les causes les plus fréquentes des infections nosocomiales dans l’unité néonatale et sont associées à une mortalité élevée.
Mots-clés: Infections nosocomiales; Septicémie néonatale ; Pathogènes bactériens
Correspondence: Dr. Abimbola E. Akindolire, Department of Paediatrics College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: abimbola_12@yahoo.com
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