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Neonatal Sepsis, Antibiotic Susceptibility Pattern, and Treatment Outcomes among Neonates Treated in Two Tertiary Care Hospitals of Yangon, Myanmar from 2017 to 2019.

ABSTRACT: Neonatal sepsis is a leading cause of morbidity and mortality in developing countries. This study aimed to assess the proportion of culture-confirmed sepsis, bacteriological pathogen profile, culture report turnaround times, antibiotic susceptibility patterns, and treatment outcomes of all with neonatal sepsis admitted in two tertiary care hospitals in Yangon, Myanmar, 2017-2019. This was a cross sectional study utilizing a standardized electronic database and paper-based records. Bacteriological profiles and associated factors were analyzed with descriptive statistics and Poisson Regression. Of those with suspected sepsis, 42% were bacteriologically confirmed and 74% of confirmed sepsis was resistant to at least first-line antibiotics. Neonates with late onset sepsis (LOS) (aPR: 1.2 (95% CI: 1.1-1.4, p = 0.008)) were more likely to have bacteriologically confirmed sepsis (45%) versus early onset sepsis (38%). Gram-negative organisms were most commonly isolated (63%), associated with multidrug-resistant organisms and with a high case-fatality rate (64%). These findings suggest that enhanced national guidance regarding infection control and prevention, antibiotic stewardship, and first-line antibiotic choices need to be provided. The link between LOS with infection and prevention protocols needs to be further explored in this context to decrease sepsis risk, neonatal mortality, and reduce further antimicrobial resistance.

SUBMITTER: Oo NAT

PROVIDER: S-EPMC8167801 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundNeonatal near miss is an infant who nearly died but survived from birth to 28 days. Neonatal period is the most vulnerable time for child's healthiness and continued existence. Globally, about 2.5 million children died in their first month of life and 7000 die/day.ObjectiveTo assess neonatal near miss and associated factors among neonates admitted to intensive care unit at hospitals in East Wollega, West Ethiopia, 2019.MethodsQuantitative, facility-based cross-sectional study was conducted from 15 July to 30 August 2019 on 403 neonates admitted to neonatal intensive care unit of hospitals. After ethical clearance, five recruited and trained nurses collected the data with pretested structured questionnaire. Neonates sampled were selected using systematic random sampling. Data entered into Epi-info version 7.1 and exported to SPSS Version 24. Binary logistic regression was performed, and adjusted odds ratio with P-value ⩽ 0.05 at 95% confidence interval was used as statistically significant.ResultsAll, 403, study participants were included in this study, yielding 100% response rate. From these, 196 (48.60%) neonates were near miss. In multivariable logistic regression, mother who lived in rural area (adjusted odds ratio = 3.84, 95% confidence interval = (1.78, 8.31)), cesarean section (adjusted odds ratio = 10.68, 95% confidence interval = (2.95, 38.71)), and neonates referred to hospitals (adjusted odds ratio = 3.32, 95% confidence interval = (3.27, 12.01)). Also, female neonates (adjusted odds ratio = 2.99, 95% confidence interval = (1.45, 6.14)) and multiple birth (adjusted odds ratio = 3.07, 95% confidence interval = (1.32, 7.16)) were significantly associated with neonatal near miss.ConclusionNeonatal near miss found to be high compared to previously existing research in Brazil. Health institutions, health professionals, and concerned bodies on plan and implementation of neonatal care need to consider these factors during pregnancy, delivery, and for neonates immediate after birth and in neonatal intensive care unit.

Project description:BACKGROUND:Previous studies in Europe and the USA have reported a high prevalence of adverse drug reactions (ADRs), but data on local ADRs in Myanmar are sparse. OBJECTIVE:Our objective was to study ADRs in patients admitted to selected wards of Yangon General Hospital (YGH) and Yangon Specialty Hospital (YSH), Myanmar. METHODS:This was a prospective observational study in three hospital wards during the first quarter of 2019. Suspected ADRs were carefully investigated in a face-to-face interview with each patient and via review of clinical records. Patients transferred to other wards or discharged were followed-up by the researchers until day 28 after admission. ADRs were divided into those that (1) led to the admission and (2) occurred during the hospital stay or after discharge (up to day 28 after admission). RESULTS:A total of 65 ADRs were identified, with 47 (29.4%) of 160 patients experiencing at least one ADR. Among these, 16 (24.6%) had led to hospital admission and 49 (75.4%) occurred in 31 patients during their hospital stay. Of 160 patients, 21 had taken at least one herbal remedy and six of these developed an ADR. Five ADR-drug associations (hypokalaemia with methylprednisolone, increased transaminase levels with standard antituberculosis drugs, upper gastrointestinal bleeding with nonsteroidal anti-inflammatory drugs, constipation with tramadol, and increased transaminase levels with herbal remedies) represented 18 (27.7%) of the 65 ADRs in this study. According to the Schumock and Thornton preventability scale, more than half of these ADRs (35 [53.9%]) were preventable. CONCLUSION:The present study highlights the existence of ADRs among patients attending these hospitals. The implementation of active pharmacovigilance in hospitals could be a helpful first step to improving the awareness of unwanted effects of medicines and patient safety, as well as a way to strengthen the national pharmacovigilance system in countries such as Myanmar.

Project description:Data on causes of community-onset bloodstream infection in Myanmar are scarce. We aimed to identify etiological agents of bloodstream infections and patterns of antimicrobial resistance among febrile adolescents and adults attending Yangon General Hospital (YGH), Yangon, Myanmar. We recruited patients ≥12 years old with fever ≥38°C who attended YGH from 5 October 2015 through 4 October 2016. A standardized clinical history and physical examination was performed. Provisional diagnoses and vital status at discharge was recorded. Blood was collected for culture, bloodstream isolates were identified, and antimicrobial susceptibility testing was performed. Using whole-genome sequencing, we identified antimicrobial resistance mechanisms of Enterobacteriaceae and sequence types of Enterobacteriaceae and Streptococcus agalactiae. Among 947 participants, 90 (9.5%) had bloodstream infections (BSI) of which 82 (91.1%) were of community-onset. Of 91 pathogens isolated from 90 positive blood cultures, we identified 43 (47.3%) Salmonella enterica including 33 (76.7%) serovar Typhi and 10 (23.3%) serovar Paratyphi A; 20 (22.0%) Escherichia coli; 7 (7.7%) Klebsiella pneumoniae; 6 (6.6%), Staphylococcus aureus; 4 (4.4%) yeasts; and 1 (1.1%) each of Burkholderia pseudomallei and Streptococcus agalactiae. Of 70 Enterobacteriaceae, 62 (88.6%) were fluoroquinolone-resistant. Among 27 E. coli and K. pneumoniae, 18 (66.6%) were extended-spectrum beta-lactamase (ESBL)-producers, and 1 (3.7%) each were AmpC beta-lactamase- and carbapenemase-producers. Fluoroquinolone resistance was associated predominantly with mutations in the quinolone resistance-determining region. blaCTX-M-15 expression was common among ESBL-producers. Methicillin-resistant S. aureus was not detected. Fluoroquinolone-resistant, but not multiple drug-resistant, typhoidal S. enterica was the leading cause of community-onset BSI at a tertiary hospital in Yangon, Myanmar. Fluoroquinolone and extended-spectrum cephalosporin resistance was common among other Enterobactericeae. Our findings inform empiric management of severe febrile illness in Yangon and indicate that measures to prevent and control enteric fever are warranted. We suggest ongoing monitoring and efforts to mitigate antimicrobial resistance among community-onset pathogens.

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Neonatal Sepsis, Antibiotic Susceptibility Pattern, and Treatment Outcomes among Neonates Treated in Two Tertiary Care Hospitals of Yangon, Myanmar from 2017 to 2019.

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