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Bacteraemia in Malawian neonates and young infants 2002-2007: a retrospective audit.

ABSTRACT: To assess the causes of bacteraemia in young infants and susceptibility to first-line antibiotics (benzylpenicillin plus gentamicin) at the Queen Elizabeth Central Hospital (QECH), Malawi during 2002-2007.Retrospective analysis of demographic and microbiological data using laboratory records.QECH is Malawi's largest hospital with 7000 neonates admitted annually, 9% for septicaemia.All infants aged 60 days or less admitted to QECH that had a blood culture taken over the 6-year period.6754 blood cultures were taken. 3323 organisms were isolated: one-third were pathogens, two-thirds contaminants. Gram-positive organisms (53%) were more common than gram-negatives (47%). Four organisms made up half of all pathogens: Staphylococcus aureus (15.3%), group B streptococci (13.5%), non-typhoidal salmonellae (12.6%) and Escherichia coli (10.5%). Apart from non-typhoidal salmonellae and Streptococcus pneumoniae, most organisms were more common in the first week of life than later. Overall, 28% of isolates during 2002-2007 were resistant to first-line antibiotic, higher than observed during 1996-2001 (22%). Penicillin susceptibility fluctuated while gram-negative resistance to gentamicin increased from 17% to 27% over the study period.In the QECH, pathogens causing young infant sepsis are an unusual mix of organisms seen in both developed and developing countries. Resistance to first-line antibiotics is higher than observed in most studies. Ongoing monitoring is needed and clinical outcome data would aid interpretation of findings. A high proportion of blood cultures were contaminated with skin flora-improved training and supervision of phlebotomists are needed to improve the utility of taking blood cultures.

SUBMITTER: Gwee A

PROVIDER: S-EPMC3358614 | biostudies-other | 2012

REPOSITORIES: biostudies-other

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Bacteraemia in Malawian neonates and young infants 2002-2007: a retrospective audit.

Gwee Amanda A Coghlan Benjamin B Everett Dean D Chagoma Newton N Phiri Amos A Wilson Lorna L Molyneux Elizabeth E

BMJ open 20120515 3

<h4>Objectives</h4>To assess the causes of bacteraemia in young infants and susceptibility to first-line antibiotics (benzylpenicillin plus gentamicin) at the Queen Elizabeth Central Hospital (QECH), Malawi during 2002-2007.<h4>Design</h4>Retrospective analysis of demographic and microbiological data using laboratory records.<h4>Setting</h4>QECH is Malawi's largest hospital with 7000 neonates admitted annually, 9% for septicaemia.<h4>Patients</h4>All infants aged 60 days or less admitted to QECH ...[more]

PMID: 22587884

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Project description:ObjectivesNewborns and small infants are unable to cooperate actively during diagnostic procedures; therefore, sedation is often employee to maintain immobilization and obtain high-quality images. However, these procedures are often indicated in sick, vulnerable, or hemodynamically unstable neonates and young infants, which raises the associated risks of sedation. This study summarizes our 4-year of experience with safe and effective procedural sedation in this vulnerable population.Study designThis retrospective study analyzed data on neonates and young infants who underwent non-painful diagnostic procedures from December 2019 to November 2023. Patients were categorized into the neonate (aged≦ 28 days) and the young infant (29 days ≦ aged ≦ 90 days) groups.ResultsNon-pharmacological strategies, including sleeping naturally, swaddling/facilitated tucking, non-nutritive sucking, and skin-to-skin care, can achieve a success rate for sedation about 98.4%. In terms of pharmacological methods, our institution primarily utilizes chloral hydrate for procedural sedation in neonates and young infants undergoing non-painful diagnostic procedures. Midazolam serves as an alternative sedative. Chloral hydrate alone demonstrated a 92.5% success rate on the first attempt, compared to midazolam alone, with an 85.11% success rate. Neonates experienced a higher incidence of adverse events during sedation compared to young infants.ConclusionThis study reviews our 4-year experience with procedural sedation in neonates and young infants. Chloral hydrate demonstrated a high degree of safety and efficacy in this population. However, supervision by skilled medical personnel and extended observation is required. In our institution, the experience with midazolam is limited in this population, and further research is warranted to establish its safety and efficacy. Non-pharmacological strategies can achieve an acceptable rate of sedation success, which can be used based on patient's tolerance.

Dataset Information

Bacteraemia in Malawian neonates and young infants 2002-2007: a retrospective audit.

Publications

Bacteraemia in Malawian neonates and young infants 2002-2007: a retrospective audit.

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