Epidemiology of Early-onset Bacterial Neonatal Infections in Madagascar

Abstract

Background: Little is known about early-onset neonatal bacterial infections (EONBI) in Madagascar. Our aim was to determine their epidemiology to improve their management. Methods: Inborn neonates at risk for EONBI and admitted in the neonatal unit of 2 tertiary hospitals in Antananarivo, Madagascar, were included in a prospective study from April 2012 to March 2013. Using a clinical algorithm, blood culture, gastric fluid culture and C-reactive protein dosage were performed in newborns at high risk of infection, that is, peri partum fever, prematurity <35 weeks’ gestation or birth weight <2000 g, or presenting with clinical signs of infection. EONBI was defined as a bacteremia occurring within the first week of life. Results: Among 307 neonates, 75 (24.4%) had an EONBI caused by 1 (n = 59) or 2 (n = 16) bacteria (91 isolates). Gram-negative bacteria were predominant (n = 62, 82.7%), including Enterobacter cloacae (n = 26), Klebsiella pneumoniae (n = 14), Escherichia coli (n = 7) and Proteus mirabilis (n = 2). Group B Streptococcus, Acinetobacter baumanii and Enterococcus sp. represented 3.6%, 8.2% and 12.1% of the isolates, respectively. All E. cloacae and 12/14 (85.7%) K. pneumoniae were extended-spectrum β-lactamase producers. At all, 41/91 (45.1%) bacteria were multidrug-resistant (MDR) and 34/75 (45.3%) newborns had an EONBI caused by an MDR bacteria. Neonatal asphyxia was the only factor associated with multidrug resistance (odds ratio: 4.52; CI: 1.20–16.94; P = 0.025). The EONBI-related mortality (n = 20/75, 26.7%) rose up to 38.2% (n = 13/34) in case of MDR bacteria. Conclusions: The epidemiology of EONBIs in Madagascar is comparable to that found in many low-income countries. Prevention, including improvement of hygiene during resuscitation for neonatal asphyxia, is likely to be more effective in reducing EONBI-related morbidity and mortality than using new antibiotics to counter resistance.

Effectiveness of Nursing Risk Management in Neonatal Asphyxia Resuscitation Care

“…As common neonatal complication [1], neonatal asphyxia refers to the di culty of the fetus in breathing normally or regularly within 1 min after delivery [2], with speci c presentations including weakened breath, blue skin, slowed heart rate, limb accidity, and scarce re exes. It is a major contributor to neonatal death and mental retardation [3]. Epidemiological studies have found that 1/4 of the neonatal deaths worldwide each year are attributed to neonatal asphyxia [4], and its incidence is on the rise with the increase in advanced maternal age and changes in the environment [5].…”

“…Epidemiological studies have found that 1/4 of the neonatal deaths worldwide each year are attributed to neonatal asphyxia [4], and its incidence is on the rise with the increase in advanced maternal age and changes in the environment [5]. Nursing risk is the possibility of patient injury or death due to uncertainties in the nursing process [3], and nursing risk management is a management approach to identify and assess these uncertainties to avoid risk events and realize maximum safety [5]. e anticipatory factors of neonatal asphyxia are complex, and ine ective treatment is associated with severe adverse outcomes.…”

Whether Cord Blood or Venous Blood Procalcitonin Level for Better Prediction of Maternofetal Infections in Algerian Newborns?

“…Probably when the newborn is exposed to microorganisms (prenatally or during delivery), the risk of maternofetal infections increase because the fetus could easily be contaminated in this situation [1] [2] . Many studies have shown the association of factors related to the mother such as chorioamnionitis, abnormal maternal body temperature preceding, during or succeeding delivery, premature rupture of membranes (PROM) more than 18 hours, urinary tract infection (UTI) with MFI [2] [6] [11] [14] [33] . In the group I of our study, we observed different risk factors; malodorous and/or colored amniotic liquid (54.8%), PROM ≥12 hours (25.4 %), PROM ≥ 24 hours (14.7%), UTI (46.3%) and maternal abnormal body temperature during delivery (18.8%).…”

Neonatal acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the community of a low-income country (NeoLIC): protocol for a household cohort study in Moramanga, Madagascar

“…However, data regarding the acquisition of ESBL-PE during the neonatal period are scarce in the community. The few studies focusing on ESBL-PE acquisition in neonates were conducted in neonatal care units, where neonates are often premature and exposed to specific factors increasing the risk of ESBL-PE acquisition (eg, invasive procedures, contact with contaminated equipment or medical staff, high antibiotic consumption) 8 13 14. In the community, the newborn is exposed at birth and during the first weeks of life to several possible sources of ESBL-PE acquisition, for example, maternal, healthcare facilities and outside hospitals: parents, other relatives, food and environment.…”