Infection prevention and care bundles addressing health care-associated infections in neonatal care in low-middle income countries: a scoping review

García, Alexandra Molina; Cross, James H.; Fitchett, Elizabeth; Kawaza, Kondwani; Okomo, Uduak; Spotswood, Naomi; Chiume, Msandeni; Ezeaka, Veronica Chinyere; Irimu, Grace; Salim, Nahya; Molyneux, Elizabeth; Lawn, Joy E

doi:10.1016/j.eclinm.2021.101259

Cited by 13 publications

(8 citation statements)

References 71 publications

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“…We performed this retrospective study to gain an insight into the diversity of GPB isolated from blood cultures, and we highlight the need for future genomic and epidemiological studies to uncover the true burden of GPB neonatal sepsis in LMICs. A recent review by Garcia et al, 2022 describe a “Paucity of [care] bundles and elements aimed at HCAI detection (4% of 295 elements)” and “barriers to strengthening laboratory capacity”[ 48 ] when addressing matters of infection control in neonatal care in LMICs, emphasising the need for surveillance studies also mirrored elsewhere [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Characterisation of Staphylococci species from neonatal blood cultures in low- and middle-income countries

Sands

Carvalho²,

Spiller³

et al. 2022

BMC Infect Dis

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Background In low- and middle-income countries (LMIC) Staphylococcus aureus is regarded as one of the leading bacterial causes of neonatal sepsis, however there is limited knowledge on the species diversity and antimicrobial resistance caused by Gram-positive bacteria (GPB). Methods We characterised GPB isolates from neonatal blood cultures from LMICs in Africa (Ethiopia, Nigeria, Rwanda, and South Africa) and South-Asia (Bangladesh and Pakistan) between 2015–2017. We determined minimum inhibitory concentrations and performed whole genome sequencing (WGS) on Staphylococci isolates recovered and clinical data collected related to the onset of sepsis and the outcome of the neonate up to 60 days of age. Results From the isolates recovered from blood cultures, Staphylococci species were most frequently identified. Out of 100 S. aureus isolates sequenced, 18 different sequence types (ST) were found which unveiled two small epidemiological clusters caused by methicillin resistant S. aureus (MRSA) in Pakistan (ST8) and South Africa (ST5), both with high mortality (n = 6/17). One-third of S. aureus was MRSA, with methicillin resistance also detected in Staphylococcus epidermidis, Staphylococcus haemolyticus and Mammaliicoccus sciuri. Through additional WGS analysis we report a cluster of M. sciuri in Pakistan identified between July-November 2017. Conclusions In total we identified 14 different GPB bacterial species, however Staphylococci was dominant. These findings highlight the need of a prospective genomic epidemiology study to comprehensively assess the true burden of GPB neonatal sepsis focusing specifically on mechanisms of resistance and virulence across species and in relation to neonatal outcome.

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Section: Discussionmentioning

confidence: 99%

Characterisation of Staphylococci species from neonatal blood cultures in low- and middle-income countries

Sands

Carvalho²,

Spiller³

et al. 2022

BMC Infect Dis

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“…Primary prevention elements were well represented in studies of care bundle interventions in LMIC, although with bias towards specific devices (catheters and ventilators), whereas detection (secondary prevention) through screening and surveillance and tertiary prevention elements (case management, cohorting, antimicrobial stewardship) were less frequently evaluated. Implementation focused on provision of facilities and equipment, consistent with a lack of these in resource-limited settings 39. Conversely, in well-resourced settings, lapses in preventive measures, including inadequate disinfection of surfaces and shared equipment, combined with resource-related factors such as proximity of cots and understaffing during periods of high demand, have been linked to cross-infection in neonatal units 40.…”

Section: Discussionmentioning

confidence: 99%

“… 38 A recent scoping review of neonatal healthcare-associated infection prevention and care bundles in LMIC proposed a ‘3+I’ framework comprising (1) primary prevention, (2) detection, (3) case management, plus (I) implementation. 39 Primary prevention elements were well represented in studies of care bundle interventions in LMIC, although with bias towards specific devices (catheters and ventilators), whereas detection (secondary prevention) through screening and surveillance and tertiary prevention elements (case management, cohorting, antimicrobial stewardship) were less frequently evaluated. Implementation focused on provision of facilities and equipment, consistent with a lack of these in resource-limited settings.…”

Section: Discussionmentioning

confidence: 99%

Incidence and aetiology of infant Gram-negative bacteraemia and meningitis: systematic review and meta-analysis

Hallmaier‐Wacker¹,

Andrews²,

Nsonwu³

et al. 2022

Arch Dis Child

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BackgroundOne in six infant deaths worldwide are caused by invasive bacterial infections, of which a substantial but unquantified proportion are caused by Gram-negative bacteria.MethodsWe conducted a systematic review of studies published from 31 May 2010 to 1 June 2020 indexed in MEDLINE, Embase and Global Health databases. We performed meta-analyses of the incidence of Gram-negative bacteraemia and of individual Gram-negative species as proportions of all infant bacteraemia, stratified by onset (early vs late) and country income (low/middle vs high).Results152 studies from 54 countries were included, 60 in high-income countries (HIC) and 92 in low-income/middle-income countries (LMIC). Gram-negatives represented a higher proportion (53%, 95% CI 49% to 57%) of all infant bacteraemia in LMIC compared with HIC (28%, 95% CI 25% to 32%). Incidence of infant Gram-negative bacteraemia was 2.01 (95% CI 1.15 to 3.51) per 1000 live births; it was five times higher in LMIC (4.35, 95% CI 2.94 to 6.43) compared with HIC (0.73, 95% CI 0.39 to 7.5). In HIC, Escherichia coli was the leading Gram-negative pathogen, representing 19.2% (95% CI 15.6% to 23.4%) of early and 7.3% (95% CI 5.3% to 10.1%) of all late-onset bacteraemia; Klebsiella spp were the next most common cause (5.3%) of late-onset bacteraemia. In LMIC, Klebsiella spp caused 16.4% (95% CI 11.5% to 22.7%) of early and 15.0% (95% CI 10.1% to 21.8%) of late-onset bacteraemia, followed by E. coli (early-onset 7.50%, 95% CI 4.98% to 11.1%; late-onset 6.53%, 95% CI 4.50% to 9.39%) and Pseudomonas spp (early-onset 3.93%, 95% CI 2.04% to 7.44%; late-onset 2.81%, 95% CI 1.99% to 3.95%).ConclusionE. coli, Klebsiella and Pseudomonas spp cause 20%–28% of early-onset infant bacteraemia and 14% cases of infant meningitis worldwide. Implementation of preventive measures could reduce the high incidence of Gram-negative bacteraemia in LMIC.PROSPERO registration numberCRD42020191618.

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“…Care-bundle approach has shown to improve practices in infection control [12] and antimicrobial stewardship [13] however, evidence on the impact of various diagnostic stewardship interventions is limited [14]. Our intent while designing the bundle was to affect processes which can minimize delays in clinical reporting of aBCD.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study to Improve Automated Blood Culture Diagnostics in Gram-Negative Sepsis by Implementing a “Diagnostic Stewardship Care-Bundle”

Gupta

Siddiqui

Purwar

et al. 2022

Preprint

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ObjectivesWe implemented a diagnostic stewardship care-bundle (DSB): “Sepsis-48” with the aim of evaluating its impact on changes in duration of key steps in automated blood culture diagnostics (aBCD), compliance to care-bundle and turnaround time (TAT).MethodsIn this prospective study, a care-bundle checklist for automated blood culture bottles (BCBs) received from adult intensive care units (AICUs) was implemented between July 2020-June 2021 (intervention period, P2) and compared with a retrospective, pre-intervention period (P1) between March-June 2020. Microbial identification in positive BCBs with gram-negatives (+nBCBs) was enabled by inoculating conventional biochemical tests directly (dID) and direct antimicrobial susceptibility testing (dAST) was done as per EUCAST RAST standard. Clinical reports were issued only if a RAST reportable gram-negative was identified in dID.ResultsWe observed significant reductions in the Loading time (LT) [63.5 (104.5-24.5) vs 32 (55-14) minutes, P<0.001] & time to dID+dAST performance (TTD) [186 (288.25-202.25) vs 115 (180-68) minutes, P=0.0018] in +nBCBs received from AICUs during P2. There was a significant increase in compliance to the bundle targets [LT≤45: 44% vs 66%, P=.006 and TTD≤120: 34% vs 51.7%, P=.03] during P2 (Table 2). Using dID+dAST method, provisional results could be read ∼13 hours earlier than those generated by VITEK®. Similar improvements were also noted for +nBCBs received from other locations.ConclusionsThe “diagnostic stewardship care-bundle” strategy to improve aBCD was successfully implemented leading to significant reductions in duration of targeted steps. Laboratories should implement “diagnostic stewardship care-bundles” as per their needs to improve microbiological diagnostics.

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Infection prevention and care bundles addressing health care-associated infections in neonatal care in low-middle income countries: a scoping review

Cited by 13 publications

References 71 publications

Characterisation of Staphylococci species from neonatal blood cultures in low- and middle-income countries

Characterisation of Staphylococci species from neonatal blood cultures in low- and middle-income countries

Incidence and aetiology of infant Gram-negative bacteraemia and meningitis: systematic review and meta-analysis

A Prospective Study to Improve Automated Blood Culture Diagnostics in Gram-Negative Sepsis by Implementing a “Diagnostic Stewardship Care-Bundle”

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