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Gad A, Khalil A, Halil M, Chandra P, Soliman A, Rahman E’mar A, Ibrahim M, Al Khzzam F, AlHendawi T, Hamed M, Bayoumi MAA, Petkar H. Preterm infants with positive conjunctival swab culture: risk factors and association with late-onset sepsis-a retrospective cohort study. Front Pediatr 2023; 11:1259558. [PMID: 38046677 PMCID: PMC10690616 DOI: 10.3389/fped.2023.1259558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Purulent conjunctival discharge in hospitalized preterm infants may indicate conjunctivitis and warrant treatment. The purpose of this study was to examine the relationship between positive conjunctival swab (CS) culture and late-onset sepsis (LOS) in preterm infants. Methods A retrospective cohort study was conducted to determine the relationship between positive CS culture growth results (CSP) obtained in preterm infants ≤34 weeks' gestation and the development of LOS within 120 h of obtaining CS compared with those who had negative CS culture results (CSN). Electronic medical records were reviewed from January 2015 until December 2019 for preterm infants presenting with purulent conjunctival discharge and underwent CS culture testing due to suspected conjunctivitis. Results Of the 234 CS cultures obtained during the study period, 145 (61.9%) were CSP compared to 89 (38.1%) CSN cultures. Gram-negative organisms accounted for 70% of all CSP cultures, with the remaining 30% being Gram-positive. Patients with CSP were smaller, younger, had lower 1-minute APGAR scores, and required respiratory support more frequently than those with CSN. Infants with CSP received antibiotics for longer periods, both topically and systemically. Infants who developed LOS were more likely to require invasive ventilation (adjusted odds ratio, 33.5; 95% CI, 2.52-446.5, p = 0.008). The incidence of LOS between the two groups was similar, with 6.2% observed in the CSP group compared to 3.4% in the CSN group (p = 0.543). Similarly, the rates of bacteremia were similar in both groups. Of the CSP patients who were presented with bacteremia, four out of seven (57%) exhibited bacteremia caused by the same organism found in their CS cultures. Similarly, within the entire cohort, respiratory cultures were performed on nine intubated patients within two weeks of obtaining CS cultures. Of these, in the CSP group, five out of six (83%) showed an organism identical to that found in the CS cultures. Conclusion The study found a significant proportion of positive CS cultures in preterm infants, with distinct patient characteristics and treatment compared to negative cultures. While the incidence of LOS was not significantly different between the two groups, some CSP patients demonstrated bacteremia with the same CS organism, suggesting a possible connection between conjunctival or respiratory colonization and bacteremia.
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Affiliation(s)
- Ashraf Gad
- Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
- Pediatric Department, Weill Cornell Medicine, Doha, Qatar
| | - Amr Khalil
- Division of Neonatology, London Health Science, Western University, London, ON, Canada
| | - Muhammed Halil
- Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Aly Soliman
- Deparment of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Abdel Rahman E’mar
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, United States
| | - Marwa Ibrahim
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Fadi Al Khzzam
- Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
- Pediatric Department, Weill Cornell Medicine, Doha, Qatar
| | - Talal AlHendawi
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Manal Hamed
- Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad A. A. Bayoumi
- Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Hawabibee Petkar
- Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
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Neonatal Healthcare-Associated Conjunctivitis: A Descriptive Study from Saudi Arabia. Medicina (B Aires) 2022; 58:medicina58101448. [PMID: 36295608 PMCID: PMC9608085 DOI: 10.3390/medicina58101448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
Healthcare-associated conjunctivitis (HAC) has been associated with serious ophthalmological complications in neonates, including blindness. This three-year retrospective, descriptive study was conducted between 2019 and 2021 to determine the most common bacteria associated with neonatal HAC at a tertiary-care hospital in Saudi Arabia. The inclusion criteria were defined based on the centers for disease control and prevention (CDC) guidelines for the diagnosis of neonatal HAC. When HAC was clinically suspected, conjunctival swabs were obtained from neonates and sent to the microbiology lab following standard protocols. A univariate analysis was conducted on the included samples. A total of 79 cases met our inclusion criteria and were retrospectively studied. A descriptive analysis showed that Pseudomonas aeruginosa was the leading cause of HAC, with 25% (20 cases), followed by Escherichia coli and Klebsiella pneumonia (11.5% for each). About 9% of the analyzed cases were positive for Staphylococcus aureus. Orogastric feeding was the most commonly (94%) associated factor with HAC, followed by respiratory distress syndrome (RDS) and preterm birth, which were found in 70% and 64% of the cases, respectively. To conclude, HAC is an alarming healthcare problem, and bacteria, including Gram-negative bacteria, are common causes. Thus, physician awareness, effective communication with microbiologists, and the implementation of infection control recommendations, including hand hygiene, could minimize this problem and avoid the serious complications of HAC.
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Rani U, Lewis LE, Chawla K, Naha A. Preventable contributors to the neonatal healthcare-associated infections: a uni-center analytical study from South India. F1000Res 2022; 11:454. [PMID: 35903417 PMCID: PMC9280113 DOI: 10.12688/f1000research.111101.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Globally, neonatal healthcare-associated infections (HAIs) are known to cause high mortality. HAIs is a preventable condition related to the healthcare environment. The current study explored the contributors to neonatal HAIs in one of the largest tertiary care referral hospitals in South India. Methods: Neonates from December 2016 to June 2018 were observed for the occurrence of healthcare-associated infections and compared with the matched control group. Various observations on neonatal demography, maternal contributors, and medical procedures were made and recorded to explore and analyse the contributors to neonatal HAIs. Univariate and multivariate analysis was carried out to find the contributors. The Odds ratio with 95% CI was also computed and reported. Results: Bloodstream infection (83%) was prevalent among neonates; the maternal contributor was only preterm labor (Odds ratio of 11.93; 95% CI; 6.47-21.98; p<.05) to acquire HAIs. On univariate analysis, mechanical ventilation for > 3days duration, NIV for > five days, and PICC line insertion procedure were significant (p<0.05) contributors to neonatal HAIs. IV cannulation for more than three times in four consecutive days was found in 100(85%) neonates considered being associated with neonatal HAIs. On multivariate analysis, NIV, PICC line, preterm labor, and low birth weight were significant (p<0.05) contributors to neonatal HAIs. Conclusion: The increased duration of invasive and non-invasive therapeutic devices and catheters contributes to neonatal HAIs. Neonates are acquiring bloodstream infections; low birth weight (LBW) neonates are more susceptible to acquiring HAIs.
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Affiliation(s)
- Usha Rani
- Department of Social and Health Innovation, Prasanna School of Public Health, Manipal academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Leslie E. Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kiran Chawla
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Anup Naha
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Optimizing Accessibility of a Hand-wash Gel to Infant's Cradle: Effect on Neonatal Conjunctivitis. Pediatr Infect Dis J 2019; 38:e7-e11. [PMID: 29570175 DOI: 10.1097/inf.0000000000002023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In our recent study in 2015, we showed a significant relationship between increased rate of clinical neonatal conjunctivitis (CNC) and performance of eye red reflex examination. Our study aim was to assess whether improved accessibility of staff to disinfectant gel (via attaching the gel bottle to infant's cradle) will increase the caring staff compliance with hand hygiene and decrease the rate of CNC. METHODS Our intervention included attaching bottles of alcohol-based gel to newborns' cradles to ensure full availability and accessibility of hand-wash disinfectant. We included all newborn infants who were born beyond 35 weeks' gestation and stayed in the well-baby nursery. We compared 2 periods: pre-intervention period (n = 9380) versus an intervention period (n = 8087). Three variables were recorded: (1) rate of CNC: number of conjunctival swabs sampled per 1000 newborns whenever an eye discharge was noted, (2) rate of bacterial conjunctivitis: number of positive swabs per 1000 newborns and (3) percentage of positive swabs out of all sampled swabs. RESULTS Compared with pre-intervention period, the rate of CNC dropped significantly during the intervention period: 28.6/1000 versus 21.3/1000, respectively, P < 0.01. However, the number of positive bacterial swabs per 1000 newborns (3.2 vs. 2.5) and the percentage of positive bacterial swabs of all sent samples (11.6% vs. 10.8%) were not different between the 2 periods. The majority of pathogens in swabs were Gram-negative sp. without difference between study periods (77.4% vs. 80%), respectively. Univariate analysis showed significant association between rate of CNC and longer length of stay >5 days (P < 0.001) and vaginal delivery. Logistic stepwise regression analysis showed that 4 variables were significantly and independently associated with higher rate of clinical conjunctivitis. These include birth during pre-intervention period [P = 0.018, odds ratio (OR) = 1.27, 95% confidence interval (CI): 1.04-1.54], length of stay 4-5 days (P < 0.001, OR = 2.23, CI: 1.63-3.06), length of stay >7 days (P < 0.001, OR = 6.51, CI: 4.24-10.02), vaginal delivery (P = 0.004, OR = 1.6, CI: 1.17-2.2) and male gender (P = 0.006, OR = 1.31, CI: 1.08-1.59). CONCLUSIONS Accessibility of a disinfectant gel within each newborn's cradle raised hygiene awareness among the caring staff and contributed to the reduction of CNC rate in the newborn nursery.
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Labreche T, MacIver S, Furtado NM. Optometric infection control guidelines assessing patients with methicillin-resistant Staphylococcus aureus. Clin Exp Optom 2018; 101:727-731. [PMID: 29572957 DOI: 10.1111/cxo.12681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/14/2018] [Accepted: 02/18/2018] [Indexed: 11/30/2022] Open
Abstract
The purpose of this scoping review was to present the state of research regarding optometric infection control guidelines for the assessment of patients with methicillin-resistant Staphylococcus aureus (MRSA) and to identify any areas requiring further research. Twelve articles were carefully chosen for review. Data extracted included information regarding appropriate handwashing methods (five articles), indications for use of personal protective equipment (one article), management of surfaces that come in contact with an MRSA-infected person (three articles), recommendations for patient appointment scheduling/seating (three articles) and suggestions for staff training (three articles). The results of the review demonstrated that there exist many gaps in the literature regarding comprehensive optometric-specific infection control guidelines. Further research regarding appropriate handwashing methods, equipment disinfection techniques, extent and breadth of staff training and indications for use of personal protective equipment is required to better understand what precautions must be taken in an optometric setting when encountering patients with MRSA.
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Affiliation(s)
- Tammy Labreche
- Faculty of Science, Waterloo School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah MacIver
- Faculty of Science, Waterloo School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Nadine M Furtado
- Faculty of Science, Waterloo School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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Maalouli WM, Pitt MB. The eyes have it: An unusual case of Escherichia coli ophthalmia neonatorum or a shifting landscape? SAGE Open Med Case Rep 2017; 5:2050313X17745905. [PMID: 29276602 PMCID: PMC5734447 DOI: 10.1177/2050313x17745905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 11/08/2017] [Indexed: 11/15/2022] Open
Abstract
Despite dramatic declines in the incidence of ophthalmia neonatorum with universal prophylaxis, it remains a clinically important cause of eye disease in newborns. While clear guidelines exist for the treatment of the historically primary agents of ophthalmia neonatorum (Chlamydia trachomatis and Neisseria gonorrhoeae), it is less clear how to manage newborns with conjunctivitis secondary to other bacterial organisms, particularly those also frequently implicated in neonatal sepsis. We present the case of a 3-day-old well-appearing term infant with unilateral purulent conjunctivitis. The eye culture grew Escherichia coli, an unusual cause of ophthalmia neonatorum. After a limited sepsis evaluation proved negative, the infant was switched to moxifloxacin ophthalmic drops and made a full recovery. This case highlights the challenge of managing a rare presentation with minimal guideline support, as well as the need to consider other bacterial causes of neonatal conjunctivitis which are emerging in the era of routine prophylaxis in the United States.
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Affiliation(s)
- Walid Mounir Maalouli
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.,University of Minnesota, Minneapolis, MN, USA
| | - Michael Barclay Pitt
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.,University of Minnesota, Minneapolis, MN, USA
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