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Bondarev DJ, Ryan RM, Mukherjee D. The spectrum of pneumonia among intubated neonates in the neonatal intensive care unit. J Perinatol 2024; 44:1235-1243. [PMID: 38698211 DOI: 10.1038/s41372-024-01973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 02/17/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
We review the pathophysiology, epidemiology, diagnosis, treatment, and prevention of ventilator-associated pneumonia (VAP) in neonates. VAP has been studied primarily in adult ICU patients, although there has been more focus on pediatric and neonatal VAP (neo-VAP) in the last decade. The definition as well as diagnosis of VAP in neonates remains a challenge to date. The neonatal intensivist needs to be familiar with the current diagnostic tools and prevention strategies available to treat and reduce VAP to reduce neonatal morbidity and the emergence of antibiotic resistance. This review also highlights preventive strategies and old and emerging treatments available.
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Affiliation(s)
- Dayle J Bondarev
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rita M Ryan
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Devashis Mukherjee
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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2
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Igwe U, Okolie OJ, Ismail SU, Adukwu E. Effectiveness of infection prevention and control interventions in health care facilities in Africa: A systematic review. Am J Infect Control 2024:S0196-6553(24)00535-2. [PMID: 38871086 DOI: 10.1016/j.ajic.2024.06.004] [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: 02/25/2024] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Health care-associated infections (HAIs) are a major threat to patient safety and quality care. However, they are avoidable by implementing evidence-based infection prevention and control (IPC) measures. This review evaluated the evidence of the effectiveness of IPC interventions in reducing rates of HAIs in health care settings in Africa. METHODS We searched several databases: CENTRAL, EMBASE, PUBMED, CINAHL, WHO IRIS, and AJOL for primary studies reporting rates of the 4 most frequent HAIs: surgical site infections, central line--associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumoniae, and increase in hand hygiene compliance. Two reviewers appraised the studies and PRISMA guidelines were followed. RESULTS Out of 4,624 studies identified from databases and additional sources, 15 studies were finally included in the review. The majority of studies were of pre- and post-test study design. All the studies implemented a combination of interventions and not as stand-alone components. Across all included studies, an improvement was reported in at least 1 primary outcome. CONCLUSIONS Our review highlights the potential of IPC interventions in reducing HAIs and improving compliance with hand hygiene in health care facilities in Africa. For future research, we recommend more pragmatic study designs with improved methodological rigor.
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Affiliation(s)
- Uzoma Igwe
- School of Applied Sciences and Centre for Research in Biosciences, University of the West of England, Bristol, United Kingdom
| | - Obiageli Jovita Okolie
- School of Applied Sciences and Centre for Research in Biosciences, University of the West of England, Bristol, United Kingdom
| | - Sanda Umar Ismail
- School of Health and Social Wellbeing, University of the West of England, Bristol, United Kingdom
| | - Emmanuel Adukwu
- School of Applied Sciences and Centre for Research in Biosciences, University of the West of England, Bristol, United Kingdom.
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3
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Napolitano SK, Boswell NL, Froese P, Henkel RD, Barnes-Davis ME, Parham DK. Early and consistent safe sleep practices in the neonatal intensive care unit: a sustained regional quality improvement initiative. J Perinatol 2024; 44:908-915. [PMID: 38253677 DOI: 10.1038/s41372-023-01855-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/17/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To increase compliance with standardized safe sleep recommendations for patients in a cohort of regional level III/IV neonatal intensive care units (NICUs) in accordance with recently revised guidelines issued by the American Academy of Pediatrics (AAP). STUDY DESIGN A regional quality improvement (QI) initiative led by a multidisciplinary task force standardized safe sleep criteria across participating NICU sites. Universal and unit-specific interventions were implemented via Plan-Do-Study-Act (PDSA) cycles with evaluation of compliance through routine crib audits, run chart completion, and Pareto chart analysis. RESULTS Following QI implementation, compliance with safe sleep guidelines for eligible NICU infants improved from 34% to 90% from October 2019 through September 2022. CONCLUSION Compliance with early, consistent modeling of safe sleep practices nearly tripled in this cohort of regional NICUs. A standardized, timely approach to safe sleep transition demonstrated dramatic and sustained improvement in the practice and modeling of safe sleep behaviors in the NICU.
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Affiliation(s)
- Stephanie K Napolitano
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Nicole L Boswell
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Patricia Froese
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rebecca D Henkel
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Maria E Barnes-Davis
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Danielle K Parham
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
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4
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Marty D, Sorum K, Smith K, Nicoski P, Sayyed BA, Amin S. Nosocomial Infections in the Neonatal Intensive Care Unit. Neoreviews 2024; 25:e254-e264. [PMID: 38688885 DOI: 10.1542/neo.25-5-e254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Nosocomial infections are relatively common in the NICU. These infections increase morbidity and mortality, particularly in the smallest and most fragile infants. The impact of these infections on long-term outcomes and health-care costs is devastating. Worldwide efforts to decrease the incidence of nosocomial infections have focused on implementing specific prevention protocols such as handwashing, central line teams, care bundles, and antimicrobial stewardship. This review summarizes common nosocomial infections in patients in the NICU.
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Affiliation(s)
| | | | | | | | - Ban Al Sayyed
- Division of Pediatric Infectious Disease, Loyola University Medical Center, Maywood, IL
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5
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Thatrimontrichai A, Phatigomet M, Maneenil G, Dissaneevate S, Janjindamai W, Kritsaneepaiboon S. Ventilator-Free Days in Neonatal Ventilator-Associated Pneumonia. Am J Perinatol 2024; 41:580-585. [PMID: 35026853 DOI: 10.1055/a-1739-3678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to compare the ventilator-free days (VFDs) at day 28 and the short-term outcomes in neonates with and without ventilator-associated pneumonia (VAP and non-VAP groups). STUDY DESIGN We performed a cohort study in a Thai neonatal intensive care unit between 2014 and 2020 to identify the VFDs in VAP and non-VAP neonates. Univariate and multivariate analyses were performed. RESULTS The incidences of VAP rates were 5.76% (67/1,163 neonates) and 10.86 per 1,000 (92/8,469) ventilator days. The medians (interquartile ranges [IQRs]) of gestational age and birth weight in the VAP versus non-VAP groups were 31 (27-35) versus 34 (30-38) weeks, and 1,495 (813-2,593) versus 2,220 (1,405-2,940) g (p < 0.001, both), respectively. The medians (IQRs) of VFDs at 28 days in the VAP and non-VAP groups were 5 (0-16) and 24 (20-26) days (p < 0.001). From the univariate analysis, the lower VFDs, longer ventilator days, and higher rates of moderate-to-severe bronchopulmonary dysplasia (BPD), postnatal steroids for BPD, length of stay, and daily hospital cost in the VAP group were significantly higher than in the non-VAP group. From the multivariate analysis, the VAP group had significantly lower VFDs (regression coefficient = -10.99, standard error = 1.11, p < 0.001) and higher BPD (adjusted risk ratio = 18.70; 95% confidence interval = 9.17-39.5, p < 0.001) than the non-VAP group. CONCLUSION Neonatal VAP lead to lower VFDs and a higher frequency of BPD. A multimodal strategy with a VAP prevention bundle care should be used in indicated cases to reduce the occurrence of neonatal VAP. KEY POINTS · The VFDs of the neonatal VAP was lower than reported in adult study.. · There are limited data on VFDs in VAP during the neonatal period.. · Neonatal VAP reduces VFDs and increases BPD rates compared with non-VAP infants..
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Affiliation(s)
- Anucha Thatrimontrichai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Manapat Phatigomet
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Gunlawadee Maneenil
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Supaporn Dissaneevate
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Waricha Janjindamai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Supika Kritsaneepaiboon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Shi J, Zhao F, Yang W, Zhu Y, Wang M, Yi B. The Status and Influencing Factors of COVID-19 Vaccination for 3-7-Year-Old Children Born Prematurely. Patient Prefer Adherence 2024; 18:787-796. [PMID: 38572223 PMCID: PMC10987788 DOI: 10.2147/ppa.s451654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
Objective To explore the status and influencing factors of COVID-19 vaccination for 3-7-year-old children born prematurely. Methods A questionnaire was administered to parents of preterm infants born between 1 January 2016 and 31 December 2019 in Gansu Maternal and Child Health Hospital using convenience sampling. Results It was found that 96.81% of 282 parents had known about COVID-19 vaccines and acquired COVID-19- and vaccine-related knowledge primarily through WeChat (104/282, 36.88%) and TikTok (91/282, 32.27%). Most parents of the group whose children were vaccinated with a COVID-19 vaccine believed that this approach was effective in preventing COVID-19 (49.75%), whereas most parents of the group whose children were not vaccinated were worried about the adverse reaction and safety of the vaccine (45.88%). According to the regression analysis, the risk factors of children born prematurely receiving a COVID-19 vaccine were no vaccination against COVID-19 in the mothers (odds ratio [OR]=48.489, 95% CI: 6.524-360.406) and in younger children (OR=12.157, 95% CI: 6.388-23.139). Previous history of referral (OR=0.229, 95% CI: 0.057-0.920), history of diseases (OR=0.130, 95% CI: 0.034-0.503) and high educational level of guardians (OR=0.142, 95% CI: 0.112-0.557) were protective factors for children born prematurely to receive COVID-19 vaccination. Conclusion There is a relatively high proportion of children born prematurely receiving COVID-19 vaccination, but some people still have concerns. Publicity in the later stage can be conducted through WeChat, TikTok and other social media platforms, with special attention paid to the populations with lower education levels.
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Affiliation(s)
- Jingyun Shi
- Department of NICU, Gansu Provincial Maternal and Child Care Hospital (Gansu Provincial Central Hospital), Lanzhou City, Gansu, 730050, People’s Republic of China
| | - Fangping Zhao
- Department of NICU, Gansu Provincial Maternal and Child Care Hospital (Gansu Provincial Central Hospital), Lanzhou City, Gansu, 730050, People’s Republic of China
| | - Wanyin Yang
- Department of NICU, Gansu University of Chinese Medicine, Lanzhou City, Gansu, 730050, People’s Republic of China
| | - Yuru Zhu
- Department of NICU, Gansu Provincial Maternal and Child Care Hospital (Gansu Provincial Central Hospital), Lanzhou City, Gansu, 730050, People’s Republic of China
| | - Min Wang
- Department of NICU, Gansu Provincial Maternal and Child Care Hospital (Gansu Provincial Central Hospital), Lanzhou City, Gansu, 730050, People’s Republic of China
| | - Bin Yi
- Department of NICU, Gansu Provincial Maternal and Child Care Hospital (Gansu Provincial Central Hospital), Lanzhou City, Gansu, 730050, People’s Republic of China
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Rangelova V, Kevorkyan A, Raycheva R, Krasteva M. Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit-Incidence and Strategies for Prevention. Diagnostics (Basel) 2024; 14:240. [PMID: 38337756 PMCID: PMC10854825 DOI: 10.3390/diagnostics14030240] [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: 12/10/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
The second most prevalent healthcare-associated infection in neonatal intensive care units (NICUs) is ventilator-associated pneumonia (VAP). This review aims to update the knowledge regarding the incidence of neonatal VAP and to summarize possible strategies for prevention. The VAP incidence ranges from 1.4 to 7 episodes per 1000 ventilator days in developed countries and from 16.1 to 89 episodes per 1000 ventilator days in developing countries. This nosocomial infection is linked to higher rates of illness, death, and longer hospital stays, which imposes a substantial financial burden on both the healthcare system and families. Due to the complex nature of the pathophysiology of VAP, various approaches for its prevention in the neonatal intensive care unit have been suggested. There are two main categories of preventative measures: those that attempt to reduce infections in general (such as decontamination and hand hygiene) and those that target VAP in particular (such as VAP care bundles, head of bed elevation, and early extubation). Some of the interventions, including practicing good hand hygiene and feeding regimens, are easy to implement and have a significant impact. One of the measures that seems very promising and encompasses a lot of the preventive measures for VAP are the bundles. Some preventive measures still need to be studied.
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Affiliation(s)
- Vanya Rangelova
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Ani Kevorkyan
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Ralitsa Raycheva
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Maya Krasteva
- Department of Obstetrics and Gynecology, Neonatology Unit, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
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Mohamed HT, Farhan Alenezi WA, Alanzi MAA, Saleh Alsuqub FI, Salem Alhazmi SA, Mohammed Alhazmi OM. Prevalence of Ventilator-Associated Pneumonia in Children Admitted to Pediatric Intensive Care Units in the Middle East: A Systematic Review. Cureus 2023; 15:e51230. [PMID: 38283472 PMCID: PMC10821754 DOI: 10.7759/cureus.51230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Ventilator-associated pneumonia (VAP) is a common healthcare-associated disease in intensive care units, leading to significant morbidity and mortality. This systematic review aims to investigate the prevalence, risk factors, and prevention strategies for VAP in the Middle East. PubMed, SCOPUS, Web of Science, Science Direct, and Google Scholar were systematically searched to include the relevant literature. Rayyan QCRI was used throughout this systematic approach. Ten studies, involving a total of 6295 patients diagnosed with VAP, were included in this review. Among these patients, 336 (5.3%) developed VAP. The prevalence of VAP in children and neonates in the Middle East was relatively low. Risk factors associated with VAP development included prematurity, low birth weight, prolonged mechanical ventilation, enteral feeding, intrusive devices such as umbilical catheters, and cardiac operations. All reviewed studies emphasized the importance of infection control measures in reducing the risk of VAP.
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Mehl SC, Portuondo JI, Fallon SC, Shah SR, Wesson DE, Vogel AM, King A, Lopez ME, Massarweh NN. Variation in Complications and Mortality According to Infant Diagnosis. Ann Surg 2023; 278:e165-e172. [PMID: 35943204 DOI: 10.1097/sla.0000000000005658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Investigate patterns of infant perioperative mortality, describe the infant diagnoses with the highest mortality burden, and evaluate the association between types of postoperative complications and mortality in infants. BACKGROUND The majority of mortality events in pediatric surgery occur among infants (ie, children <1 y old). However, there is limited data characterizing patterns of infant perioperative mortality and diagnoses that account for the highest proportion of mortality. METHODS Infants who received inpatient surgery were identified in the National Surgical Quality Improvement Program-Pediatric database (2012-2019). Perioperative mortality was stratified into mortality associated with a complication or mortality without a complication. Complications were categorized as wound infection, systemic infection, pulmonary, central nervous system, renal, or cardiovascular. Multivariable logistic regression was used to evaluate the association between different complications and complicated mortality. RESULTS Among 111,946 infants, the rate of complications and perioperative mortality was 10.4% and 1.6%, respectively. Mortality associated with a complication accounted for 38.8% of all perioperative mortality. Seven diagnoses accounted for the highest proportion of mortality events (40.3%): necrotizing enterocolitis (22.3%); congenital diaphragmatic hernia (7.3%); meconium peritonitis (3.8%); premature intestinal perforation (2.5%); tracheoesophageal fistula (1.8%); gastroschisis (1.4%); and volvulus (1.1%). Relative to wound complications, cardiovascular [odds ratio (OR): 19.4, 95% confidence interval (95% CI): 13.9-27.0], renal (OR: 6.88; 4.65-10.2), and central nervous system complications (OR: 6.50; 4.50-9.40) had the highest odds of mortality for all infants. CONCLUSIONS A small subset of diagnoses account for 40% of all infant mortality and specific types of complications are associated with mortality. These data suggest targeted quality improvement initiatives could be implemented to reduce adverse surgical outcomes in infants.
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Affiliation(s)
- Steven C Mehl
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Jorge I Portuondo
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Sara C Fallon
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Sohail R Shah
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - David E Wesson
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Adam M Vogel
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Alice King
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - Monica E Lopez
- Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University, Nashville, TN
| | - Nader N Massarweh
- Surgical and Perioperative Care, Atlanta VA Health Care System, Decatur, GA
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA
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Tuteja A, Pournami F, Nandakumar A, Prabhakar J, Jain N. Endotracheal Aspirate and Ventilator-Associated Pneumonia in Neonates: Revisiting an Age-Old Debate. Indian J Pediatr 2022; 89:1202-1208. [PMID: 35503590 DOI: 10.1007/s12098-022-04142-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore the utility of endotracheal aspirates (ETA) for analyzing microbiological yield, incidence, risk factors for VAP, and clinically relevant outcomes. METHODS Ventilated neonates suspected to have VAP were studied prospectively; they were classified as "VAP" or "No VAP" based on a predefined combination of clinical, radiological, and laboratory criteria. The microbiological yield from blood and ETA cultures was analyzed. RESULTS Of 165 neonates who were ventilated for > 48 h, 65 were suspected of having VAP. Thirty-six (22.9%) were classified as VAP. Microbiological agents could be identified in 31 cases (86.1%) by ETA/blood cultures. Acinetobacter sp was the common organism identified. Duration of ventilation, and a higher number of reintubations before suspicion of VAP were significant risk factors for VAP. Positive ETA culture was associated with a greater duration of oxygen therapy and ventilation days after suspicion of VAP. CONCLUSIONS The commonest culture yield from ETA in those suspected to have VAP was gram-negative bacilli. Duration of ventilation and reintubations were identified as significant risk factors for VAP. These are potentially modifiable factors. Positive ETA culture was associated with longer needs for respiratory supports. Negative ETA culture might encourage clinicians to stop antibiotics. TRIAL REGISTRATION Clinical Trials Registry of India No. CTRI/2019/03/017912, www.ctri.nic.in.
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Affiliation(s)
- Amrit Tuteja
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, 695029, India
| | - Femitha Pournami
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, 695029, India.
| | - Anand Nandakumar
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, 695029, India
| | - Jyothi Prabhakar
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, 695029, India
| | - Naveen Jain
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, 695029, India
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Dramowski A, Aucamp M, Beales E, Bekker A, Cotton MF, Fitzgerald FC, Labi AK, Russell N, Strysko J, Whitelaw A, Coffin S. Healthcare-Associated Infection Prevention Interventions for Neonates in Resource-Limited Settings. Front Pediatr 2022; 10:919403. [PMID: 35874586 PMCID: PMC9301049 DOI: 10.3389/fped.2022.919403] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Healthcare-associated infections (HAIs) and antimicrobial-resistant (AMR) infections are leading causes of neonatal morbidity and mortality, contributing to an extended hospital stay and increased healthcare costs. Although the burden and impact of HAI/AMR in resource-limited neonatal units are substantial, there are few HAI/AMR prevention studies in these settings. We reviewed the mechanism of action and evidence supporting HAI/AMR prevention interventions, including care bundles, for hospitalized neonates in low- and middle-income countries (LMIC).
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Affiliation(s)
- Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marina Aucamp
- Infection Prevention and Control Service, Mowbray Maternity Hospital, Cape Town, South Africa
| | - Emily Beales
- Center for Neonatal and Pediatric Infection, St George's University of London, London, United Kingdom
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mark Frederic Cotton
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Felicity C. Fitzgerald
- Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Appiah-Korang Labi
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Neal Russell
- Center for Neonatal and Pediatric Infection, St George's University of London, London, United Kingdom
| | - Jonathan Strysko
- Department of Paediatric and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana
- Department of Global Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Andrew Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Susan Coffin
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Alriyami A, Kiger JR, Hooven TA. Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit. Neoreviews 2022; 23:e448-e461. [PMID: 35773508 DOI: 10.1542/neo.23-7-e448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
See Bonus NeoBriefs videos and downloadable teaching slides Intubated infants in the NICU are at risk of developing ventilator-associated pneumonia (VAP), a common type of health care-associated infection. The Centers for Disease Control and Prevention developed guidelines for diagnosing VAP in patients younger than 1 year, which include worsening gas exchange, radiographic findings, and at least 3 defined clinical signs of pneumonia. VAP in infants is treated with empiric antibiotics selected based on local resistance patterns and individualized patient data. Many NICUs have implemented prevention bundles in an effort to decrease VAP by ensuring the cleanest environment for intubated neonates (hand hygiene, sterile handling of equipment), positioning of infants to prevent gastric reflux, and constantly reevaluating for extubation readiness. Although these prevention bundle elements are intuitive and generally low risk, none are based on strong research support. This article reviews the epidemiology, pathogenesis, diagnosis, treatment, and prevention of VAP in NICU patients, focusing on recent evidence, highlighting areas of emerging research, and identifying persistent knowledge gaps.
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Affiliation(s)
- Ayesha Alriyami
- Division of Newborn Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - James R Kiger
- Division of Newborn Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas A Hooven
- Division of Newborn Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Richard King Mellon Institute for Pediatric Research, Pittsburgh, PA
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Fitzgerald FC, Zingg W, Chimhini G, Chimhuya S, Wittmann S, Brotherton H, Olaru ID, Neal SR, Russell N, da Silva ARA, Sharland M, Seale AC, Cotton MF, Coffin S, Dramowski A. The Impact of Interventions to Prevent Neonatal Healthcare-associated Infections in Low- and Middle-income Countries: A Systematic Review. Pediatr Infect Dis J 2022; 41:S26-S35. [PMID: 35134037 PMCID: PMC8815829 DOI: 10.1097/inf.0000000000003320] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinically suspected and laboratory-confirmed bloodstream infections are frequent causes of morbidity and mortality during neonatal care. The most effective infection prevention and control interventions for neonates in low- and middle-income countries (LMIC) are unknown. AIM To identify effective interventions in the prevention of hospital-acquired bloodstream infections in LMIC neonatal units. METHODS Medline, PUBMED, the Cochrane Database of Systematic Reviews, EMBASE and PsychInfo (January 2003 to October 2020) were searched to identify studies reporting single or bundled interventions for prevention of bloodstream infections in LMIC neonatal units. RESULTS Our initial search identified 5206 articles; following application of filters, 27 publications met the inclusion and Integrated Quality Criteria for the Review of Multiple Study Designs assessment criteria and were summarized in the final analysis. No studies were carried out in low-income countries, only 1 in Sub-Saharan Africa and just 2 in multiple countries. Of the 18 single-intervention studies, most targeted skin (n = 4) and gastrointestinal mucosal integrity (n = 5). Whereas emollient therapy and lactoferrin achieved significant reductions in proven neonatal infection, glutamine and mixed probiotics showed no benefit. Chlorhexidine gluconate for cord care and kangaroo mother care reduced infection in individual single-center studies. Of the 9 studies evaluating bundles, most focused on prevention of device-associated infections and achieved significant reductions in catheter- and ventilator-associated infections. CONCLUSIONS There is a limited evidence base for the effectiveness of infection prevention and control interventions in LMIC neonatal units; bundled interventions targeting device-associated infections were most effective. More multisite studies with robust study designs are needed to inform infection prevention and control intervention strategies in low-resource neonatal units.
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Affiliation(s)
- Felicity C. Fitzgerald
- From the Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Walter Zingg
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gwendoline Chimhini
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Zimbabwe
| | - Simbarashe Chimhuya
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Zimbabwe
| | - Stefanie Wittmann
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Brotherton
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- MRC Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ioana D. Olaru
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Samuel R. Neal
- From the Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Neal Russell
- Paediatric Infectious Diseases Research Group, St George’s University of London, United Kingdom
| | - André Ricardo Araujo da Silva
- Laboratory of Teaching of Prevention and Control of Healthcare-Associated Infections, Federal Fluminense University, Brazil
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, St George’s University of London, United Kingdom
| | - Anna C. Seale
- From the Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mark F. Cotton
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, South Africa, and
| | - Susan Coffin
- Children’s Hospital of Philadelphia, Pennsylvania, Philadelphia
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, South Africa, and
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14
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Molina García A, Cross JH, Fitchett EJ, Kawaza K, Okomo U, Spotswood NE, Chiume M, Ezeaka VC, Irimu G, Salim N, Molyneux EM, Lawn JE. Infection prevention and care bundles addressing health care-associated infections in neonatal care in low-middle income countries: a scoping review. EClinicalMedicine 2022; 44:101259. [PMID: 35059614 PMCID: PMC8760419 DOI: 10.1016/j.eclinm.2021.101259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Health care-associated infections (HCAI) in neonatal units in low- and middle-income countries (LMIC) are a major cause of mortality. This scoping review aimed to synthesise published literature on infection prevention and care bundles addressing neonatal HCAI in LMICs and to construct a Classification Framework for their components (elements). METHODS Five electronic databases were searched between January 2001 and July 2020. A mixed-methods approach was applied: qualitative content analysis was used to build a classification framework to categorise bundle elements and the contents of the classification groups were then described quantitatively. FINDINGS 3619 records were screened, with 44 eligible studies identified. The bundle element Classification Framework created involved: (1) Primary prevention, (2) Detection, (3) Case management, and Implementation (3 + I). The 44 studies included 56 care bundles with 295 elements that were then classified. Primary prevention elements (128, 43%) predominated of which 71 (55%) focused on central line catheters and mechanical ventilators. Only 12 elements (4%) were related to detection. A further 75 (25%) elements addressed case management and 66 (88%) of these aimed at outbreak control. INTERPRETATION The 3 + I Classification Framework was a feasible approach to reporting and synthesising research for infection-relevant bundled interventions in neonatal units. A shift towards the use in infection prevention and care bundles of primary prevention elements focused on the neonate and on commonly used hospital devices in LMIC (e.g., self-inflating bags, suctioning equipment) would be valuable to reduce HCAI transmission. Detection elements were a major gap. FUNDING This work was made possible in part by the John D. and Catherine T. MacArthur Foundation, the Bill & Melinda Gates Foundation, ELMA Philanthropies, The Children's Investment Fund Foundation UK, The Lemelson Foundation, and the Ting Tsung and Wei Fong Chao Foundation under agreements to William Marsh Rice University. The project leading to these results has also received the support of a fellowship from the "la Caixa" Foundation (ID 100010434). The fellowship code is LCF/BQ/EU19/11710040. EJAF is an Academic Clinical Fellow whose salary is funded by the UK National Institute for Health Research (NIHR). NES receives a Research Training Program Scholarship (Australian Commonwealth Government).
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Affiliation(s)
| | - James H. Cross
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kondwani Kawaza
- Department of Paediatrics, Kamuzu University of Health Sciences (formerly College of Medicine, University of Malawi), Blantyre, Malawi
| | - Uduak Okomo
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Naomi E. Spotswood
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Msandeni Chiume
- Department of Paediatrics, Kamuzu University of Health Sciences (formerly College of Medicine, University of Malawi), Blantyre, Malawi
| | | | - Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi, Kenya
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Elizabeth M. Molyneux
- Department of Paediatrics, Kamuzu University of Health Sciences (formerly College of Medicine, University of Malawi), Blantyre, Malawi
| | - Joy E. Lawn
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - with the NEST360 Infection Prevention, Detection and Care Collaborative Group
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatrics, Kamuzu University of Health Sciences (formerly College of Medicine, University of Malawi), Blantyre, Malawi
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Paediatrics, College of Medicine, University of Lagos, Nigeria
- Department of Paediatrics and Child Health, University of Nairobi, Kenya
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
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15
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Ting JY, Autmizguine J, Dunn MS, Choudhury J, Blackburn J, Gupta-Bhatnagar S, Assen K, Emberley J, Khan S, Leung J, Lin GJ, Lu-Cleary D, Morin F, Richter LL, Viel-Thériault I, Roberts A, Lee KS, Skarsgard ED, Robinson J, Shah PS. Practice Summary of Antimicrobial Therapy for Commonly Encountered Conditions in the Neonatal Intensive Care Unit: A Canadian Perspective. Front Pediatr 2022; 10:894005. [PMID: 35874568 PMCID: PMC9304938 DOI: 10.3389/fped.2022.894005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Neonates are highly susceptible to infections owing to their immature cellular and humoral immune functions, as well the need for invasive devices. There is a wide practice variation in the choice and duration of antimicrobial treatment, even for relatively common conditions in the NICU, attributed to the lack of evidence-based guidelines. Early decisive treatment with broad-spectrum antimicrobials is the preferred clinical choice for treating sick infants with possible bacterial infection. Prolonged antimicrobial exposure among infants without clear indications has been associated with adverse neonatal outcomes and increased drug resistance. Herein, we review and summarize the best practices from the existing literature regarding antimicrobial use in commonly encountered conditions in neonates.
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Affiliation(s)
- Joseph Y Ting
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Julie Autmizguine
- Division of Infectious Diseases, Department of Pediatrics, Université de Montreal, Montreal, QC, Canada.,Department of Pharmacology and Physiology, Université de Montréal, Montreal, QC, Canada
| | - Michael S Dunn
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Julie Choudhury
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Julie Blackburn
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montreal, Montreal, QC, Canada
| | - Shikha Gupta-Bhatnagar
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Katrin Assen
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Julie Emberley
- Division of Neonatology, Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Sarah Khan
- Department of Microbiology, McMaster University, Hamilton, ON, Canada
| | - Jessica Leung
- Department of Pediatrics, University of Massachusetts, Worcester, MA, United States
| | - Grace J Lin
- School of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Frances Morin
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay L Richter
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Isabelle Viel-Thériault
- Division of Infectious Diseases, Department of Pediatrics, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Ashley Roberts
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Erik D Skarsgard
- Division of Pediatric Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Joan Robinson
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Prakesh S Shah
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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16
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Nair NS, Lewis LE, Dhyani VS, Murthy S, Godinho M, Lakiang T, Venkatesh BT. Factors Associated With Neonatal Pneumonia and its Mortality in India: A Systematic Review and Meta-Analysis. Indian Pediatr 2021. [PMID: 34837367 PMCID: PMC8639407 DOI: 10.1007/s13312-021-2374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Neonatal pneumonia remains a significant contributor to infant mortality in India and responsible for increased prevalence of infant deaths globally. Objective To identify risk factors associated with neonatal pneumonia and its mortality in India. Study design A systematic review was conducted including both analytic study designs and descriptive study designs, which reported a quantitative analysis of factors associated with all the three types of pneumonia among neonates. The search was conducted from August to December, 2016 on the following databases; CINAHL, EMBASE, Ovid MEDLINE, PubMed, ProQuest, SCOPUS, Web of Science, WHO IMSEAR and IndMED. The search was restricted to Indian setting. Participants The population of interest was neonates. Outcomes The outcome measures included risk factors for incidences and mortality predictors of neonatal pneumonia. These could be related to neonate, maternal and pregnancy, caregiver, family, environment, healthcare system, iatrogenic and others. Results A total of three studies were included. For risk factors, two studies on ventilator-associated pneumonia were included with 194 neonates; whereas for mortality predictors, only one study with 150 neonates diagnosed with pneumonia was included. 11 risk factors were identified from two studies: duration of mechanical ventilation, postnatal age, birth weight, prematurity, sex of the neonate, length of stay in NICU, primary diagnosis, gestational age, number of re-intubation, birth asphyxia, and use of nasogastric tube. Metaanalysis with random-effects model was possible only for prematurity (<37 week) and very low birth weight (<1500 g) and very low birth weight was found to be significant (OR 5.61; 95% CI 1.76, 17.90). A single study was included on predictors of mortality. Mean alveolar arterial oxygen gradient (AaDO2) >250 mm Hg was found to be the single most significant predictor of mortality due to pneumonia in neonates. Conclusion The study found scant evidence from India on risk factors of neonatal pneumonia other than ventilator-associated pneumonia. Electronic Supplementary Material Supplementary material is available in the online version of this article at 10.1007/s13312-021-2374-4
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Affiliation(s)
- N Sreekumaran Nair
- Department of Statistics, Public Health Evidence South Asia (PHESA), Manipal Academy of Higher Education, Manipal, Karnataka
| | - Leslie Edward Lewis
- Department of Pediatrics, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Manipal, Karnataka
| | - Vijay Shree Dhyani
- Department of Statistics, Public Health Evidence South Asia (PHESA), Manipal Academy of Higher Education, Manipal, Karnataka
| | - Shruti Murthy
- Department of Statistics, Public Health Evidence South Asia (PHESA), Manipal Academy of Higher Education, Manipal, Karnataka
| | - Myron Godinho
- Department of Statistics, Public Health Evidence South Asia (PHESA), Manipal Academy of Higher Education, Manipal, Karnataka
| | - Theophilus Lakiang
- Department of Statistics, Public Health Evidence South Asia (PHESA), Manipal Academy of Higher Education, Manipal, Karnataka
| | - Bhumika T Venkatesh
- Department of Statistics, Public Health Evidence South Asia (PHESA), Manipal Academy of Higher Education, Manipal, Karnataka. Correspondence to: Dr Bhumika T Venkatesh, Room no. 35, Public Health Evidence South Asia (PHESA), Prasanna School of Public Health, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka.
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17
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Effect of breast milk oral care in infants who underwent surgical correction of ventricular septal defect. Cardiol Young 2021; 31:2015-2018. [PMID: 33883048 DOI: 10.1017/s1047951121001438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study explored the clinical effect of employing breast milk oral care for infants who underwent surgical correction of ventricular septal defect. METHODS A prospective randomised controlled study was conducted in a provincial hospital between January, 2020 and July, 2020 in China. Patients were randomly divided into an intervention group (breast milk oral care, n = 28) and a control group (physiological saline oral care, n = 28). The intervention group was given oral nursing using breast milk for infants in the early post-operative period, and the control group was given oral nursing using physiological saline. Related clinical data were recorded and analysed. RESULTS There were no significant differences in age, gender, weight, operation time, cardiopulmonary bypass time, or aortic cross-clamping time between the two groups. Compared with the physiological saline oral care group, the mechanical ventilation duration, the length of ICU stay in the breast milk oral care group were significantly shorter. The time of start feeding and total enteral nutrition were significantly earlier in the intervention group than those in the control group. The incidence of post-operative pneumonia in the breast milk oral care group was 3.6%, which was significantly lower than that of the physiological saline oral care group. CONCLUSION The use of breast milk for oral care in infants who underwent surgical correction of VSD can reduce the incidence of post-operative pneumonia and promote the recovery of gastrointestinal function.
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18
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Wang HC, Tsai MH, Chu SM, Liao CC, Lai MY, Huang HR, Chiang MC, Fu RH, Hsu JF. Clinical characteristics and outcomes of neonates with polymicrobial ventilator-associated pneumonia in the intensive care unit. BMC Infect Dis 2021; 21:965. [PMID: 34535089 PMCID: PMC8446475 DOI: 10.1186/s12879-021-06673-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/08/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ventilator associated pneumonia (VAP) caused by more than one microorganisms is not uncommon and may be potentially challenging, but the relevant data is scarce in ventilated neonates. We aimed to investigate the clinical characteristics and outcomes of polymicrobial VAP in the neonatal intensive care unit (NICU). METHODS All neonates with definite diagnosis of VAP from a tertiary level neonatal intensive care unit (NICU) in Taiwan between October 2017 and September 2020 were prospectively observed and enrolled for analyses. All clinical features, therapeutic interventions and outcomes were compared between the polymicrobial VAP and monomicrobial VAP episodes. Multivariate regression analyses were used to find the independent risk factors for treatment failure. RESULTS Among 236 episodes of neonatal VAP, 60 (25.4%) were caused by more than one microorganisms. Polymicrobial VAP episodes were more likely to be associated with multidrug-resistant pathogens (53.3% versus 34.7%, P = 0.014), more often occurred in later days of life and in neonates with prolonged intubation and underlying bronchopulmonary dysplasia. Otherwise most clinical characteristics of polymicrobial VAP were similar to those of monomicrobial VAP. The therapeutic responses and treatment outcomes were also comparable between these two groups, although modification of therapeutic antibiotics were significantly more common in polymicrobial VAP episodes than monomicrobial VAP episodes (63.3% versus 46.2%; P < 0.001). None of any specific pathogens was significantly associated with worse outcomes. Instead, it is the severity of illness, including presence of concurrent bacteremia, septic shock, and requirement of high-frequency oscillatory ventilator and underlying neurological sequelae that are independently associated with treatment failure. CONCLUSIONS Polymicrobial VAP accounted for 25.4% of all neonatal VAP in the NICU, and frequently occurred in neonates with prolonged intubation and underlying bronchopulmonary dysplasia. In our cohort, most clinical features, therapeutic responses and final outcomes of neonates with monomicrobial and polymicrobial VAP did not differ significantly.
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Affiliation(s)
- Hsiao-Chin Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Horng Tsai
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Chu Liao
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Yin Lai
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Rong Huang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ren-Huei Fu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, No. 5, Fu-Shin Rd., Kwei Shan, Taoyuan County, 333, Linkou, Taiwan, ROC.
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19
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Yang ZQ, Mai JY, Zhu ML, Xiao XM, He XX, Chen SQ, Lin ZL, Feng X. Soluble Triggering Receptors Expressed on Myeloid Cells-1 as a Neonatal Ventilator-Associated Pneumonia Biomarker. Int J Gen Med 2021; 14:4529-4534. [PMID: 34421311 PMCID: PMC8372303 DOI: 10.2147/ijgm.s315987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/26/2021] [Indexed: 12/25/2022] Open
Abstract
Background Neonatal ventilator-associated pneumonia (NVAP) is one of the main infections acquired in hospitals, and soluble triggering receptors expressed on myeloid cells-1 (sTREM-1) are a TREM-1 subtype that can be released into the blood or bodily fluids during an infection. Methods The patients included in the present study were divided into three groups: the NVAP group, the first control group, and the second control group (n = 20, each). Children requiring respiratory treatment were assigned to the NVAP group, newborns who received mechanical ventilation and had neonatal respiratory distress syndrome were assigned to the first control group, and newborns with normal X-ray and electrocardiogram results but no non-pulmonary infection was assigned to the second control group. The blood and bronchoalveolar lavage fluid (BALF) sTREM-1 levels in all newborns were analyzed. Results The acute-phase blood and BALF sTREM-1 levels were significantly higher in the NVAP group than in the first control group, and the blood sTREM-1 expression level was lower in the second control group than in the NVAP group. Conclusion The present results suggest that sTREM-1 might be a useful biomarker for NVAP prediction in the Department of Pediatrics.
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Affiliation(s)
- Zu-Qin Yang
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215025, Jiangsu, People's Republic of China
| | - Jing-Yun Mai
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Min-Li Zhu
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Xiu-Man Xiao
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Xiao-Xiao He
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Shang-Qin Chen
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Zhen-Lang Lin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Xing Feng
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215025, Jiangsu, People's Republic of China
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20
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Katayama Y, Takanishi H, Sato Y, Fujita S, Enomoto M. Effect of oral care in reducing the incidence of early-onset ventilator-associated pneumonia in preterm infants. Pediatr Pulmonol 2021; 56:2570-2575. [PMID: 33983679 DOI: 10.1002/ppul.25451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/19/2021] [Accepted: 04/25/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Oral care using chlorhexidine has been considered useful in reducing the incidence of ventilator-associated pneumonia (VAP) in adult patients. However, no study has proved the effect of oral care in reducing the incidence of VAP in preterm infants. OBJECTIVES To investigate the efficacy of oral care using a sponge brush moistened with sterile water in reducing the bacterial load in the oral cavity and the incidence of early-onset VAP in preterm infants METHODS: The bacterial number in the oral cavity was evaluated on-site with the dielectrophoretic impedance measurement system. Bacterial numbers before and after oral care were investigated prospectively. Then, the incidence of early-onset VAP was compared retrospectively between infants who received oral care before re-intubation and those who did not. RESULTS The mean bacterial number (cfu/ml) in the oral cavity in infants managed with endotracheal intubation (n = 23), continuous positive airway pressure (n = 38), and high-flow nasal cannula (n = 22) significantly reduced (p < .01) after versus before oral care (4.46 × 107 vs. 1.25 × 106 ; 1.32 × 107 vs. 6.82 × 105 ; and 1.68 × 107 vs. 6.50 × 105 ). The incidence rate of early-onset VAP after re-intubation was 51% (20/39) in patients who did not receive oral care. Then, it significantly decreased to 21% (7/33; p = .009) after receiving oral care. CONCLUSION Oral care with sterile water may be effective in reducing the bacterial load in the oral cavity and the incidence of early-onset VAP in preterm infants.
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Affiliation(s)
| | | | - Yumi Sato
- Neonatal Intensive Care Unit, Takatsuki General Hospital, Osaka, Japan
| | - Satoshi Fujita
- Neonatal Intensive Care Unit, Takatsuki General Hospital, Osaka, Japan
| | - Masahiro Enomoto
- Department of Neonatology, Takatsuki General Hospital, Osaka, Japan
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21
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Ramaswamy VV, Oommen VI, Gupta A, Weerapperuma N, Zivanovic S, Roehr CC. Care practices and outcomes of extremely preterm neonates born at 22-24 weeks -A single centre experience. J Neonatal Perinatal Med 2021; 14:575-582. [PMID: 34120919 DOI: 10.3233/npm-200670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Wide variation in the care practices and survival rates of neonates born at peri-viable gestational ages of 22 +0 -24 +6 weeks exists. This study elucidates the postnatal risk factors for morbidity/mortality, contrasts the care practices and short-term outcomes of this vulnerable group of preterm neonates from a single center with others. METHODS Retrospective study of neonates born at 22 +0 -24 +6 weeks in a level 3 neonatal intensive care unit in UK, over a period of 4 years (2016-2019). RESULTS 94 neonates given active care studied. Survival until discharge was 51.1%(22-23 wks -44%, 24 wks -59.1%) and survival with no major brain injury (MBI) [grade III/IV IVH, cystic periventricular leukomalacia] was 38.3%(22-23 wks -32%, 24 wks -45.4%). Of those who survived until discharge, 75%had no MBI (22-23 wks -72.7%, 24 wks -76.9%). Neonates requiring significant respiratory support within first 72 hours as well as needing rescue high frequency ventilation had significantly high risk of mortality or MBI [aOR -7.17 (2.24-25.79), p = 0.00; 4.76 (1.43-20.00), p = 0.01]. CONCLUSIONS Survival rate differed from other centres. MBI was low amongst survivors. Severe respiratory disease in the initial days was associated with a higher risk of death or MBI.
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Affiliation(s)
- V V Ramaswamy
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - V I Oommen
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - A Gupta
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - N Weerapperuma
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - S Zivanovic
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - C C Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Medical Sciences, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Abiramalatha T, Ramaswamy VV, Thanigainathan S, Pullattayil AK, Kirubakaran R. Frequency of ventilator circuit changes to prevent ventilator-associated pneumonia in neonates and children-A systematic review and meta-analysis. Pediatr Pulmonol 2021; 56:1357-1365. [PMID: 33713572 DOI: 10.1002/ppul.25345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the effect of different frequencies of ventilator circuit changes in neonates and children through a systematic review and meta-analysis. INTERVENTIONS (1) "No routine change of ventilator circuit (unless visibly soiled)" versus "routine change at any fixed interval"; (2) routine change of circuit at "less frequent" versus "more frequent" intervals. OUTCOMES Primary outcomes were VAP rate (number of VAP episodes per 1000 ventilator-days) and all-cause mortality before discharge. METHODS MEDLINE, CENTRAL, EMBASE, and CINAHL were systematically searched from inception till November 3, 2020. Two authors assessed trial eligibility and risk of bias, and independently extracted data. Data were synthesized using fixed effects model. GRADE was used to assess certainty of evidence (CoE). RESULTS We identified six studies enrolling 768 participants evaluating circuit changes at two fixed intervals. Meta-analysis of studies on circuit changes "once in less than 7 days" versus "once weekly" showed no difference in VAP rate (risk ratio: 0.83 [0.38-1.81]; one randomized controlled trial (RCT) and 0.94 [0.49-1.81]; two before-after studies) or mortality before discharge (0.67 [0.34-1.3]; one RCT and 1.01 [0.63-1.64]; two before-after studies). CoE was very low. Less frequent circuit changes reduced health-care costs. No study evaluating "circuit changes only when visibly soiled" versus "circuit changes at a fixed interval" was identified. CONCLUSION There is no evidence to suggest that ventilator circuits can be safely left unchanged until visibly soiled in neonates and children. Extending circuit changes interval to "once weekly" may not increase VAP rate (CoE-very low) and reduces healthcare costs.
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Affiliation(s)
- Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | | | - Sivam Thanigainathan
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Richard Kirubakaran
- Department of Biostatistics, Prof. BV Moses Centre for Evidence-Informed Healthcare and Health Policy, Christian Medical College, Vellore, Tamil Nadu, India
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Pinilla-González A, Solaz-García Á, Parra-Llorca A, Lara-Cantón I, Gimeno A, Izquierdo I, Vento M, Cernada M. Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants. J Perinatol 2021; 41:1467-1473. [PMID: 34035449 PMCID: PMC8147910 DOI: 10.1038/s41372-021-01086-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We hypothesized that the implementation of evidence-based interventions shaping a bundle approach could significantly reduce the incidence of ventilator-associated pneumonia (VAP) in the neonatal intensive care unit. STUDY DESIGN We conducted a prospective observational cohort study including neonates undergoing mechanical ventilation >48 h. VAP rate and endotracheal intubation ratio were compared before (pre-period) and after (post-period) applying VAP prevention bundle strategies. RESULT One hundred seventy-four neonates were included in pre-period (30 months) and 106 in post-period (17 months). Demographic characteristics were comparable and device use ratios were similar. Twenty-eight VAP episodes were diagnosed, 25 in the first period and 3 after the implementation of prevention bundle. This represents a reduction in the incidence rate from 11.79 to 1.93 episodes/1000 ventilator days (p < 0.01). CONCLUSION The implementation of an educational evidence-based program using a bundle approach to prevent VAP has shown a statistically significant reduction in its incidence density.
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Affiliation(s)
| | | | - Anna Parra-Llorca
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | | | - Ana Gimeno
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Isabel Izquierdo
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Máximo Vento
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain.
| | - María Cernada
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain.
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Simon A, Zemlin M, Geipel M, Gärtner B, Armann J, Meyer S. [Infection prevention in neonatal intensive care units]. DER GYNAKOLOGE 2021; 54:428-434. [PMID: 33967301 PMCID: PMC8094126 DOI: 10.1007/s00129-021-04804-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 12/24/2022]
Abstract
In diesem Beitrag werden einige Besonderheiten der Infektionsprävention bei intensivmedizinisch behandelten Früh und Neugeborenen dargestellt. Ergänzend finden sich Hinweise zum krankenhaushygienischen Management der SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Pandemie und zur Antibiotic Stewardship in der neonatologischen Intensivmedizin.
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Affiliation(s)
- Arne Simon
- Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 9, Geb. 9, 66421 Homburg/Saar, Deutschland
| | - Michael Zemlin
- Allgemeine Pädiatrie und Neonatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Martina Geipel
- Allgemeine Pädiatrie und Neonatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Barbara Gärtner
- Institut für Medizinische Mikrobiologie und Hygiene (IMMH), Universität und Universitätsklinikums des Saarlandes, Homburg/Saar, Deutschland
| | - Jakob Armann
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - Sascha Meyer
- Allgemeine Pädiatrie und Neonatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
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Liao CC, Tsai MH, Lai SH, Lai MY, Chu SM, Huang HR, Hsu KH, Chiang MC, Fu RH, Hsu JF. Safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator-associated pneumonia. Pediatr Neonatol 2021; 62:195-201. [PMID: 33413988 DOI: 10.1016/j.pedneo.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/27/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The safety and clinical application of nonbronchoscopic bronchoalveolar lavage (NB-BAL) in preterm neonates with ventilator-associated pneumonia (VAP) have not been fully investigated, and limited data on the feasibility of this method are available. METHODS Premature infants with clinically suspected VAP between October 2017 and June 2019 were enrolled, and NB-BAL was performed. The tolerance and safety of NB-BAL were prospectively recorded during the procedure, and the clinical applications of NB-BAL were observed. RESULTS A total of 46 NB-BAL procedures were performed in 31 neonates with clinically suspected VAP. The median (interquartile range) gestational age and birth body weight were 28.7 (26.7-31.3) weeks and 1055.0 (817.0-1475.0) grams, respectively. Overall, all episodes of the procedure were well tolerated, with only 9 (19.5%) episodes showing transient desaturation and one patient (2.2%) showing bradycardia during the NB-BAL procedure. There were no impairments in arterial blood gas, cardiopulmonary parameters or respiratory severity scores after NB-BAL. No significant complications occurred in any of the patients who received NB-BAL. No chronic comorbidities affected the safety and clinical application of NB-BAL in these mechanically ventilated preterm neonates. NB-BAL yielded a diagnosis in 32 (69.6%) of these VAP episodes. Staphylococcus aureus was the most common isolated bacterium and accounted for 7 (15.2%) confirmed cases of VAP in our study, followed by polymicrobial microorganisms (n = 6, 13.0%). The appropriate antibiotics were prescribed and modified according to the NB-BAL results in 25 (54.3%) cases of VAP. CONCLUSIONS NB-BAL is a safe and clinically applicable method for determining the etiology and diagnosis of VAP in the NICU, even in extremely preterm neonates with major chronic comorbidities. Further studies to investigate the diagnostic accuracy and impact of NB-BAL on VAP treatment in neonates are warranted in the future.
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Affiliation(s)
- Chen-Chu Liao
- Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Horng Tsai
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shen-Hao Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mei-Yin Lai
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Rong Huang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Hsiang Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ren-Huei Fu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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26
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Tusor N, De Cunto A, Basma Y, Klein JL, Meau-Petit V. Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound. Eur J Pediatr 2021; 180:137-146. [PMID: 32592026 PMCID: PMC7317892 DOI: 10.1007/s00431-020-03710-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/29/2020] [Accepted: 05/29/2020] [Indexed: 12/27/2022]
Abstract
No consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Between March 25, 2018, and May 25, 2019, infants with VAP were identified. Clinical, laboratory and microbiology data were collected. CXRs and LU scans were reviewed. A multiparameter VAP score, including LU, was calculated on Day 1 and Day 3 for infants with VAP and for a control group and compared with CXR. VAP incidence was 10.47 episodes/1000 ventilator days. LU and CXR were available for 31 episodes in 21 infants with VAP, and for six episodes in five patients without VAP. On Day 1, a VAP score of > 4, and on Day 3 a score of > 5 showed sensitivity of 0.94, and area under the curve of 0.91 and 0.97, respectively. AUC for clinical information only was 0.88 and for clinical and CXR 0.85.Conclusion: The multiparameter VAP score including LU could be useful in diagnosing VAP in neonates with underlying lung pathology. What is Known: • Ventilator associated pneumonia (VAP) is common in infants on the neonatal unit and is associated with increased use of antibiotics, prolonged ventilation and higher incidence of chronic lung disease. • Commonly used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease. What is New: • The multiparameter VAP score combining clinical, microbiology and lung ultrasound (LU) data is predictive for VAP diagnosis in preterm infants with chronic lung disease. • LU findings of VAP in neonates showed high inter-rater agreement and included consolidated lung areas, dynamic bronchograms and pleural effusion.
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Affiliation(s)
- Nora Tusor
- Neonatal Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK.
| | - Angela De Cunto
- Neonatal Intensive Care Unit, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, North Wing 6th floor, Westminster Bridge Road, London, SE1 0EH UK
| | - Yousef Basma
- Neonatal Transfer Service London, Royal London Hospital, Whitechapel Road, London, E1 1FR UK
| | - John L. Klein
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, North Wing 2nd floor, Westminster Bridge Road, London, SE1 0EH UK
| | - Virginie Meau-Petit
- Neonatal Intensive Care Unit, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, North Wing 6th floor, Westminster Bridge Road, London, SE1 0EH UK
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Maran E, Novakowski Spigolon D, Misue Matsuda L, Ferraz Teston E, Campos de Oliveira JL, Soares de Souza V, Silva Marcon S. Efeitos da utilização do bundle na prevenção de pneumonia associada à ventilação mecânica: revisão integrativa. REVISTA CUIDARTE 2020. [DOI: 10.15649/cuidarte.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introdução: A Pneumonia Associada à Ventilação Mecânica é uma infecção relacionada à assistência à saúde que predomina em unidades de terapia intensiva e que compromete a segurança do paciente. Objetivo: Identificar na literatura científica os efeitos do uso de Bundles na prevenção da Pneumonia Associada à Ventilação Mecânica em Unidade de Terapia Intensiva. Método: Revisão integrativa realizada com estudos disponibilizados nas bases dados online: Cumulative Index to Nursing and Allied Health Literature, Cocrhane, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online e Scopus. A busca dos estudos nas bases de dados se deu no período de dois de junho a 18 de julho de 2018, no idioma inglês ou português, sem limite de tempo de publicação, utilizando os termos dos DeCS e MeSH. O recrutamento foi realizado por dois pesquisadores independentes. Dos artigos selecionados, extraíram-se as informações: ano, país de origem, objetivo(s), grau de recomendação científica e tipo de estudo, intervenção, conformidade do uso do Bundle, principais resultados e conclusões. Resultados: Dentre as 20 publicações analisadas, 13 eram de diferentes países e a maioria dos estudos (n=18) constata que o uso de Blundes reduziu significativamente a taxa de Pneumonia Associada à Ventilação Mecânica, com impacto na redução da mortalidade, no tempo de internação e nos custos hospitalares. Os principais componentes de escolha para composição do pacote de cuidado foram à elevação da cabeceira e o protocolo de higiene oral. Conclusão: Apesar de existir espaço para estudos com maior grau de recomendação, o rol de evidências de muitos países indica que o uso de Bundles tem efeito positivo na prevenção da pneumonia associada a ventilação mecânica e também na melhoria de desempenho institucional, pela redução de custos hospitalares.
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El-Sokkary RH, Negm EM, Othman HA, Tawfeek MM, Metwally WS. Stewardship actions for device associated infections: An intervention study in the emergency intensive care unit. J Infect Public Health 2020; 13:1927-1931. [PMID: 33148497 DOI: 10.1016/j.jiph.2020.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/29/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022] Open
Abstract
Improving the practices of antimicrobial use in hospitals, especially in developing countries, is a challenging duty. OBJECTIVES The aim of the study was to determine the effect of certain stewardship actions on the use of antibiotics for device-associated infections in the emergency intensive care unit in Egypt. MEHODS The intervention included establishment of AS team, design an antibiogram and preparation of antibiotic use guidelines, education, and infection prevention and control measures. Pre- and postinterventions surveys tookplace including: antibiotic prescription compliance, antibiotic cost, bacterial profile and antibiotic resistance rates. RESULTS Antibiotic prescription compliance improved, especially for prophylactic antibiotics prescription; in preintervention phase, 27.4% of cases received unindicated antibiotic prophylaxis vs 5.8% after intervention. A statistically significant decrease in cost after the intervention was reported (p = 0.04). Acinetobacter baumannii and Klebsiella pneumonia were the most frequently isolated pathogens (25.6%) and (21.8%) in pre and post-intervention phases respectively. A statistically significant decrease in the prevalence of MDR (X² = 11.9, p = 0.009) was observed. The most prevalent XDR is K-pneumonia (45% vs 17%) in phase 1&3. No pan drug-resistant isolates were detected. CONCLUSION Sound antibiotic guidelines coupled with effective infection control precautions and education would be a good intervention, particularly with a leadership commitment. The use of microbiology tests to direct prescribing decisions should be a underscored. Sustained research initiatives may support the proper implementation of AS programmes in limited resource settings.
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Affiliation(s)
- Rehab H El-Sokkary
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Essamedin M Negm
- Anesthesia & Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Howaydah A Othman
- Anesthesia & Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M Tawfeek
- Anesthesia & Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Wafaa S Metwally
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Impacts of Multidrug-Resistant Pathogens and Inappropriate Initial Antibiotic Therapy on the Outcomes of Neonates with Ventilator-Associated Pneumonia. Antibiotics (Basel) 2020; 9:antibiotics9110760. [PMID: 33143219 PMCID: PMC7693013 DOI: 10.3390/antibiotics9110760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022] Open
Abstract
It is unknown whether neonatal ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) pathogens and inappropriate initial antibiotic treatment is associated with poor outcomes after adjusting for confounders. Methods: We prospectively observed all neonates with a definite diagnosis of VAP from a tertiary level neonatal intensive care unit (NICU) in Taiwan between October 2017 and March 2020. All clinical features, therapeutic interventions, and outcomes were compared between the MDR–VAP and non-MDR–VAP groups. Multivariate regression analyses were used to investigate independent risk factors for treatment failure. Results: Of 720 neonates who were intubated for more than 2 days, 184 had a total of 245 VAP episodes. The incidence rate of neonatal VAP was 10.1 episodes/per 1000 ventilator days. Ninety-six cases (39.2%) were caused by MDR pathogens. Neonates with MDR–VAP were more likely to receive inadequate initial antibiotic therapy (51.0% versus 4.7%; p < 0.001) and had delayed resolution of clinical symptoms (38.5% versus 25.5%; p = 0.034), although final treatment outcomes were comparable with the non-MDR–VAP group. Inappropriate initial antibiotic treatment was not significantly associated with worse outcomes. The VAP-attributable mortality rate and overall mortality rate of this cohort were 3.7% and 12.0%, respectively. Independent risk factors for treatment failure included presence of concurrent bacteremia (OR 4.83; 95% CI 2.03–11.51; p < 0.001), septic shock (OR 3.06; 95% CI 1.07–8.72; p = 0.037), neonates on high-frequency oscillatory ventilator (OR 4.10; 95% CI 1.70–9.88; p = 0.002), and underlying neurological sequelae (OR 3.35; 95% CI 1.47–7.67; p = 0.004). Conclusions: MDR–VAP accounted for 39.2% of all neonatal VAP in the neonatal intensive care unit (NICU), but neither inappropriate initial antibiotics nor MDR pathogens were associated with treatment failure. Neonatal VAP with concurrent bacteremia, septic shock, and underlying neurological sequelae were independently associated with final worse outcomes.
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A glass half-full: defining ventilator-associated pneumonia in the neonatal intensive care unit. Pediatr Res 2020; 87:1155-1156. [PMID: 32241018 PMCID: PMC7223166 DOI: 10.1038/s41390-020-0884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 11/08/2022]
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Niedzwiecka T, Patton D, Walsh S, Moore Z, O'Connor T, Nugent L. What are the effects of care bundles on the incidence of ventilator-associated pneumonia in paediatric and neonatal intensive care units? A systematic review. J SPEC PEDIATR NURS 2019; 24:e12264. [PMID: 31332968 DOI: 10.1111/jspn.12264] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/15/2019] [Accepted: 06/27/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this review was to ascertain the impact of ventilator bundles on the incidence of ventilator-associated pneumonia in mechanically ventilated neonates and children in intensive care units. METHODS A systematic review was conducted. Key computerised databases (CINAHL, Medline, Embase and Cochrane) as well as additional sources, with no publication date limitations, were extensively searched in January 2018. Inclusion criteria focused on ventilator bundles used in mechanically ventilated neonates and children aged from 0 to 18 years. After identification and inclusion, all studies were critically appraised for quality. Data were analysed and narratively synthesised. RESULTS Eight studies of observational and nonrandomised interventional methods design were included in the review. However, the validity of five of the eight studies which were reviewed was considered substandard. In addition, there were variations in the care bundles elements studied. Nevertheless, all these studies demonstrated that the incidences of VAP in mechanically ventilated neonates and children were found to be significantly reduced by the use of ventilator bundles. PRACTICE IMPLICATIONS This systematic review determines that ventilator bundles impact positively on the incidence of VAP in critically ill neonates and children in the neonatal intensive care unit and paediatric intensive care unit. However, the variations in the bundle elements and insufficient valid evidence necessitates further research in the area to validate the findings and to ensure standardisation of clinical practice. Prevention of VAP is aimed at avoiding the risk of aspiration in the lungs, colonisation of respiratory tract with pathogenic microorganisms and contamination of respiratory equipment. Moreover, the implementation of evidence-based interventions grouped together is fundamental to improve patient outcomes. It is recommended that a further bona fide research is required to standardise the components of paediatric ventilator bundles.
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Affiliation(s)
- Teresa Niedzwiecka
- Infection Prevention & Control Department, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Simone Walsh
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom O'Connor
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Linda Nugent
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Abstract
With the improvement in neonatal care in last two decades, the survival of very low birth weight (VLBW), extremely low birth weight (ELBW), fetus diagnosed with malformations, and congenital heart disease and severe birth asphyxia has increased significantly. These infants when admitted to the neonatal intensive care unit (NICU) need numerous interventions depending upon the severity of sickness and postnatal course like need of mechanical ventilation (MV) or noninvasive ventilation, surfactant administration, placement of central lines, total parenteral nutrition, and numerous medications. The duration of NICU and hospital stay of these high-risk infants varies from few days to few weeks to few months. Long stay in the hospital leads to high hospital bills and increase the cost of neonatal care substantially. The cost of NICU stay varies from 90 USD to 1250-2500 USD per day as per various studies, depending upon the level of care and sickness of the admitted infants. In developed countries, the burden of NICU cost is often taken care by the government or insurance companies but in many developing countries the parents bear the substantial cost of NICU admission of their infants. There are many interventions which when implemented in the NICU will lead to reduction of the cost and will make the NICU cost effective. In this review, we cover various interventions mostly from our own published work which have shown to reduce the NICU cost and make it more cost effective with equivalent and better neonatal outcomes, especially in developing countries like ours.
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Affiliation(s)
- Deepak Sharma
- Department of Neonatology, National Institute of Medical Sciences, Jaipur, India
| | - Srinivas Murki
- Department of Neonatology, Paramitha Children Hospital, Kothapet, Hyderabad, India
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Abd-Elgawad M, Eldegla H, Khashaba M, Nasef N. Oropharyngeal Administration of Mother's Milk Prior to Gavage Feeding in Preterm Infants: A Pilot Randomized Control Trial. JPEN J Parenter Enteral Nutr 2019; 44:92-104. [PMID: 31062377 DOI: 10.1002/jpen.1601] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/27/2019] [Accepted: 04/22/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Oropharyngeal administration of mother's colostrum in early days has an immunoprotective effect in preterm infants. OBJECTIVES Our aim was to study the effect of oropharyngeal administration of mother's milk (OPAMM) on decreasing the incidence of nosocomial sepsis. METHODS In a pilot prospective randomized study on preterm (<32 weeks gestation and 1500 g weight) infants, we compared OPAMM practice (applying 0.2 mL of mother's colostrum or milk prior to gavage feeding until full oral feeding is reached) with regular gavage feeding. The primary outcome was incidence of culture-proven nosocomial sepsis. Secondary outcomes included bacterial colonization of the gastrointestinal tract, feeding intolerance, time to reach full feeding, incidence of necrotizing enterocolitis, ventilator-associated pneumonia, duration of respiratory support, incidence of bronchopulmonary dysplasia (BPD), length of hospital stay, and neonatal mortality. RESULTS The outcomes of 200 neonates (100 in each group) were analyzed. OPAMM practice did not significantly reduce the incidence of culture proven nosocomial sepsis (8% vs 13%, P = 0.35). Infants in the OPAMM group had a significantly lower growth of Klebsiella species in the oropharyngeal pouch, borderline lower incidence of ventilator-associated pneumonia, shorter duration of oxygen therapy, less episodes of feeding intolerance, reached full feeding earlier, and had a shorter length of hospital stay. OPAMM practice did not affect the incidence of necrotizing enterocolitis, BPD, or neonatal mortality. CONCLUSION OPAMM prior to gavage feeding does not reduce the incidence of nosocomial sepsis but had beneficial effects on early achievement of feeding, and early hospital discharge in preterm very low-birth-weight infants.
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Affiliation(s)
- Mahmoud Abd-Elgawad
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Dakahlia, Egypt
| | - Heba Eldegla
- Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Mohammed Khashaba
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Dakahlia, Egypt.,Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Nehad Nasef
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Dakahlia, Egypt.,Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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Irek EO, Amupitan AA, Obadare TO, Aboderin AO. A systematic review of healthcare-associated infections in Africa: An antimicrobial resistance perspective. Afr J Lab Med 2018; 7:796. [PMID: 30568902 PMCID: PMC6296034 DOI: 10.4102/ajlm.v7i2.796] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022] Open
Abstract
Background Healthcare-associated infection (HCAI) is a global health challenge, not only as an issue of patient safety but also as a major driver of antimicrobial resistance (AMR). It is a major cause of morbidity and mortality with economic consequences. Objective This review provides an update on the occurrence of HCAI, as well as the contribution of emerging AMR on healthcare delivery in Africa. Methods We searched PubMed, Cochrane database, African Journals Online and Google Scholar for relevant articles on HCAI in Africa between 2010 and 2017. Preferred reporting items of systematic reviews and meta-analyses guidelines were followed for selection. Thirty-five eligible articles were considered for the qualitative synthesis. Results Of the 35 eligible articles, more than half (n = 21, 60%) were from East Africa. Klebsiella spp., Staphylococcus aureus, Escherichia coli and Pseudomonas spp. were the common pathogens reported in bloodstream infection, (catheter-associated) urinary tract infection, surgical site infection and healthcare-associated pneumonia. Among these various subtypes of HCAI, methicillin-resistant S. aureus (3.9% – 56.8%) and extended-spectrum beta-lactamase producing Gram-negative bacilli (1.9% – 53.0%) were the most reported antimicrobial resistant pathogens. Conclusion This review shows a paucity of HCAI surveillance in Africa and an emergence of AMR priority pathogens. Hence, there is a need for a coordinated national and regional surveillance of both HCAI and AMR in Africa.
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Affiliation(s)
- Emmanuel O Irek
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Adewale A Amupitan
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Temitope O Obadare
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Aaron O Aboderin
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria.,Department of Medical Microbiology and Parasitology, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
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Iosifidis E, Pitsava G, Roilides E. Ventilator-associated pneumonia in neonates and children: a systematic analysis of diagnostic methods and prevention. Future Microbiol 2018; 13:1431-1446. [PMID: 30256161 DOI: 10.2217/fmb-2018-0108] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIM While ventilator-associated pneumonia (VAP) remains frequent in Pediatric ICU, there is no gold standard for diagnosis. METHODOLOGY We conducted a systematic PUBMED analysis (January 1990-January 2017) searching original, full-length studies addressing only pediatric patients; for VAP diagnosis, only those comparing different diagnostic methods and for VAP prevention those implementing preventive measures. RESULTS Among 367 articles, 17 and 16 were analyzed for diagnosis and prevention, respectively. For diagnosis, 13 studies used CDC criteria; whereas, 14 assessed algorithms: clinical pulmonary index score, ventilator-associated events and biomarkers. Among five randomized trials assessing preventive strategies one found a role of probiotics. Ventilator-care bundles reduced VAP rates. CONCLUSION Absence of diagnostic gold standard impedes comparison of current approaches and preventive strategies.
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Affiliation(s)
- Elias Iosifidis
- Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki Greece
| | - Georgia Pitsava
- Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki Greece
| | - Emmanuel Roilides
- Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki Greece
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Infection control bundles in intensive care: an international cross-sectional survey in low- and middle-income countries. J Hosp Infect 2018; 101:248-256. [PMID: 30036635 DOI: 10.1016/j.jhin.2018.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/13/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), the burden of healthcare-associated infections (HCAIs) is not known due to a lack of national surveillance systems, standardized infection definitions, and paucity of infection prevention and control (IPC) organizations and legal infrastructure. AIM To determine the status of IPC bundle practice and the most frequent interventional variables in LMICs. METHODS A questionnaire was emailed to Infectious Diseases International Research Initiative (ID-IRI) Group Members and dedicated IPC doctors working in LMICs to examine self-reported practices/policies regarding IPC bundles. Responding country incomes were classified by World Bank definitions into low, middle, and high. Comparison of LMIC results was then made to a control group of high-income countries (HICs). FINDINGS This survey reports practices from one low-income country (LIC), 16 middle-income countries (MICs) (13 European), compared to eight high-income countries (HICs). Eighteen (95%) MICs had an IPC committee in their hospital, 12 (63.2%) had an annual agreed programme and produced an HCAI report. Annual agreed programmes (87.5% vs 63.2%, respectively) and an annual HCAI report (75.0% vs 63.2%, respectively) were more common in HICs than MICs. All HICs had at least one invasive device-related surveillance programme. Seven (37%) MICs had no invasive device-related surveillance programme, six (32%) had no ventilator-associated pneumonia prevention bundles, seven (37%) had no catheter-associated urinary tract infection prevention bundles, and five (27%) had no central line-associated bloodstream infection prevention bundles. CONCLUSION LMICs need to develop their own bundles with low-cost and high-level-of-evidence variables adapted to the limited resources, with further validation in reducing infection rates.
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Development of a novel prevention bundle for pediatric healthcare-associated viral infections. Infect Control Hosp Epidemiol 2018; 39:1086-1092. [DOI: 10.1017/ice.2018.149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo reduce the healthcare-associated viral infection (HAVI) rate to 0.70 infections or fewer per 1,000 patient days by developing and sustaining a comprehensive prevention bundle.SettingA 546-bed quaternary-care children’s hospital situated in a large urban area.PatientsInpatients with a confirmed HAVI were included. These HAVIs were identified through routine surveillance by infection preventionists and were confirmed using National Healthcare Safety Network definitions for upper respiratory infections (URIs), pneumonia, and gastroenteritis.MethodsQuality improvement (QI) methods and statistical process control (SPC) analyses were used in a retrospective observational analysis of HAVI data from July 2012 through June 2016.ResultsIn total, 436 HAVIs were identified during the QI initiative: 63% were URIs, 34% were gastrointestinal infections, and 2.5% were viral pneumonias. The most frequent pathogens were rhinovirus (n=171) and norovirus (n=83). Our SPC analysis of HAVI rate revealed a statistically significant reduction in March 2014 from a monthly average of 0.81 to 0.60 infections per 1,000 patient days. Among HAVIs with event reviews completed, 15% observed contact with a sick primary caregiver and 15% reported contact with a sick visitor. Patient outcomes identified included care escalation (37%), transfer to ICU (11%), and delayed discharge (19%).ConclusionsThe iterative development, implementation, and refinement of targeted prevention practices was associated with a significant reduction in pediatric HAVI. These practices were ultimately formalized into a comprehensive prevention bundle and provide an important framework for both patient and systems-level interventions that can be applied year-round and across inpatient areas.
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Silva ARAD, Silva TCD, Bom GJT, Vasconcelos RMB, Junior RS. Ventilator-associated pneumonia agents in Brazilian Neonatal Intensive Care Units - a systematic review. Braz J Infect Dis 2018; 22:338-344. [PMID: 30278872 PMCID: PMC9427972 DOI: 10.1016/j.bjid.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/10/2018] [Accepted: 06/15/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections (HAI) in neonates admitted in neonatal intensive care units (NICUs). METHODS We did a systematic review using PRISMA methodology to identify the main etiological agents in Brazilian NICUs. Eligible studies published without period restriction were identified in PUBMED, SCIELO, LILACS and DOAJ. Studies were included if they were conducted in neonates hospitalized at NICU. Studies done in outpatient care, neonates outside NICU, emergency department, primary care, long-term care facilities or a combination of these were excluded. RESULTS We identified 6384 articles in the initial search and four papers met the inclusion criteria. In all studies included, rates of device-associated infections were described, including VAP rates. The VAP incidence density, in exclusively Brazilian NICU, ranged from 3.2 to 9.2 per 1000 ventilator-days. Pneumonia was described as the main HAI in NICU in one article, as the second type of HAI in two other articles and as the fourth type of HAI in the last one. The main pathogens causing all HAI types were described in three of four articles, but, none of the articles reported which pathogens were related or associated to VAP. CONCLUSION Etiological agents causing VAP in Brazilian NICUs are, until the present time, not known.
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Affiliation(s)
- André Ricardo Araujo da Silva
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento Materno-Infantil, Laboratório de Ensino em Controle e Prevenção de Infecções Relacionadas à Assistência à Saúde, Niterói, Brazil; Universidade Federal Fluminense, Faculdade de Medicina, Niterói, RJ, Brazil.
| | - Thais Carolina da Silva
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento Materno-Infantil, Laboratório de Ensino em Controle e Prevenção de Infecções Relacionadas à Assistência à Saúde, Niterói, Brazil
| | - Gabriel José Teixeira Bom
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento Materno-Infantil, Laboratório de Ensino em Controle e Prevenção de Infecções Relacionadas à Assistência à Saúde, Niterói, Brazil
| | - Raissa Maria Bastos Vasconcelos
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento Materno-Infantil, Laboratório de Ensino em Controle e Prevenção de Infecções Relacionadas à Assistência à Saúde, Niterói, Brazil
| | - Robinson Simões Junior
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento Materno-Infantil, Laboratório de Ensino em Controle e Prevenção de Infecções Relacionadas à Assistência à Saúde, Niterói, Brazil
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Goerens A, Lehnick D, Büttcher M, Daetwyler K, Fontana M, Genet P, Lurà M, Morgillo D, Pilgrim S, Schwendener-Scholl K, Regamey N, Neuhaus TJ, Stocker M. Neonatal Ventilator Associated Pneumonia: A Quality Improvement Initiative Focusing on Antimicrobial Stewardship. Front Pediatr 2018; 6:262. [PMID: 30320046 PMCID: PMC6165906 DOI: 10.3389/fped.2018.00262] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/03/2018] [Indexed: 12/24/2022] Open
Abstract
Background and Aims: Neonatal ventilator associated pneumonia (VAP) is a common nosocomial infection and a frequent reason for empirical antibiotic therapy in NICUs. Nonetheless, there is no international consensus regarding diagnostic criteria and management. In a first step, we analyzed the used diagnostic criteria, risk factors and therapeutic management of neonatal VAP by a literature review. In a second step, we aimed to compare suspected vs. confirmed neonatal VAP episodes in our unit according to different published criteria and to analyze interrater-reliability of chest x-rays. Additionally, we aimed to evaluate the development of VAP incidence and antibiotic use after implementation of multifaceted quality improvement changes regarding antimicrobial stewardship and infection control (VAP-prevention-bundle, early-extubation policy, antimicrobial stewardship rounds). Methods: Neonates until 44 weeks of gestation with suspected VAP, hospitalized at our level-III NICU in Lucerne from September 2014 to December 2017 were enrolled. VAP episodes were analyzed according to 4 diagnostic frameworks. Agreement regarding chest x-ray interpretation done by 10 senior physicians was assessed. Annual incidence of suspected and confirmed neonatal VAP episodes and antibiotic days were calculated and compared for the years 2015, 2016, and 2017. Results: 17 studies were identified in our literature review. Overall, CDC-guidelines or similar criteria, requesting radiographic changes as main criteria, are mostly used. Comparison of suspected vs. confirmed neonatal VAP episodes showed a great variance (20.4 vs. 4.5/1,000 ventilator-days). The interrater-reliability of x-ray interpretation was poor (intra-class correlation 0.25). Implemented changes resulted in a gradual decline in annual VAP incidence and antibiotic days from 2015 compared with 2017 (28.8 vs. 7.4 suspected episodes/1,000 ventilator-days, 5.5 vs. 0 confirmed episodes/1,000 ventilator-days and 211 vs. 34.7 antibiotic days/1,000 ventilation-days, respectively). Conclusion: The incidence of suspected VAP and concomitant antibiotic use is much higher than for confirmed VAP, therefore inclusion of suspected episodes should be considered for accurate evaluation. There is a high diagnostic inconsistency and a low reliability of interpretation of chest x-rays regarding VAP. Implementation of combined antimicrobial stewardship and infection control measures may lead to an effective decrease in VAP incidence and antibiotic use.
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Affiliation(s)
- Anouk Goerens
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Dirk Lehnick
- Clinical Trial Unit, University of Lucerne, Lucerne, Switzerland
| | - Michael Büttcher
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Infectious Diseases Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Karin Daetwyler
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Matteo Fontana
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Petra Genet
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Marco Lurà
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric Pulmonology Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Davide Morgillo
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Sina Pilgrim
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Katharina Schwendener-Scholl
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Nicolas Regamey
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric Pulmonology Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Thomas J Neuhaus
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.,Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
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Ventilator-associated Pneumonia in Neonatal Intensive Care Unit Due to Chryseobacterium indologenes. Pediatr Infect Dis J 2017; 36:e353-e355. [PMID: 28806281 DOI: 10.1097/inf.0000000000001730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ventilator-associated pneumonia represents one of the most common nosocomial infections in neonatal intensive care units, increasing morbidity and mortality and associated costs. The authors report the case of a neonatal patient with ventilator-associated pneumonia secondary to Chryseobacterium indologenes and a review of the literature. The most effective empiric treatment for C. indologenes infection remains unclear due to limited data in the literature, and therefore, therapy should be adjusted in accordance with the result of the susceptibility profile.
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Abstract
Neonatal pneumonia may occur in isolation or as one component of a larger infectious process. Bacteria, viruses, fungi, and parasites are all potential causes of neonatal pneumonia, and may be transmitted vertically from the mother or acquired from the postnatal environment. The patient's age at the time of disease onset may help narrow the differential diagnosis, as different pathogens are associated with congenital, early-onset, and late-onset pneumonia. Supportive care and rationally selected antimicrobial therapy are the mainstays of treatment for neonatal pneumonia. The challenges involved in microbiological testing of the lower airways may prevent definitive identification of a causative organism. In this case, secondary data must guide selection of empiric therapy, and the response to treatment must be closely monitored.
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Affiliation(s)
| | - Richard A. Polin
- Corresponding author. Babies Hospital Central, 115, New York, NY, USA.
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42
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Kim N, Ahn Y. Glucose and pH of Oral Secretions in Newborns. CHILD HEALTH NURSING RESEARCH 2017. [DOI: 10.4094/chnr.2017.23.3.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Mohamed ER, Aly SA, Halby HM, Ahmed SH, Zakaria AM, El-Asheer OM. Epidemiological typing of multidrug-resistant Klebsiella pneumoniae, which causes paediatric ventilator-associated pneumonia in Egypt. J Med Microbiol 2017; 66:628-634. [PMID: 28485710 DOI: 10.1099/jmm.0.000473] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Multidrug-resistant Klebsiella pneumoniae is a common nosocomial pathogen that plays an important role in ventilator-associated pneumonia (VAP). This study aimed to define the clonal relatedness of K. pneumoniae strains isolated from paediatric VAP in addition to those isolated from environmental samples. METHODOLOGY This study included 19 clinical and 4 environmental K. pneumoniae isolates recovered from the paediatric intensive care unit (PICU) in Assiut University Children's Hospital. The K. pneumoniae isolates were confirmed by biotyping using API strips and subjected to antimicrobial susceptibility testing. The genes coding K1 and K2 capsular types were detected by PCR. The clonal relationships between the K. pneumoniae isolates were determined by pulsed-field gel electrophoresis (PFGE). RESULTS Ten resistotypes were detected among all the K. pneumoniae isolates, while PFGE identified seventeen K. pneumoniae pulsotypes. Similar PFGE patterns were found between environmental and clinical isolates and between isolates recovered from different patients, suggesting the circulation of K. pneumoniae pathogens in the PICU and the role of the environment in the spread of infection. No correlation was found between the resistotypes and pulsotypes of the K. pneumoniae isolates. PFGE showed higher discriminatory power for the typing of nosocomial K. pneumoniae [Simpson's diversity index (DI)=0.96] than resistotyping (DI=0.72). CONCLUSION As far as we know, this is the first report of the isolation of the same multidrug-resistant (MDR) K. pneumoniae pulsotype from patients and environmental samples in the same hospital ward in Egypt. This study provides a step on the way to understanding the genotyping and epidemiology of MDR K. pneumoniae for enhanced prevention of bacterial transmission.
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Affiliation(s)
- Eman R Mohamed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Egypt
| | - Sherine A Aly
- Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt
| | - Hamada M Halby
- Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Egypt
| | - Shabaan H Ahmed
- Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt
| | - Amira M Zakaria
- Biotechnology Research Institute, Suez Canal University, Ismailia, Egypt
| | - Osama M El-Asheer
- Department of Pediatric Medicine, Faculty of Medicine, Assiut University, Egypt
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Ramasethu J. Prevention and treatment of neonatal nosocomial infections. Matern Health Neonatol Perinatol 2017; 3:5. [PMID: 28228969 PMCID: PMC5307735 DOI: 10.1186/s40748-017-0043-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/27/2017] [Indexed: 12/02/2022] Open
Abstract
Nosocomial or hospital acquired infections threaten the survival and neurodevelopmental outcomes of infants admitted to the neonatal intensive care unit, and increase cost of care. Premature infants are particularly vulnerable since they often undergo invasive procedures and are dependent on central catheters to deliver nutrition and on ventilators for respiratory support. Prevention of nosocomial infection is a critical patient safety imperative, and invariably requires a multidisciplinary approach. There are no short cuts. Hand hygiene before and after patient contact is the most important measure, and yet, compliance with this simple measure can be unsatisfactory. Alcohol based hand sanitizer is effective against many microorganisms and is efficient, compared to plain or antiseptic containing soaps. The use of maternal breast milk is another inexpensive and simple measure to reduce infection rates. Efforts to replicate the anti-infectious properties of maternal breast milk by the use of probiotics, prebiotics, and synbiotics have met with variable success, and there are ongoing trials of lactoferrin, an iron binding whey protein present in large quantities in colostrum. Attempts to boost the immunoglobulin levels of preterm infants with exogenous immunoglobulins have not been shown to reduce nosocomial infections significantly. Over the last decade, improvements in the incidence of catheter-related infections have been achieved, with meticulous attention to every detail from insertion to maintenance, with some centers reporting zero rates for such infections. Other nosocomial infections like ventilator acquired pneumonia and staphylococcus aureus infection remain problematic, and outbreaks with multidrug resistant organisms continue to have disastrous consequences. Management of infections is based on the profile of microorganisms in the neonatal unit and community and targeted therapy is required to control the disease without leading to the development of more resistant strains.
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Affiliation(s)
- Jayashree Ramasethu
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, MedStar Georgetown University Hospital, Washington DC, 20007 USA
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Folic N, Djordjevic Z, Folic M, Markovic S, Vuletic B, Savic D, Gajovic O, Jankovic S. Hospital-Acquired Pneumonia in Newborns with Birth Weight Less Than 1500 Grams: Risk Factors and Causes. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2016. [DOI: 10.1515/sjecr-2016-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Low birth weight newborns (≤1500 grams) are at a high risk of acquiring hospital infections due to the immaturity of the immune system, lack of efficient structural barriers, and an incomplete development of endogenous microbial flora.
The aim of this study was to reveal the potential risk factors for hospital-acquired pneumonia in low birth weight newborns.
This study was a prospective cohort design with a nested case-control study and was conducted between January 1st, 2012 and June 30th, 2015 at the Neonatology Department, Clinical Centre Kragujevac, Serbia. There were 1140 newborns hospitalized at the Neonatology Department for longer than 48 hours during the study period, and 169 of them (14.82%) weighed less than 1500 grams at birth. In total, 73 (43.19%) newborns with low birth weights developed HIs. The most prevalent HI was hospital pneumonia (n=64, 87.67%).
Although univariate analyses identified many risk factors with a significant influence on the occurrence of hospital pneumonia, multivariate analysis identified only the following two independent risk factors for hospital pneumonia in newborns with birth weights below 1500 grams: mechanical ventilation (p=0.003, OR=68.893, 95% CI=4.285-1107.699) and longer hospitalization (p=0.003, OR=1.052, 95% CI=1.017-1.088). Almost all of the pathogens isolated from the patients with pneumonia were gram-negative bacteria (98.50%). More than half of all of the isolates were Acinetobacter spp (37.50%) and Enterobacter spp (18.75%).
Our study showed that mechanical ventilation and prolonged hospitalization were significant risk factors for the development of hospital pneumonia in newborns with birth weights below 1500 grams.
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Affiliation(s)
- Nevena Folic
- Pediatric Clinic, Clinical Centre Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Zorana Djordjevic
- Department of Hospital Infections Control, Clinical Centre Kragujevac, Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia
| | - Marko Folic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia Serbia
- Clinical Pharmacology Department, Clinical Centre Kragujevac, Kragujevac, Serbia
| | - Slavica Markovic
- Pediatric Clinic, Clinical Centre Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Biljana Vuletic
- Pediatric Clinic, Clinical Centre Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Dragana Savic
- Pediatric Clinic, Clinical Centre Kragujevac, Kragujevac, Serbia Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Olgica Gajovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia Serbia
- Infectious Diseases Clinic, Clinical Centre Kragujevac, Kragujevac, Serbia
| | - Slobodan Jankovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia Serbia
- Clinical Pharmacology Department, Clinical Centre Kragujevac, Kragujevac, Serbia
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Torres-Castro C, Valle-Leal J, Martínez-Limón AJ, Lastra-Jiménez Z, Delgado-Bojórquez LC. [Pulmonary complications associated with mechanical ventilation in neonates]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:318-324. [PMID: 29384124 DOI: 10.1016/j.bmhimx.2016.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/12/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND To determine the incidence of0 associated with mechanical ventilation in patients admitted to a service in a second level hospital NICU. METHODS Retrospective analytical study records of newborns admitted to NICU room and receiving mechanical ventilation in a secondary hospital health care. Demographic data, of mechanical ventilation, intubation and complications reported in the clinical record were collected and analyzed in SPSS 20. RESULTS 53 patients selected a total of 40 complications found. The annual incidence of pulmonary complications associated with mechanical ventilation in the area of service neonatology NICU, at a second level hospital at Sonora was 49.05% (95% CI 0.35 to 0.62). The most frequent pulmonary complications were atelectasis 35%, pneumonia 27.5%, pneumothorax 15%, bronchopulmonary dysplasia 15%, pneumomediastinum 15% and pulmonary hemorrhage 2.5%. CONCLUSIONS The presentation of pulmonary complications secondary to mechanical ventilation in neonatal patients is similar to that reported in developing countries. Atelectasis is the most common pulmonary complication in neonatal patients undergoing mechanical ventilation.
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Affiliation(s)
- Cristabel Torres-Castro
- Departamento de Pediatría del Hospital General Regional número uno del Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora, México
| | - Jaime Valle-Leal
- Departamento de Pediatría del Hospital General Regional número uno del Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora, México.
| | - Alba J Martínez-Limón
- Departamento de Neonatología del Hospital General Regional número uno del Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora, México
| | - Zaira Lastra-Jiménez
- Departamento de Epidemiología del Hospital General Regional número uno del Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora, México
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Abstract
Antibiotics are invaluable in the management of neonatal infections. However, overuse or misuse of antibiotics in neonates has been associated with adverse outcomes, including increased risk for future infection, necrotizing enterocolitis, and mortality. Strategies to optimize the use of antibiotics in the neonatal intensive care unit include practicing effective infection prevention, improving the diagnostic evaluation and empiric therapy for suspected infections, timely adjustment of therapy as additional information becomes available, and treating proven infections with an effective, narrow-spectrum agent for the minimum effective duration. Antibiotic stewardship programs provide support for these strategies but require the participation and input of neonatologists as stakeholders to be most effective.
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Affiliation(s)
- Joseph B Cantey
- Division of Neonatal/Perinatal Medicine, Division of Infectious Diseases, Texas A&M Health Science Center College of Medicine, Baylor Scott & White Health, Temple, TX, USA.
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