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Lewnard JA, Charani E, Gleason A, Hsu LY, Khan WA, Karkey A, Chandler CIR, Mashe T, Khan EA, Bulabula ANH, Donado-Godoy P, Laxminarayan R. Burden of bacterial antimicrobial resistance in low-income and middle-income countries avertible by existing interventions: an evidence review and modelling analysis. Lancet 2024:S0140-6736(24)00862-6. [PMID: 38797180 DOI: 10.1016/s0140-6736(24)00862-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/18/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
National action plans enumerate many interventions as potential strategies to reduce the burden of bacterial antimicrobial resistance (AMR). However, knowledge of the benefits achievable by specific approaches is needed to inform policy making, especially in low-income and middle-income countries (LMICs) with substantial AMR burden and low health-care system capacity. In a modelling analysis, we estimated that improving infection prevention and control programmes in LMIC health-care settings could prevent at least 337 000 (95% CI 250 200-465 200) AMR-associated deaths annually. Ensuring universal access to high-quality water, sanitation, and hygiene services would prevent 247 800 (160 000-337 800) AMR-associated deaths and paediatric vaccines 181 500 (153 400-206 800) AMR-associated deaths, from both direct prevention of resistant infections and reductions in antibiotic consumption. These estimates translate to prevention of 7·8% (5·6-11·0) of all AMR-associated mortality in LMICs by infection prevention and control, 5·7% (3·7-8·0) by water, sanitation, and hygiene, and 4·2% (3·4-5·1) by vaccination interventions. Despite the continuing need for research and innovation to overcome limitations of existing approaches, our findings indicate that reducing global AMR burden by 10% by the year 2030 is achievable with existing interventions. Our results should guide investments in public health interventions with the greatest potential to reduce AMR burden.
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Affiliation(s)
- Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.
| | - Esmita Charani
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Alec Gleason
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Clare I R Chandler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Tapfumanei Mashe
- One Health Office, Ministry of Health and Child Care, Harare, Zimbabwe; Health System Strengthening Unit, WHO, Harare, Zimbabwe
| | - Ejaz Ahmed Khan
- Department of Pediatrics, Shifa Tameer-e-Millat University, Shifa International Hospital, Islamabad, Pakistan
| | - Andre N H Bulabula
- Division of Disease Control and Prevention, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Pilar Donado-Godoy
- AMR Global Health Research Unit, Colombian Integrated Program of Antimicrobial Resistance Surveillance, Corporación Colombiana de Investigación Agropecuaria, Cundinamarca, Colombia
| | - Ramanan Laxminarayan
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA.
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Katz J, Khatry SK, Shrestha L, Summers A, Visscher MO, Sherchand JB, Tielsch JM, Subedi S, LeClerq SC, Mullany LC. Impact of topical applications of sunflower seed oil on neonatal mortality and morbidity in southern Nepal: a community-based, cluster-randomised trial. BMJ Glob Health 2024; 9:e013691. [PMID: 38423547 PMCID: PMC10910473 DOI: 10.1136/bmjgh-2023-013691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Hospital-based studies have demonstrated topical applications of sunflower seed oil (SSO) to skin of preterm infants can reduce nosocomial infections and improve survival. In South Asia, replacing traditional mustard with SSO might have similar benefits. METHODS 340 communities in Sarlahi, Nepal were randomised to use mustard oil (MO) or SSO for community practice of daily newborn massage. Women were provided oil in late pregnancy and the first month post partum, and visited daily through the first week of life to encourage massage practice. A separate data collection team visited on days 1, 3, 7, 10, 14, 21 and 28 to record vital status and assess serious bacterial infection. RESULTS Between November 2010 and January 2017, we enrolled 39 479 pregnancies. 32 114 live births were analysed. Neonatal mortality rates (NMRs) were 31.8/1000 (520 deaths, 16 327 births) and 30.5/1000 (478 deaths, 15 676 births) in control and intervention, respectively (relative risk (RR)=0.95, 95% CI: 0.84, 1.08). Among preterm births, NMR was 90.4/1000 (229 deaths, 2533 births) and 79.2/1000 (188 deaths, 2373 births) in control and intervention, respectively (RR=0.88; 95% CI: 0.74, 1.05). Among preterm births <34 weeks, the RR was 0.83 (95% CI: 0.67, 1.02). No statistically significant differences were observed in incidence of serious bacterial infection. CONCLUSIONS We did not find any neonatal mortality or morbidity benefit of using SSO instead of MO as emollient therapy in the early neonatal period. Further studies examining whether very preterm babies may benefit are warranted. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT01177111).
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Affiliation(s)
- Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Laxman Shrestha
- Institute of Medicine, Tribhuvan University, Kirtipur, Nepal
| | - Aimee Summers
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marty O Visscher
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - James M Tielsch
- Global Health, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA
| | - Seema Subedi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project, Kathmandu, Nepal
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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3
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Nyantakyi E, Caci L, Castro M, Schlaeppi C, Cook A, Albers B, Walder J, Metsvaht T, Bielicki J, Dramowski A, Schultes MT, Clack L. Implementation of infection prevention and control for hospitalized neonates: A narrative review. Clin Microbiol Infect 2024; 30:44-50. [PMID: 36414203 DOI: 10.1016/j.cmi.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/04/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The most prevalent infections encountered in neonatal care are healthcare-associated infections. The majority of healthcare-associated infections are considered preventable with evidence-based infection prevention and control (IPC) practices. However, substantial knowledge gaps exist in IPC implementation in neonatal care. Furthermore, the knowledge of factors which facilitate or challenge the uptake and sustainment of IPC programmes in neonatal units is limited. The integration of implementation science approaches in IPC programmes in neonatal care aims to address these problems. OBJECTIVES The aim of this narrative review was to identify determinants which have been reported to influence the implementation of IPC programmes and best practices in inpatient neonatal care settings. SOURCES A literature search was conducted in PubMed, MEDLINE (Medical Literature Analysis and Retrieval System Online) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) in May 2022. Primary study reports published in English, French, German, Spanish, Portuguese, Italian, Danish, Swedish or Norwegian since 2000 were eligible for inclusion. Included studies focused on IPC practices in inpatient neonatal care settings and reported determinants which influenced implementation processes. CONTENT The Consolidated Framework for Implementation Research was used to identify and cluster reported determinants to the implementation of IPC practices and programmes in neonatal care. Most studies reported challenges and facilitators at the organizational level as particularly relevant to implementation processes. The commonly reported determinants included staffing levels, work- and caseloads, as well as aspects of organizational culture such as communication and leadership. IMPLICATIONS The presented knowledge about factors influencing neonatal IPC can support the design, implementation, and evaluation of IPC practices.
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Affiliation(s)
- Emanuela Nyantakyi
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland.
| | - Laura Caci
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Marta Castro
- Neonatal Intensive Care Unit, University Children's Hospital, Basel, Switzerland
| | - Chloé Schlaeppi
- Paediatric Infectious Diseases and Vaccinology, University Children's Hospital, Basel, Switzerland
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, United Kingdom
| | - Bianca Albers
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Joel Walder
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Tuuli Metsvaht
- Department of Paediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Julia Bielicki
- Paediatric Infectious Diseases and Vaccinology, University Children's Hospital, Basel, Switzerland; Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, United Kingdom
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marie-Therese Schultes
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland; Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
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4
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Iroh Tam PY, Bekker A, Bosede Bolaji O, Chimhini G, Dramowski A, Fitzgerald F, Gezmu AM, Nkuranga JB, Okomo U, Stevenson A, Strysko JP. Neonatal sepsis and antimicrobial resistance in Africa. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:677-679. [PMID: 37604175 DOI: 10.1016/s2352-4642(23)00167-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Pui-Ying Iroh Tam
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Research Programme, Blantyre, Malawi; School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi; Division of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Adrie Bekker
- School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Olufunke Bosede Bolaji
- Department of Paediatrics, Federal Teaching Hospital Ido-Ekiti, Ado Ekiti, Nigeria; Department of Paediatrics, Afe Babalola University, Ado Ekiti, Nigeria
| | - Gwendoline Chimhini
- Department of Paediatrics and Child Health, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Angela Dramowski
- School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Felicity Fitzgerald
- Department of Infectious Diseases, Imperial College London, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - John Baptist Nkuranga
- Department of Paediatrics and Child Health, University of Rwanda, Kigali, Rwanda; King Faisal Hospital, Kigali, Rwanda
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia; MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexander Stevenson
- Department of Paediatrics, Mbuya Nehanda Hospital, Harare, Zimbabwe; African Neonatal Association, Harare, Zimbabwe
| | - Jonathan P Strysko
- Department of Paediatrics, Botswana-UPenn Partnership, Gaborone, Botswana
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Kamalo P, Iroh Tam PY, Noniwa T, Mpanga C, Mulambia C, Phiri E, Kumwenda D, Phillipo E, Lissauer S, Kulapani D, Mwinjiwa C. Antimicrobial resistance control activities at a tertiary hospital in a low-resource setting: an example of Queen Elizabeth Central Hospital in Malawi. FRONTIERS IN ANTIBIOTICS 2023; 2:frabi.2023.1202256. [PMID: 38077777 PMCID: PMC7615358 DOI: 10.3389/frabi.2023.1202256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Addressing AMR has been most problematic in low- and middle-income countries, which lack infrastructure, diagnostic capacity, and robust data management systems, among other factors. The implementation of locally-led efforts in a low-income country to develop sustainability and build capacity for AMR control within the existing infrastructure has not been well documented. Methods We detail current AMR control initiatives at Queen Elizabeth Central Hospital, a tertiary referral government hospital in Malawi with limited resources, and present the activities accomplished to date, lessons learned, and challenges ahead. Results The key areas of AMR control initiatives that the group focused on included laboratory diagnostics and surveillance, antimicrobial stewardship, infection prevention and control, pharmacy, leadership, education, and funding. Discussion The hospital AMR Control Working Group increased awareness, built capacity, and implemented activities around AMR control throughout the hospital, in spite of the resource limitations in this setting. Our results are based on the substantial leadership provided by the working group and committed stakeholders who have taken ownership of this process. Conclusion Limited resources pose a challenge to the implementation of AMR control activities in low- and middle-income countries. Leadership is central to implementation. Future efforts will need to transition the initiative from an almost fully personal commitment to one with wider engagement to ensure sustainability.
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Affiliation(s)
- Patrick Kamalo
- Department of Neurosurgery, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Pui-Ying Iroh Tam
- Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi
- Division of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Thokozani Noniwa
- Department of Laboratory Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Chikumbutso Mpanga
- Department of Trauma and Orthopaedic Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Chanizya Mulambia
- Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Ethwako Phiri
- Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Dingase Kumwenda
- Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Ed Phillipo
- Department of Laboratory Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Samantha Lissauer
- Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi
- Dept of Infection and Immunity, University of Liverpool, Liverpool, United Kingdom
| | - David Kulapani
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi
| | - Christina Mwinjiwa
- Department of Pharmacy, Queen Elizabeth Central Hospital, Blantyre, Malawi
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Al Bizri A, Hanna Wakim R, Obeid A, Daaboul T, Charafeddine L, Mounla N, Nakad P, Yunis K. A Quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit in a low-and-middle-income country. BMJ Open Qual 2023; 12:bmjoq-2022-002129. [PMID: 37308256 DOI: 10.1136/bmjoq-2022-002129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Premature and sick neonates in the neonatal intensive care unit (NICU) are in need of central lines placing them at high risk of contracting a central line-associated bloodstream infection (CLABSI). CLABSI extends length of stay to 10-14 days post negative cultures and increases morbidity, use of multiple antibiotics, mortality and hospital cost. To reduce CLABSI rate at the American University of Beirut Medical Center NICU, the National Collaborative Perinatal Neonatal Network developed a quality improvement project to reduce CLABSI rate by 50% over a 1-year period and to sustain reduced CLABSI rate. METHODS Central line insertion and maintenance bundles were implemented for all infants admitted to the NICU necessitating central lines placement. Bundles included hand washing, wearing protective material and sterile drapes during central lines insertion and maintenance. RESULTS CLABSI rate decreased by 76% from 4.82 (6 infections; 1244 catheter days) to 1.09 (2 infection; 1830 catheter days) per 1000 CL days after 1 year. Following the bundles' success in reducing CLABSI rate, they were incorporated permanently to NICU standard procedure and bundle checklists were added to the medical sheets. CLABSI rate was maintained at 1.15 per 1000 CL days during the second year. It then decreased to 0.66 per 1000 CL days in the third year before reaching zero in the fourth year. In total, zero CLABSI rate was sustained for 23 consecutive months. CONCLUSION Reducing CLABSI rate is necessary to improving newborn quality of care and outcome. Our bundles were successful in drastically reducing and sustaining a low CLABSI rate. It was even successful in achieving a zero CLABSI unit for 2 years.
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Affiliation(s)
- Ayah Al Bizri
- National Collaborative Perinatal Neonatal Network, Department Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima Hanna Wakim
- Department Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Alaa Obeid
- Department Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Tania Daaboul
- Department Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Lama Charafeddine
- Department Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Nabil Mounla
- Department Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Pascale Nakad
- National Collaborative Perinatal Neonatal Network, Department Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Khalid Yunis
- National Collaborative Perinatal Neonatal Network, Department Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Nissimov S, Joye S, Kharrat A, Zhu F, Ripstein G, Baczynski M, Choudhury J, Jasani B, Deshpande P, Ye XY, Weisz DE, Jain A. Dopamine or norepinephrine for sepsis-related hypotension in preterm infants: a retrospective cohort study. Eur J Pediatr 2023; 182:1029-1038. [PMID: 36544000 DOI: 10.1007/s00431-022-04758-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
The purpose of this study is to compare the clinical effectiveness of dopamine (DA) versus norepinephrine (NE) as first-line therapy for sepsis-related hypotension in preterm infants. This is a retrospective cohort study over 10 years at two tertiary neonatal units. Preterm infants born < 35 weeks post-menstrual age (PMA), who received DA or NE as primary therapy for hypotension during sepsis, defined as culture-positive or culture-negative infections or necrotizing enterocolitis (NEC), were included. Episode-related mortality (< 7 days from treatment), pre-discharge mortality, and major morbidities among survivors were compared between two groups. Analyses were adjusted using the inverse probability of treatment weighting estimated by propensity score (PS). A total of 156 infants were included, 113 received DA and 43 NE. The mean ± SD PMA at birth and at treatment for the DA and NE groups were 25.8 ± 2.3 vs. 25.2 ± 2.0 weeks and 27.7 ± 3.0 vs. 27.1 ± 2.6 weeks, respectively (p > 0.05). Pre-treatment, the NE group had higher mean airway pressure (14 ± 4 vs. 12 ± 4 cmH2O), heart rate (185 ± 17 vs. 175 ± 17 beats per minute), and median (IQR) fraction of inspired oxygen [0.67 (0.42, 1.0) vs. 0.52 (0.32, 0.82)] (p < 0.05 for all). After PS adjustment, NE was associated with lower episode-related mortality [adjusted odds ratio (95% CI) 0.55 (0.33, 0.92)], pre-discharge mortality [0.60 (0.37, 0.97)], post-illness new diagnosis of significant neurologic injury [0.32 (0.13, 0.82)], and subsequent occurrence of NEC/sepsis among the survivors [0.34, (0.18, 0.65)]. CONCLUSION NE may be more effective than DA for management of sepsis-related hypotension among preterm infants. These data provide a rationale for prospective evaluation of these commonly used agents. WHAT IS KNOWN •Dopamine is the commonest vasoactive agent used to support blood pressure among preterm infants. •For adult patients, norepinephrine is recommended as the preferred therapy over dopamine for septic shock. WHAT IS NEW •This is the first study examining the relative clinical effectiveness of dopamine and norepinephrine as first-line pharmacotherapy for sepsis-related hypotension among preterm infants. •Norepinephrine use may be associated with lower mortality and morbidity than dopamine in preterm infants with sepsis.
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Affiliation(s)
- Sagee Nissimov
- Department of Paediatrics, Mount Sinai Hospital, ON, Toronto, Canada
| | - Sébastien Joye
- Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Ashraf Kharrat
- Department of Paediatrics, Mount Sinai Hospital, ON, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Faith Zhu
- Department of Paediatrics, Mount Sinai Hospital, ON, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Michelle Baczynski
- Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada
| | - Julie Choudhury
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Bonny Jasani
- Division of Neonatology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Poorva Deshpande
- Department of Paediatrics, Mount Sinai Hospital, ON, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Xiang Y Ye
- Lunnenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Dany E Weisz
- Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Amish Jain
- Department of Paediatrics, Mount Sinai Hospital, ON, Toronto, Canada.
- Lunnenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
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8
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Kartikeswar G, Parikh T, Randive B, Kinikar A, Rajput U, Valvi C, Vaidya U, Malwade S, Agarkhedkar S, Kadam A, Smith R, Westercamp M, Schumacher C, Mave V, Robinson M, Gupta A, Milstone A, Manabe Y, Johnson J. Bloodstream infections in neonates with central venous catheters in three tertiary neonatal intensive care units in Pune, India. J Neonatal Perinatal Med 2023; 16:507-516. [PMID: 37718859 PMCID: PMC10875914 DOI: 10.3233/npm-221110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Neonates admitted to the neonatal intensive care unit (NICU) are at risk for healthcare-associated infections, including central line-associated bloodstream infections. We aimed to characterize the epidemiology of bloodstream infections among neonates with central venous catheters admitted to three Indian NICUs. METHODS We conducted a prospective cohort study in three tertiary NICUs, from May 1, 2017 until July 31, 2019. All neonates admitted to the NICU were enrolled and followed until discharge, transfer, or death. Cases were defined as positive blood cultures in neonates with a central venous catheter in place for greater than 2 days or within 2 days of catheter removal. RESULTS During the study period, 140 bloodstream infections were identified in 131 neonates with a central venous catheter. The bloodstream infection rate was 11.9 per 1000 central line-days. Gram-negative organisms predominated, with 38.6% of cases caused by Klebsiella spp. and 14.9% by Acinetobacter spp. Antimicrobial resistance was prevalent among Gram-negative isolates, with 86.9% resistant to third- or fourth-generation cephalosporins, 63.1% to aminoglycosides, 61.9% to fluoroquinolones, and 42.0% to carbapenems. Mortality and length of stay were greater in neonates with bloodstream infection than in neonates without bloodstream infection (unadjusted analysis, p < 0.001). CONCLUSIONS We report a high bloodstream infection rate among neonates with central venous catheters admitted to three tertiary care NICUs in India. Action to improve infection prevention and control practices in the NICU is needed to reduce the morbidity and mortality associated with BSI in this high-risk population.
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Affiliation(s)
- G.A.P. Kartikeswar
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - T.B. Parikh
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - B. Randive
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - A. Kinikar
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - U.C. Rajput
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - C. Valvi
- Department of Pediatrics, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - U. Vaidya
- Division of Neonatology, Department of Pediatrics, King Edward Memorial Hospital, Pune, India
| | - S. Malwade
- Department of Pediatrics, Dr. D.Y. Patil Medical College, Pune, India
| | - S. Agarkhedkar
- Department of Pediatrics, Dr. D.Y. Patil Medical College, Pune, India
| | - A. Kadam
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - R.M. Smith
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M. Westercamp
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - C. Schumacher
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - V. Mave
- Byramjee-Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M.L. Robinson
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A. Gupta
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A.M. Milstone
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Y.C. Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J. Johnson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Sands K, Carvalho MJ, Spiller OB, Portal EAR, Thomson K, Watkins WJ, Mathias J, Dyer C, Akpulu C, Andrews R, Ferreira A, Hender T, Milton R, Nieto M, Zahra R, Shirazi H, Muhammad A, Akif S, Jan MH, Iregbu K, Modibbo F, Uwaezuoke S, Chan GJ, Bekele D, Solomon S, Basu S, Nandy RK, Naha S, Mazarati JB, Rucogoza A, Gaju L, Mehtar S, Bulabula ANH, Whitelaw A, Walsh TR. Characterisation of Staphylococci species from neonatal blood cultures in low- and middle-income countries. BMC Infect Dis 2022; 22:593. [PMID: 35790903 PMCID: PMC9254428 DOI: 10.1186/s12879-022-07541-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/15/2022] [Indexed: 11/14/2022] Open
Abstract
Background In low- and middle-income countries (LMIC) Staphylococcus aureus is regarded as one of the leading bacterial causes of neonatal sepsis, however there is limited knowledge on the species diversity and antimicrobial resistance caused by Gram-positive bacteria (GPB). Methods We characterised GPB isolates from neonatal blood cultures from LMICs in Africa (Ethiopia, Nigeria, Rwanda, and South Africa) and South-Asia (Bangladesh and Pakistan) between 2015–2017. We determined minimum inhibitory concentrations and performed whole genome sequencing (WGS) on Staphylococci isolates recovered and clinical data collected related to the onset of sepsis and the outcome of the neonate up to 60 days of age. Results From the isolates recovered from blood cultures, Staphylococci species were most frequently identified. Out of 100 S. aureus isolates sequenced, 18 different sequence types (ST) were found which unveiled two small epidemiological clusters caused by methicillin resistant S. aureus (MRSA) in Pakistan (ST8) and South Africa (ST5), both with high mortality (n = 6/17). One-third of S. aureus was MRSA, with methicillin resistance also detected in Staphylococcus epidermidis, Staphylococcus haemolyticus and Mammaliicoccus sciuri. Through additional WGS analysis we report a cluster of M. sciuri in Pakistan identified between July-November 2017. Conclusions In total we identified 14 different GPB bacterial species, however Staphylococci was dominant. These findings highlight the need of a prospective genomic epidemiology study to comprehensively assess the true burden of GPB neonatal sepsis focusing specifically on mechanisms of resistance and virulence across species and in relation to neonatal outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07541-w.
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Swanson SJ, Martinez KK, Shaikh HA, Philipo GM, Martinez J, Mushi EJ. Every breath counts: Lessons learned in developing a training NICU in Northern Tanzania. Front Pediatr 2022; 10:958628. [PMID: 36090561 PMCID: PMC9452716 DOI: 10.3389/fped.2022.958628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Neonatal mortality rates in resource-limited hospitals of Sub-Saharan Africa (SSA) remain disproportionately high and are likely underestimated due to misclassification of extremely preterm births as "stillbirths" or "abortions", incomplete death registries, fear of repercussions from hospital and governmental authorities, unrecorded village deaths, and cultural beliefs surrounding the viability of premature newborns. While neonatology partnerships exist between high income countries and hospitals in SSA, efforts have largely been directed toward improving newborn survival through neonatal resuscitation training and provision of equipment to nascent neonatal intensive care units (NICUs). These measures are incomplete and fail to address the challenges which NICUs routinely face in low-resource settings. We draw on lessons learned in the development of a low-technology referral NICU in Tanzania that achieved an overall 92% survival rate among infants. LESSONS LEARNED Achieving high survival rates among critically ill and preterm neonates in SSA is possible without use of expensive, advanced-skill technologies like mechanical ventilators. Evidence-based protocols adapted to low-resource hospitals, mentorship of nurses and physicians, changes in hierarchal culture, improved nurse-infant staffing ratios, involvement of mothers, improved procurement of consumables and medications, and bedside diagnostics are necessary steps to achieving high survival rates. Our NICU experience indicates that low-technology solutions of thermoregulation, respiratory support via continuous positive airway pressure, feeding protocols and infection control measures can ensure that infants not only survive, but thrive. CONCLUSIONS Neonatal mortality and survival of preterm newborns can be improved through a long-term commitment to training NICU staff, strengthening basic neonatal care practices, contextually appropriate protocols, and limited technology.
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Affiliation(s)
- Stephen J Swanson
- Department of Paediatrics, Arusha Lutheran Medical Centre, Arusha, Tanzania.,Global Pediatrics Program, University of Minnesota, Minneapolis, MN, United States
| | - Kendra K Martinez
- Department of Paediatrics, Arusha Lutheran Medical Centre, Arusha, Tanzania.,Global Pediatrics Program, University of Minnesota, Minneapolis, MN, United States
| | - Henna A Shaikh
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Godbless M Philipo
- Department of Paediatrics, Arusha Lutheran Medical Centre, Arusha, Tanzania
| | - Jarian Martinez
- Department of Paediatrics, Arusha Lutheran Medical Centre, Arusha, Tanzania
| | - Evelyine J Mushi
- Department of Paediatrics, Arusha Lutheran Medical Centre, Arusha, Tanzania.,Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
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