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Kalter HD, Koffi AK, Perin J, Kamwe MA, Black RE. Maternal interventions to decrease stillbirths and neonatal mortality in Tanzania: evidence from the 2017-18 cross-sectional Tanzania verbal and social autopsy study. BMC Pregnancy Childbirth 2023; 23:849. [PMID: 38082404 PMCID: PMC10714492 DOI: 10.1186/s12884-023-06099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Reduction of Tanzania's neonatal mortality rate has lagged behind that for all under-fives, and perinatal mortality has remained stagnant over the past two decades. We conducted a national verbal and social autopsy (VASA) study to estimate the causes and social determinants of stillbirths and neonatal deaths with the aim of identifying relevant health care and social interventions. METHODS A VASA interview was conducted of all stillbirths and neonatal deaths in the prior 5 years identified by the 2015-16 Tanzania Demographic and Health Survey. We evaluated associations of maternal complications with antepartum and intrapartum stillbirth and leading causes of neonatal death; conducted descriptive analyses of antenatal (ANC) and delivery care and mothers' careseeking for complications; and developed logistic regression models to examine factors associated with delivery place and mode. RESULTS There were 204 stillbirths, with 185 able to be classified as antepartum (88 [47.5%]) or intrapartum (97 [52.5%]), and 228 neonatal deaths. Women with an intrapartum stillbirth were 6.5% (adjusted odds ratio (aOR) = 1.065, 95% confidence interval (CI) 1.002, 1.132) more likely to have a C-section for every additional hour before delivery after reaching the birth attendant. Antepartum hemorrhage (APH), maternal anemia, and premature rupture of membranes (PROM) were significantly positively associated with early neonatal mortality due to preterm delivery, intrapartum-related events and serious infection, respectively. While half to two-thirds of mothers made four or more ANC visits (ANC4+), a third or fewer received quality ANC (Q-ANC). Women with a complication were more likely to deliver at hospital only if they received Q-ANC (neonates: aOR = 4.5, 95% CI 1.6, 12.3) or ANC4+ (stillbirths: aOR = 11.8, 95% CI 3.6, 38.0). Nevertheless, urban residence was the strongest predictor of hospital delivery. CONCLUSIONS While Q-ANC and ANC4 + boosted hospital delivery among women with a complication, attendance was low and the quality of care is critical. Quality improvement efforts in urban and rural areas should focus on early detection and management of APH, maternal anemia, PROM, and prolonged labor, and on newborn resuscitation.
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Affiliation(s)
- Henry D Kalter
- Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Alain K Koffi
- Department of International Health, Health Systems, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jamie Perin
- Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Mlemba A Kamwe
- National Bureau of Statistics, Dodoma, United Republic of Tanzania
| | - Robert E Black
- Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Majigo M, Makupa J, Mwazyunga Z, Luoga A, Kisinga J, Mwamkoa B, Kim S, Joachim A. Bacterial Aetiology of Neonatal Sepsis and Antimicrobial Resistance Pattern at the Regional Referral Hospital, Dar es Salam, Tanzania; A Call to Strengthening Antibiotic Stewardship Program. Antibiotics (Basel) 2023; 12:antibiotics12040767. [PMID: 37107129 PMCID: PMC10135403 DOI: 10.3390/antibiotics12040767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
The diagnosis of neonatal sepsis in lower-income countries is mainly based on clinical presentation. The practice necessitates empirical treatment with limited aetiology and antibiotic susceptibility profile knowledge, prompting the emergence and spread of antimicrobial resistance. We conducted a cross-sectional study to determine the aetiology of neonatal sepsis and antimicrobial resistance patterns. We recruited 658 neonates admitted to the neonatal ward with signs and symptoms of sepsis and performed 639 automated blood cultures and antimicrobial susceptibility testing. Around 72% of the samples were culture positive; Gram-positive bacteria were predominantly isolated, contributing to 81%. Coagulase-negative Staphylococci were the most isolates, followed by Streptococcus agalactiae. Overall, antibiotic resistance among Gram-positive pathogens ranged from 23% (Chloramphenicol) to 93% (Penicillin) and from 24.7% (amikacin) to 91% (ampicillin) for Gram-negative bacteria. Moreover, about 69% of Gram-positive and 75% of Gram-negative bacteria were multidrug-resistant (MDR). We observed about 70% overall proportion of MDR strains, non-significantly more in Gram-negative than Gram-positive pathogens (p = 0.334). In conclusion, the pathogen causing neonatal sepsis in our setting exhibited a high resistance rate to commonly used antibiotics. The high rate of MDR pathogens calls for strengthening antibiotic stewardship programs.
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Affiliation(s)
- Mtebe Majigo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Jackline Makupa
- Medipeace Global Health, Dar es Salaam P.O. Box 77978, Tanzania
| | - Zivonishe Mwazyunga
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Anna Luoga
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Julius Kisinga
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Bertha Mwamkoa
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Sukyung Kim
- Medipeace Global Health, Dar es Salaam P.O. Box 77978, Tanzania
| | - Agricola Joachim
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
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Mashau RC, Meiring ST, Dramowski A, Magobo RE, Quan VC, Perovic O, von Gottberg A, Cohen C, Velaphi S, van Schalkwyk E, Govender NP. Culture-confirmed neonatal bloodstream infections and meningitis in South Africa, 2014-19: a cross-sectional study. Lancet Glob Health 2022; 10:e1170-e1178. [PMID: 35839815 PMCID: PMC9296659 DOI: 10.1016/s2214-109x(22)00246-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Few population-level estimates of invasive neonatal infections have been reported from sub-Saharan Africa. We estimated the national incidence risk, aetiology, and pathogen antimicrobial susceptibility for culture-confirmed neonatal bloodstream infections and meningitis in South Africa. METHODS We conducted a cross-sectional study of neonates (<28 days of life) admitted to neonatal or paediatric wards of 256 public sector health facilities in South Africa during 2014-19. Diagnostic pathology records from Jan 1, 2014, to Dec 31, 2019, were extracted from a national pathology data warehouse. A case was defined as a neonate with at least one positive blood or cerebrospinal fluid culture during a 14-day period. Incidence risk was calculated using annual numbers of registered livebirths. Among the causative pathogens identified, we calculated the proportion of cases attributed to each of them, as well as the rates of antibiotic susceptibility of Gram-positive and Gram-negative bacteria. FINDINGS Among 43 438 records of positive cultures, there were 37 631 incident cases of neonatal infection with at least one pathogen isolated. The overall incidence risk of culture-confirmed infections was 6·0 per 1000 livebirths (95% CI 6·0-6·1). The incidence risk of late-onset sepsis (days 3-27 of life) was 4·9 per 1000 livebirths (4·9-5·0) and that of early-onset sepsis (days 0-2 of life) was 1·1 per 1000 livebirths (1·1-1·1); risk ratio 4·4 (95% CI 4·3-4·5). The cause of infection differed by syndrome, timing of infection onset, facility, and province, although Klebsiella pneumoniae (26%), Acinetobacter baumannii (13%), and Staphylococcus aureus (12%) were the dominant pathogens overall. Gram-negative bacteria had declining susceptibility to most antibiotics over the study period. INTERPRETATION We found a high incidence risk of late-onset sepsis with provincial variations, predominance of K pneumoniae, and declining antibiotic susceptibility among Gram-negative bacteria. This national surveillance in an upper-middle-income country provides a baseline burden of neonatal infections against which the impact of future clinical and public health interventions can be measured. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Rudzani C Mashau
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
| | - Susan T Meiring
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Rindidzani E Magobo
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Vanessa C Quan
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Olga Perovic
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Erika van Schalkwyk
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Nelesh P Govender
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Institute of Infection and Immunity, St George's University of London, London, UK; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
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Sands K, Spiller OB, Thomson K, Portal EAR, Iregbu KC, Walsh TR. Early-Onset Neonatal Sepsis in Low- and Middle-Income Countries: Current Challenges and Future Opportunities. Infect Drug Resist 2022; 15:933-946. [PMID: 35299860 PMCID: PMC8921667 DOI: 10.2147/idr.s294156] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/17/2022] [Indexed: 12/18/2022] Open
Abstract
Neonatal sepsis is defined as a systemic infection within the first 28 days of life, with early-onset sepsis (EOS) occurring within the first 72h, although the definition of EOS varies in literature. Whilst the global incidence has dramatically reduced over the last decade, neonatal sepsis remains an important cause of neonatal mortality, highest in low- and middle-income countries (LMICs). Symptoms at the onset of neonatal sepsis can be subtle, and therefore EOS is often difficult to diagnose from clinical presentation and laboratory testing and blood cultures are not always conclusive or accessible, especially in resource limited countries. Although the World Health Organisation (WHO) currently advocates a ß-lactam, and gentamicin for first line treatment, availability and cost influence the empirical antibiotic therapy administered. Antibiotic treatment of neonatal sepsis in LMICs is highly variable, partially caused by factors such as cost of antibiotics (and who pays for them) and access to certain antibiotics. Antimicrobial resistance (AMR) has increased considerably over the past decade and this review discusses current microbiology data available in the context of the diagnosis, and treatment for EOS. Importantly, this review highlights a large variability in data availability, methodology, availability of diagnostics, and aetiology of sepsis pathogens.
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Affiliation(s)
- Kirsty Sands
- Ineos Institute of Antimicrobial Research, Department of Zoology, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Owen B Spiller
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Kathryn Thomson
- Ineos Institute of Antimicrobial Research, Department of Zoology, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | | | | | - Timothy R Walsh
- Ineos Institute of Antimicrobial Research, Department of Zoology, University of Oxford, Oxford, UK
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
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Malmir M, Boroojerdi NA, Masoumi SZ, Parsa P. Factors affecting postpartum infection: A systematic review. Infect Disord Drug Targets 2021; 22:e291121198367. [PMID: 34844548 DOI: 10.2174/1871526521666211129100519] [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] [Received: 04/22/2021] [Revised: 06/15/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Puerperal infection is used to describe any bacterial infection of the reproductive tract after delivery. Identifying the factors affecting postpartum infections can reduce the risk and complications of such factors and postpartum maternal mortality. OBJECTIVE This structured study was designed to evaluate factors affecting postpartum infections. METHODS In this study, after selecting Scopus, PubMed, SID, and Web of Science electronic databases, all observational studies (cohort and case-control) available and published in Farsi and English to investigate factors affecting postpartum infections were searched. The search was performed using the terms postpartum, infection, wound infection, puerperium, reason, risk factor, and their equivalent Persian words from 2010 to November 2019 regardless of publication status. RESULTS Out of the 3227 studies obtained, 19 were reviewed after removing irrelevant articles, duplicates (shared in databases), and animal samples. Age, level of education, delivery method, presence of episiotomy, anemia due to postpartum hemorrhage, interventions and manipulations during childbirth, prenatal hygiene, Povidone Iodine usage before delivery to wash the vagina, antibiotic prevention, increased labor duration, obesity, and the presence of bacteria were common symptoms affecting postpartum infection. CONCLUSION In this study, the factors affecting postpartum infection have been identified, some of which are avoidable. Identifying these factors helps reduce postpartum infections and their complications.
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Affiliation(s)
- Maryam Malmir
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan. Iran
| | | | - Seyedeh Zahra Masoumi
- Mother and Child Care Research Center, Midwifery Department, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan. Iran
| | - Paarisa Parsa
- , School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan. Iran
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Maternal vaccination with a type-III glycoconjugate protects mouse neonates against Group B Streptococcus intranasal infection. Sci Rep 2021; 11:21384. [PMID: 34725414 PMCID: PMC8560876 DOI: 10.1038/s41598-021-00941-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022] Open
Abstract
Group B Streptococcus (GBS) is generally an asymptomatic colonizer of human mucosa but it occasionally infects pregnant women and neonates through vertical transmission, causing disease during the first weeks of life with frequent and severe complications. Preclinical studies have shown that maternal vaccination with polysaccharide-based vaccines protects mothers and offspring from GBS mucosal colonization and consecutive infection. In these models, bacteria were inoculated in mouse either intravaginally in the last trimester of pregnancy or systemically in pups. Here, we investigated whether maternal vaccination with glycoconjugate vaccines may also prevent GBS-mediated colonization and disease in neonates using an infection route that more closely mimics inhalation or ingestion of bacteria during human delivery. To address this point, mice aged less than two days were intranasally challenged with epidemiologically relevant GBS strains. Bacteria were found to colonize nose and intestine, reaching in some cases lungs and blood during the first days of life. Bacteria were also found in vagina of a fraction of colonized female mice within the first month of life. GBS-specific IgG induced by maternal vaccination with a glycoconjugate vaccine formulation were found in blood and mucosal tissues of newborns. Finally, when intranasally challenged with GBS serotype III strains, pups delivered by vaccinated mothers were partially protected against mucosal colonization and deeper infection.
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Low birth weight and birth weight status in Bangladesh: A systematic review and meta-analysis. ANTHROPOLOGICAL REVIEW 2021. [DOI: 10.2478/anre-2021-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The prevalence of low birth weight (LBW) is high in Bangladesh, but no study has collated recent estimates of LBW prevalence from throughout the country. The aim of this meta-analysis was to evaluate the prevalence of LBW and birth weight status in Bangladesh. We searched PubMed, Medline, Ovo and Google Scholar to find published articles in national and international journals from 2000–2020 and reviewed for relevance. Meta-analysis and Q test were performed to estimate the prevalence and heterogeneity of LBW from all included articles. Meta-regression was done to quantify associations with sample size and study year. Stratified analysis was conducted and effect size calculated for differences in LBW prevalence by sex, division and urban/rural area. In total 48 studies with 166,520 births were found and included in this meta-analysis. The pooled prevalence of LBW was 29.1% (95% CI, 28.9–29.3%) in overall, 29.9% (29.7–30.2%) in rural and 15.7% (14.9–16.6%) in urban areas. There was no significant difference in average birth weight between boys and girls (SD, 0.71; 95% CI, −0.43–1.83). Prevalence of LBW was higher in north-east Bangladesh compared to other zones (p<0.05). The pooled prevalence of LBW did not change significantly for last two decades. The prevalence of LBW in Bangladesh remains high. Lack of improvement suggests an urgent need for scaled up maternal and prenatal interventions and services known to reduce LBW. Urban/rural and divisional differences in rates suggest areas of greatest need.
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Chorioamnionitis and Risk for Maternal and Neonatal Sepsis: A Systematic Review and Meta-analysis. Obstet Gynecol 2021; 137:1007-1022. [PMID: 33957655 DOI: 10.1097/aog.0000000000004377] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To estimate the risk of maternal and neonatal sepsis associated with chorioamnionitis. DATA SOURCES PubMed, BIOSIS, and ClinicalTrials.gov databases were systematically searched for full-text articles in English from inception until May 11, 2020. METHODS OF STUDY SELECTION We screened 1,251 studies. Randomized controlled trials, case-control, or cohort studies quantifying a relationship between chorioamnionitis and sepsis in mothers (postpartum) or neonates born at greater than 22 weeks of gestation were eligible. Studies were grouped for meta-analyses according to exposures of histologic or clinical chorioamnionitis and outcomes of maternal or neonatal sepsis. TABULATION, INTEGRATION, AND RESULTS One hundred three studies were included, and 55 met criteria for meta-analysis (39 studies of preterm neonates, 10 studies of general populations of preterm and term neonates, and six studies of late preterm and term neonates). Study details and quantitative data were abstracted. Random-effects models were used to generate pooled odds ratios (ORs); most studies only reported unadjusted results. Histologic chorioamnionitis was associated with confirmed and any early-onset neonatal sepsis (unadjusted pooled ORs 4.42 [95% CI 2.68-7.29] and 5.88 [95% CI 3.68-9.41], respectively). Clinical chorioamnionitis was also associated with confirmed and any early-onset neonatal sepsis (unadjusted pooled ORs 6.82 [95% CI 4.93-9.45] and 3.90 [95% CI 2.74-5.55], respectively). Additionally, histologic and clinical chorioamnionitis were each associated with higher odds of late-onset sepsis in preterm neonates. Confirmed sepsis incidence was 7% (early-onset) and 22% (late-onset) for histologic and 6% (early-onset) and 26% (late-onset) for clinical chorioamnionitis-exposed neonates. Three studies evaluated chorioamnionitis and maternal sepsis and were inconclusive. CONCLUSION Both histologic and clinical chorioamnionitis were associated with early- and late-onset sepsis in neonates. Overall, our findings support current guidelines for preventative neonatal care. There was insufficient evidence to determine the association between chorioamnionitis and maternal sepsis. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42020156812.
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Nyma Z, Rahman M, Hasan SMM, Roby NU, Khanam F, Alam ME, Ali M. Prevalence and Associated Risk Factors of Sepsis among Neonates Admitted into Neonatal Intensive Care Units of Public Hospitals in Dhaka. Cureus 2020; 12:e7461. [PMID: 32351840 PMCID: PMC7188015 DOI: 10.7759/cureus.7461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To determine the prevalence and associated risk factors of sepsis among neonates admitted into neonatal intensive care units (NICU) of public hospitals in Dhaka. METHODS This was a cross-sectional study conducted among 173 neonates admitted into the NICUs of Dhaka Medical College Hospital (DMCH) and Dhaka Shishu (Children) Hospital from March 1, 2016 to September 30, 2016 at Dhaka, Bangladesh. On the basis of the presence of clinical signs and symptoms of sepsis, neonates were admitted into the NICUs. The weight of the baby was measured and blood culture, complete blood count (CBC), C-reactive protein (CRP) and urine R/M/E were done at the time of admission. The neonates, who had positive blood culture reports, were confirmed as having sepsis. After receiving informed written consent, maternal data were collected from the mother of the neonate and neonatal data were collected from NICUs. RESULTS The prevalence of sepsis among the neonates admitted into NICU of the concerned public hospitals in Dhaka was 69.35%. In the multiple logistic regression model, perinatal asphyxia (adjusted odds ratio (aOR) = 3.37, 95% confidence interval (CI) = 1.27-8.90), presence of infection at umbilical cord (aOR = 3.32, 95% CI = 1.40-7.85), history of bottle feeding of the neonates (aOR = 3.02, 95% CI = 1.11-8.25) and pre-existing maternal infection (aOR = 4.44, 95% CI = 1.92-10.26) were significantly (p-value < 0.05) associated with neonatal sepsis. The odds of developing sepsis among the neonates with ≤ 2.5 kg weight at admission was more than three times higher (aOR 3.82, 95% CI = 1.59-9.19) than neonates with admission weight > 2.5 kg. CONCLUSION Like other South Asian countries, the prevalence of neonatal sepsis is alarming in Bangladesh. Further research should be conducted to measure the burden of infections in the entire neonatal period and observe the effects of biological risk factors on the early and late-onset neonatal sepsis.
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Affiliation(s)
- Zannatun Nyma
- Epidemiology and Public Health, American International University Bangladesh, Dhaka, BGD
| | - Mahfuzur Rahman
- Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD
| | - S M Mehedi Hasan
- Epidemiology and Public Health, United International University, Dhaka, BGD
| | - Naym Uddin Roby
- Epidemiology and Public Health, North South University, Dhaka, BGD
| | - Farhana Khanam
- Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD
| | - Md Ehsanul Alam
- Physical Medicine and Rehabilitation, Dhaka Medical College and Hospital, Dhaka, BGD
| | - Mohammad Ali
- Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD
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Bulabula ANH, Dramowski A, Mehtar S. Transmission of multidrug-resistant Gram-negative bacteria from colonized mothers to their infants: a systematic review and meta-analysis. J Hosp Infect 2019; 104:57-67. [PMID: 31604126 DOI: 10.1016/j.jhin.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/22/2019] [Accepted: 10/01/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Neonatal sepsis remains a leading cause of neonatal mortality. Maternal bacterial colonization plays a major role in transmission to the infant, with potential for subsequent development of neonatal sepsis with maternally derived strains. AIM To review the molecular evidence supporting transmission of multidrug-resistant Gram-negative bacteria (MDR-GNB) from colonized mothers to their infants and the risk factors for MDR-GNB transmission. METHODS PubMed and Scopus were searched for studies investigating the mechanisms, risk factors for and/or scale of transmission of MDR-GNB from colonized mothers to their infants. Random effects meta-analyses were performed to determine pooled proportions of MDR-GNB transmission and the neonatal outcomes of transmission. FINDINGS Eight studies were included in the narrative description and six in the meta-analysis. Five studies used pulsed-field gel electrophoresis to assess relatedness of isolates from colonized mothers and their infants. Pooled proportion of MDR-GNB transmission from colonized mothers to their infants was 27% (95% confidence interval (CI): 8-47%). Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae were the most frequently studied MDR-GNB pathogens transmitted between mother-infant pairs. Following mother-to-infant transmission of an MDR-GNB pathogen, the pooled proportion for the outcome of neonatal colonization was 19% (95% CI: 3-35%). CONCLUSION This systematic review strongly supports MDR and/or ESBL Enterobacteriaceae transmission from colonized mothers to their infants, with subsequent infant colonization. The risk factors contributing to transmission of MDR-GNB between colonized mothers and their infants warrants further research.
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Affiliation(s)
- A N H Bulabula
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Infection Control Africa Network, Cape Town, South Africa.
| | - A Dramowski
- Infection Control Africa Network, Cape Town, South Africa; Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - S Mehtar
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Infection Control Africa Network, Cape Town, South Africa
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Risk Factors for Vaginal Colonization and Relationship between Bacterial Vaginal Colonization and In-Hospital Outcomes in Women with Obstructed Labor in a Ugandan Regional Referral Hospital. Int J Microbiol 2018; 2018:6579139. [PMID: 30327672 PMCID: PMC6171204 DOI: 10.1155/2018/6579139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction The proportion of women with severe maternal morbidity from obstructed labor is between 2 and 12% in resource-limited settings. Maternal vaginal colonization with group B streptococcus (GBS), Escherichia coli, and Enterococcus spp. is associated with maternal and neonatal morbidity. It is unknown if vaginal colonization with these organisms in obstructed labor women is associated with poor outcomes. Objectives To determine whether vaginal colonization with GBS, E. coli, or Enterococcus is associated with increased morbidity among women with obstructed labor and to determine the risk factors for colonization and antibiotic susceptibility patterns. Methods We screened all women presenting in labor to Uganda's Mbarara Regional Referral Hospital maternity ward from April to October 2015 for obstructed labor. Those meeting criteria had vaginal swabs collected prior to Cesarean delivery and surgical antibiotic prophylaxis. Swabs were inoculated onto sterile media for routine bacterial culture and antimicrobial susceptibility testing. Results Overall, 2,168 women were screened and 276 (13%) women met criteria for obstructed labor. Vaginal swabs were collected from 272 women (99%), and 170 (64%) were colonized with a potential pathogen: 49% with E. coli, 5% with GBS, and 8% with Enterococcus. There was no difference in maternal and fetal clinical outcomes between those colonized and not colonized. The number of hours in labor was a significant independent risk factor for vaginal colonization (aOR 1.02, 95% CI 1.00–1.03, P=0.04). Overall, 38% of GBS was resistant to penicillin; 61% of E. coli was resistant to ampicillin, 4% to gentamicin, and 5% to ceftriaxone and cefepime. All enterococci were ampicillin and vancomycin susceptible. Conclusion There was no difference in maternal or neonatal morbidity between women with vaginal colonization with E. coli, GBS, and Enterococcus and those who were not colonized. Duration of labor was associated with increased risk of vaginal colonization in women with obstructed labor.
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Bojang A, Kendall L, Usuf E, Egere U, Mulwa S, Antonio M, Greenwood B, Hill PC, Roca A. Prevalence and risk factors for Staphylococcus aureus nasopharyngeal carriage during a PCV trial. BMC Infect Dis 2017; 17:588. [PMID: 28841852 PMCID: PMC5574132 DOI: 10.1186/s12879-017-2685-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 08/15/2017] [Indexed: 12/30/2022] Open
Abstract
Background We conducted an ancillary study among individuals who had participated in a cluster-randomized PCV-7 trial in rural Gambia (some clusters were wholly-vaccinated while in others only young children had been vaccinated), to determine the prevalence and risk factors for Staphylococcus aureus nasopharyngeal carriage. Methods Two hundred thirty-two children aged 5–10 years were recruited and followed from 4 to 20 months after vaccination started. We collected 1264 nasopharyngeal swabs (NPS). S. aureus was isolated following conventional microbiological methods. Risk factors for carriage were assessed by logistic regression. Results Prevalence of S. aureus carriage was 25.9%. In the univariable analysis, prevalence of S. aureus carriage was higher among children living in villages wholly-vaccinated with PCV-7 [OR = 1.57 95%CI (1.14 to 2.15)] and children with least 1 year of education [OR = 1.44 95%CI (1.07 to 1.92)]. S. aureus carriage was also higher during the rainy season [OR = 1.59 95%CI (1.20 to 2.11)]. Carriage of S. pneumoniae did not have any effect on S. aureus carriage for any pneumococcal, vaccine-type (VT) or non-vaccine-type (NVT) carriage. Multivariate analysis showed that the higher prevalence of S. aureus observed among children living in villages wholly-vaccinated with PCV-7 occurred only during the rainy season OR 2.72 95%CI (1.61–4.60) and not in the dry season OR 1.28 95%CI (0.78–2.09). Conclusions Prevalence of nasopharyngeal carriage of S. aureus among Gambian children increased during the rainy season among those children living in PCV-7 wholly vaccinated communities. However, carriage of S. aureus is not associated with carriage of S. pneumoniae. Trial registration ISRCTN51695599. Registered August 04th 2006.
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Affiliation(s)
- Abdoulie Bojang
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia
| | - Lindsay Kendall
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia
| | - Effua Usuf
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Uzochukwu Egere
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia
| | - Sarah Mulwa
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia
| | - Martin Antonio
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Philip C Hill
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia.,Centre for International Health, School of Medicine, University of Otago, Dunedin, New Zealand
| | - Anna Roca
- Medical Research Council Unit, P. O. Box 273, Fajara, The Gambia. .,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Prevalence and risk factors of chorioamnionitis in Dhaka, Bangladesh. J Perinatol 2016; 36:1039-1044. [PMID: 27629373 DOI: 10.1038/jp.2016.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/17/2016] [Accepted: 06/28/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the association between chorioamnionitis, maternal risk factors and birth outcomes. STUDY DESIGN A cross-sectional study of 600 pregnant women was conducted at a maternity center in Dhaka from January to October 2011. Outcomes included histologic, microbiologic and clinical chorioamnionitis. Log-binomial models assessed the association between risk factors and histologic chorioamnionitis (HC). RESULTS Of the 552 women with placental specimens, 70 (12.7%) were classified with HC: 46 (65.7%) with and 24 (34.3%) without fetal involvement. HC was associated with non-physician care (relative risk [RR] 2.04, 95% confidence interval [CI] 1.04 to 4.00), home slab or hanging latrine (RR 1.69, 95% CI 1.10 to 2.62), and lack of tetanus toxoid (RR 1.80, 95% CI 1.03 to 3.14). Women with fever (RR 2.30, 95% CI 1.18 to 4.50) or discolored amniotic fluid (RR 1.74, 95% CI 1.08 to 2.81) had a higher risk of HC. Microbiologic and clinical chorioamnionitis were unreliable HC measures. CONCLUSION Prevalence of HC is high; many cases are not captured by clinical diagnosis or microbiologic cultures.
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Prevalence, Serotype Distribution and Mortality Risk Associated With Group B Streptococcus Colonization of Newborns in Rural Bangladesh. Pediatr Infect Dis J 2016; 35:1309-1312. [PMID: 27455441 DOI: 10.1097/inf.0000000000001306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Group B Streptococcus (GBS) is a predominant cause of early-onset neonatal sepsis globally; however, the impact of this organism on the health of newborns in South Asia is debated, due in part to a paucity of community-based assessments. We estimated the prevalence and serotypes of GBS colonization of the umbilical cord stump and the association of colonization with mortality in a population-based cohort of newborns in rural Sylhet District, Bangladesh. METHODS Umbilical cord swabs were collected from 646 newborns up to 3 times within the first week after birth (ages <24 hours, ~3 days, ~6 days) and processed to identify GBS serotypes. RESULTS GBS was isolated from 6.3% (41/646) of newborns. Sixty-one percent of the GBS colonization occurred in neonates within 24 hours of delivery. Serotypes VII (37.1%, n = 13/36) and Ia (33.3%, n = 12/36) were the most predominant colonizing GBS isolates. Other detected serotypes were Ib (11.1%, n = 4/36), II (11.1%, n = 4/36), V (5.6%, n = 2/36) and VI (2.8%, n = 1/36). Mortality risk among newborns with GBS colonization was 6.6 (95% confidence interval: 2.1-20.4) times higher than for those without GBS. CONCLUSIONS The overall prevalence of GBS colonization was lower than in settings, where GBS is a predominant etiology of neonatal illness. In addition, the GBS serotype distribution differed from that reported in the developed part of the world. However, further studies are needed to understand the true burden of GBS-related illness. Mortality risk was substantially increased in the presence of GBS on the umbilical stump, providing support for chlorhexidine antisepsis to the cord to prevent colonization of invasive pathogens.
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Kobayashi M, Vekemans J, Baker CJ, Ratner AJ, Le Doare K, Schrag SJ. Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries. F1000Res 2016; 5:2355. [PMID: 27803803 PMCID: PMC5070600 DOI: 10.12688/f1000research.9363.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 01/07/2023] Open
Abstract
Globally, group B Streptococcus (GBS) remains the leading cause of sepsis and meningitis in young infants, with its greatest burden in the first 90 days of life. Intrapartum antibiotic prophylaxis (IAP) for women at risk of transmitting GBS to their newborns has been effective in reducing, but not eliminating, the young infant GBS disease burden in many high income countries. However, identification of women at risk and administration of IAP is very difficult in many low and middle income country (LMIC) settings, and is not possible for home deliveries. Immunization of pregnant women with a GBS vaccine represents an alternate pathway to protecting newborns from GBS disease, through the transplacental antibody transfer to the fetus in utero. This approach to prevent GBS disease in young infants is currently under development, and is approaching late stage clinical evaluation. This manuscript includes a review of the natural history of the disease, global disease burden estimates, diagnosis and existing control options in different settings, the biological rationale for a vaccine including previous supportive studies, analysis of current candidates in development, possible correlates of protection and current status of immunogenicity assays. Future potential vaccine development pathways to licensure and use in LMICs, trial design and implementation options are discussed, with the objective to provide a basis for reflection, rather than recommendations.
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Affiliation(s)
- Miwako Kobayashi
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, USA
| | - Johan Vekemans
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Carol J. Baker
- Department of Pediatrics, Baylor College of Medicine, Houston, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, USA
- Center for Vaccine Awareness and Research, Texas Children's Hospital, Houston, USA
| | - Adam J. Ratner
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York, USA
| | - Kirsty Le Doare
- Centre for International Child Health, Imperial College, London, UK
| | - Stephanie J. Schrag
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, USA
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Diagnostic and therapeutic advancements for aerobic vaginitis. Arch Gynecol Obstet 2014; 291:251-7. [PMID: 25367602 DOI: 10.1007/s00404-014-3525-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 10/01/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Aerobic vaginitis (AV) is a newly defined clinical entity that is distinct from candidiasis, trichomoniasis and bacterial vaginosis (BV). Because of the poor recognition of AV, this condition can lead to treatment failures and is associated with severe complications, such as pelvic inflammatory disease, infertility, preterm birth and foetal infections. OBJECTIVE This review describes the diagnosis and treatment of AV and the relationship between AV and pregnancy. RESULTS The characteristics of AV include severely depressed levels of lactobacilli, increased levels of aerobic bacteria and an inflamed vagina. The diagnosis is made by microscopy on wet mounts of fresh vaginal fluid, and some distinct clinical features are recognized. Vaginal suppositories that contain kanamycin or clindamycin have shown curative effects in nonpregnant women. Additionally, the application of topical probiotics can restore the vaginal flora and reduce the recurrence of AV. Clindamycin vaginal suppositories and probiotics may be a better choice for gravida with AV than metronidazole. AV requires prompt attention, and the early diagnosis and treatment of AV during pregnancy significantly improves perinatal outcomes. CONCLUSION Further research is needed to define the pathogenesis, diagnostic criteria and standard treatment guidelines for AV.
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Maternal and neonatal colonization in Bangladesh: prevalences, etiologies and risk factors. J Perinatol 2013; 33:971-6. [PMID: 23989196 DOI: 10.1038/jp.2013.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/24/2013] [Accepted: 07/08/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To estimate the prevalence of maternal colonizers in South Asia and their potential to colonize the umbilicus, an important precondition causing neonatal sepsis. STUDY DESIGN We conducted a cross-sectional study at a maternity center in Dhaka with 1219 pregnant women and a subset of 152 newborns from 15 January to 31 October 2011. During labor, study paramedics collected vaginal swabs for bacterial culture and rectal swabs for Group B Streptococcus (GBS) testing. Community health workers collected neonatal umbilical swabs. Log-binomial regression models were used to estimate risk ratios. RESULT In all, 454 women (37.2%, 95% confidence interval (CI) 34.5 to 40.0%) were colonized. The most common organisms isolated were Staphylococcus aureus, Non-GBS and GBS. A total of 94 women (7.7%, 95% CI 6.2 to 9.2%) were colonized with GBS. The risk of GBS umbilical colonization was higher (RR=12.98, 95% CI 3.97 to 42.64) among newborns of mothers with GBS colonization. CONCLUSION Newborns of mothers colonized with GBS are at higher risk of developing umbilical colonization.
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