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|Title||Epidemiology of Septicemia at Neonatal Intensive Care Units in Gaza City Hospitals|
Background: The prevalence of healthcare-associated neonatal bloodstream infections is increasing and results in significant morbidity, mortality, and economic cost. The continuous emerging of bacterial resistance to antibiotics worsens the situation and complicates the challenges. The epidemiology of these infections is well studied in developed countries, but the picture is not that clear in developing countries. The neonatal septicemia is reported in Gaza and connected to mortality, but the epidemiology of neonatal septicemia was never studied. Objectives: The research aimed to study the epidemiology of neonatal septicemia by defining the main etiological bacterial agents of it in the neonatal intensive care units, the potential predisposing factors for acquiring septicemia, the potential pathogenic bacteria existed in the environment of the units, and the antibiotic resistance patterns of isolated bacteria. Methodology: A three-month descriptive cross-sectional study in two intensive care units inGaza city (Al-Shifa and Al-Nasser hospitals). The study consists of a checklist to evaluate environmental and working conditions, a questionnaire to survey the healthcare workers' knowledge and perspective, scanning patient's records for potential risk factors, blood cultures for patients, sampling the environment and the workers for potential pathogens and testing isolated microorganisms for antibiotic susceptibility. Results: A total of 622 cases, more than half of them from Al-Nasser hospital (56.6%, n=346). The incidence rate of septicemia was 10.4% (24.2/1000 patient day) in Al-Nasser unit (n=36), and 9.1% (14.4/1000 patient day) in Al-Shifa's (n=25). The causative bacteria were: coagulase-negative Staphylococcus (39%, n=24), Staphylococcus aureus (23%, n=14), Streptococcus spp.(12%, n=7), Enterobacter cloacae and Pseudomonas spp. (8%, n=5 each), and Escherichia coli and Klebsiella pneumoniae (5%, n=3 each). Lack of institutional commitment and worker's interest in preventive measures, shortage of environment disinfection and unfacilitated handwashing are the main negative observations. The environment and the healthcare workers are harbored with potential pathogens. Ampicillin, Gentamicin and Cefotaxime (claforan) are extensively used in the units as a prophylactic medicines. Klebsiella pneumoniae has shown the highest rate of antibiotic resistance (53%), while Enterobacter cloacae has shown the least resistance(27%). Conclusions: Neonatal sepsis is not a risk factor for mortality. Apgar score <7, birthweight less than2.5 kg, preterm, inherited disorders and cesarean section delivery are the risk factors. Potential intrinsic risk factors for septicemia are: preterm, low birth weight and gender (male). Maternal fever and meconium staining of amniotic fluid could be predictive factors for septicemia in newborns. Extended beta-lactamase producing gram negative bacteria may be associated to resistance to quinolones. Resistance of Staphylococcus spp. to Meropenem is a serious finding. Adherence of healthcare workers to hand hygiene and personal protective procedures beside appropriate disinfection of the environment are key factors to reduce the acquisition of neonatal septicemia and other infections. This may be achieved by promotion, role modeling and continuous monitoring. Besides that, the availability and accessibility of alcoholic hand-rub solutions will make the difference.
|Publisher||the islamic university|
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