Nosocomial Infections in Egypt

Neonatal Nosocomial InfectionsEgyptian Data

Mohamed Khashaba,MD

NCU, MUCH

Mansoura Faculty of Medicine

Mansoura University, Mansoura, Egypt

Nosocomical Infection

Infections developing in hospitalized patients

and were neither present nor incubating at

time of admission

Background

Neonatal deaths constitute about 40% of deaths in children under 5 years

Martines J, et al. Lancet. 2005

Neonatal infections are responsible for approximately one third of the estimated 4.0 million neonatal deaths that occur globally every year

Lawn JE, et al Lancet. 2005.

infections may be responsible for 8% to 80% of all neonatal deaths and as many as 42% of deaths in the first week of life.

Rates of neonatal sepsis are as high as

170/1000 live births (clinically diagnosed) and 5.5/1000 live births (blood culture-confirmed).

USA Data

The CDC estimates some 90,000 to 100,000 people die from NI each year, and that it costs $4.6 billion per year to treat them. Nosocomial infections are now the fourth leading cause of death in the U.S., right after such other killers as stroke, cancer and heart disease.

Hospital-based data suggest alarming rates of resistance to ampicillin and gentamicin, the first-line antimicrobial agents

Durrane et al: Pediatric Infectious Disease Journal 28 (1):s19-s21,2009

71% of Klebsiella and 50% of Escherichia coli are reportedly resistant to gentamicin,

TOSHIBA

TOSHIBA

suggesting that the who recommended amp, gent combination for ttt of neonatal sepsis may not be longer effective.

The challenge for medicine is to attempt to treat disease with as minimal disruption to the patient’s physiology and normal host flora as possible.

Objectives

1. Factors contributing to Nosocomial Infection in Egyptian Nurseries

2. Egyptian published Data.

3. MUCH, NCU Data of 2008.

Objectives




.Factors contributing to nosocomial infections in Egypt

Overcrowding and understaffing

Abuse of antibiotics and other drugs

Non compliance to infection control policy.

Lack of facilities for diagnosis and surveillance.

Overcrowding and understaffing

Nurse : patient ratio.

Space and allocation

Abuse of antibiotics

Cephalosporines as 1st line empirical antibiotic.

Other drugs e.g. H2 blockers

Non compliance to infection control policy

Hand washing.

Drying hands.

Reusable instruments.

Parenteral Nutrition and fluids

Lack of facilities for diagnosis and surveillance

lack of appropriate culture and susceptibility testing facilities and challenges of conducting studies.

Objectives




el-Teheawy et al. in Egypt in 1988 reported that >80% of admitted patients were prescribed antibiotics, in many cases without documented proof of infection.

Among these patients, >30% received repeated courses, with no apparent indication.

J Egypt Public Health Assoc. 1990;65:207–220.

Mohamed TA.

Registration of births and infants deaths in Demo village in Fayoum governorate.

Mansour

E,

Eissa

AN,

Nofal

LM

,

et

al.

Morbidity

andeightinfants in

Egypt.

East

Mediterr

Health

J.

2005;11:723–731

Journal of Tropical Pediatrics 1996 42(3):154-157

Maternal and Neonatal Prevalence of Toxoplasma and Cytomegalovirus (CMV) Antibodies and Hepatitis-B Antigens in an Egyptian Rural Area

,Ahmed El-Nawawy, Ashraf T. Soliman,, Omar El Azzouni,, El-Sayed Amer,, Mohammed Abdel Karim,, Soheir Demian, MonEl Sayed,

Journal of Women's Health

Effect of Predelivery Vaginal Antisepsis on Maternal and Neonatal Morbidity and Mortality in Egypt

Ahmad F. Bakr,

Department of Pediatric ,Alexandria University, Egypt.

Journal of Antimicrobial Chemotherapy (2003) 51, 625–630

Antimicrobial resistance in Cairo, Egypt 1999–2000: a survey of five hospitals.

Amani El Kholy1, Hadia Baseem2, Geraldine S. Hall3*, Gary W. Procop3 and David L. Longworth4

Antimicrobial resistance

10 relevant reports were retrievedE. coli were ampicillin (72%) and cotrimoxazole%) resistant;

19% were resistant to third generation cephalosporins.

Klebsiella species, almost all were resistant to ampicillin, , and 66% to third generation cephalosporins. Resistance to gentamicin was low among E. coli (13%), but

much higher among Klebsiella species (60%). Methicillin resistance S. aureus (MRSA) was rare (1 of 33isolates) but 46% were resistant to cotrimoxazole

They suggested a potentially high rate of extended-spectrum β-lactamase (ESBL)

The Pediatric Infectious Disease Journal: 23(8)August 2004pp 719-725

Topically Applied Sunflower Seed Oil Prevents Invasive Bacterial Infections in Preterm Infants in Egypt: A Randomized, Controlled Clinical Trial

Darmstadt, Gary L. Badrawi, Nadia Law, Paul A.; Ahmed, Saifuddin Bashir, Moataza ,Iskander, Iman Said, Dalia Al Kholy, Amani El Husein, Mohamed Hassan Alam, Asif Winch, Peter J., Gipson, Reginald Santosham, Muhammad

Health JournalRegional Office WHO EMRO

Volume 11 No 4 May , 2005

Morbidity and mortality of low-birth-weight infants in Egypt

E. Mansour,1 A.N. Eissa,2 L.M. Nofal,3 I. Kharboush3 and A.A. Reda3

Med Princ Pract 2008;17:500-503

Case ReportPantoea agglomerans Bloodstream Infection in Preterm

NeonatesNasser Yehia A. Alya, b, Hadeel N. Salmeene, Reda A. Abo Lilac, Prem A. Nagarajad

Department of Tropical Medicine and Hygiene, Faculty of Medicine, University of Alexandria, Alexandria, Egypt; Departments of Neonatology, infection control,

Fives cases of nosocomial BSI with P. agglomerans in preterm neonates (weight 1,500 g; age 8-17 days; gestational age 26-30 weeks

All isolates shared in vitro susceptibility to gentamicin, amikacin, ciprofloxacin, piperacillin/tazobactam and meropenem

Journal of Perinatology (2008) 28, 685–690

Extended-spectrum -lactamase producing Klebsiella pneumoniae in neonatal intensive care unit

H Abdel-Hady1, S Hawas2, M El-Daker2 and R El-Kady2

Our results call for further epidemiological studies to define whether ESBLs are highly endemic in the community.

Objectives




NCI RATE BY MONTH

1 2 . 81 0 . 7

1 3 . 7

1 6 . 9

1 4

5 . 9

9 . 4

1 4 . 5

2 6 . 9

5 . 4

1 0 . 9

1 9 . 2

0

5

1 0

1 5

2 0

2 5

3 0

M O N T H

NC

I R

AT

E

Duration of

Hospital Stay

Admis.Age

Gest. ageAdmisn.

wt

Mean32.47.234.72.1

Median284371.97

Std deviation21.67.74.80.8

Max8132173.26

Minimum31230.74

Range8433404

Gestational Age

3 1 %

6 %

1 1 %

5 2 %

= < 3 2 w k

3 2 - < 3 4

3 4 - < 3 7 w k

= > 3 7 w k

GENDER

4 1 ; 4 8 %4 4 ;

5 2 %

M a l eF e m a l e

Admission Age

1 0 ; 1 2 %

4 1 ; 4 8 %

3 4 ; 4 0 % 1 s t d a y

2 - < 7 d a y s

= > 7 d a y s

Site of Born

1 3 ; 1 5 %

7 2 ; 8 5 %

In b o r n

O u t b o r n

Type of Delivery

3 7 ; 4 4 %

4 8 ; 5 6 %

S V D

C S

3 5

6 0

1 7

4 3

7 9

5 0

2 5

6 8

4 2

6

01 02 03 04 05 06 07 08 09 0

Sur

gery

Intu

batio

n

Cen

tral l

ine

Con

geni

tal

mal

form

antio

n TPN

P o s t i v e

N e g a t i v e

Infection Form

6 3

2 1

6

3

0 2 0 4 0 6 0 8 0

B lo o d s t r e a m in f e c t io n

L R T I

W o u n d in f e c t io n

U T I

I S O L A T E D O R G A N I S M S

4 2 %

1 5 %

1 3 %

7 %

6 %

5 %

3 %3 %

2 % 1 %1 %1 %1 %

K le b s ie lla s p e c ie s

S t a p h y lo c o c c u s a u r e u s

M R S A

C a n d id a

P r o t e u s s p e c ie s

P s e u d o m o n a s S p e c ie s

C o N S

E . c o li

E n t e r o c o c c i

S t r e p t o c o c c u s p y o g e n e s

B a c illu s c e r e u s

C it r o b a c t e r

A c in t o b a c t e r S p e c ie s .

Antibiotic Susceptibility pattern1 0 0

0

8 1 . 1

1 9 . 9

7 1 . 4

2 8 . 6

6 2

3 8

5 9 . 1

4 0 . 9

0

2 0

4 0

6 0

8 0

1 0 0

Va

nc

om

yc

in

Ta

zo

cin

Me

rop

en

em

Ime

pe

ne

m

Am

ika

cin

S

R

Our results call for implementation of a regional and nationwide surveillance system to monitor antimicrobial resistance trends in Egypt

Addressed Questions

1.What is the feasibility and effectiveness of approaches to improve aseptic practices in labor rooms, maternity pediatric wards and nurseries?

2. What is the feasibility and effectiveness of approaches to increase quality of care in hospitals, such as using standardized protocols for management of infections in hospitals?

Research priorities Other Than Health Policy and Systems Research

Identification of new interventions to prevent transmission of infections during childbirth, eg, chlorhexidine vaginal douche, immune modulators like zinc to mothers.

Epidemiology What is the incidence of

nosocomial neonatal sepsis in nurseries and postnatal wards of developing countries?

Two recent factors influencing infection control are:

use of antibiotic-bonded vascular catheters and access to alcohol hand-cleansing materials that improve handwashing compliance

D Thornby et al 1999

Change of technology or Behaviour?

the former will likely be 5 to 10 times more effective, but at substantially increased cost. Neither, however, is mutually exclusive, and both need to be in place.

Documents

Nosocomial Infections in Egypt