Document Detail


Neonatal sepsis in Egypt associated with bacterial contamination of glucose-containing intravenous fluids.
MedLine Citation:
PMID:  15998998     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Rates of sepsis exceeding 50% in a neonatal intensive care unit (NICU) in Cairo, Egypt, were not controlled by routine antimicrobial therapy. We investigated these conditions in September 2001. METHODS: Case series and retrospective cohort studies were conducted on 2 groups of NICU infants admitted to an academic medical center between February 12 and July 31, 2001. Observation of clinical practices led us to culture in-use intravenous (i.v.) fluids and medications. We monitored rates of i.v. fluid contamination, clinical sepsis and mortality after interventions to establish new procedures for handling and disposal of i.v. fluids, infection control training and improved clinical laboratory capacity. RESULTS: Among infants in the retrospective cohort group, 88 (77%) of 115 had clinical sepsis, and 59 (51%) died. In the case series group, we documented the time of initial positive blood culture; 21 (64%) of 33 were septic <24 hours after birth. Klebsiella pneumoniae accounted for 24 (73%) of 33 isolates; 14 (58%) of 24 were extended spectrum beta-lactamase-producing and aminoglycoside-resistant. On admission, all neonates received glucose-containing i.v. fluids; i.v. bottles (500 mL) were divided among multiple infants. The i.v. fluids were prepared at the bedside; poor hand hygiene and poor adherence to aseptic techniques were observed. K. pneumoniae was isolated from 13 (65%) of 20 in-use glucose-containing i.v. fluids. Fluid contamination, sepsis and mortality rates declined significantly after intervention. CONCLUSION: Extrinsically contaminated i.v. fluids resulted in sepsis and deaths. Standard infection control precautions significantly improve mortality and sepsis rates and are prerequisites for safe NICU care.
Authors:
Kelly L Moore; Marion A Kainer; Nadia Badrawi; Salma Afifi; Momtaz Wasfy; Moataza Bashir; William R Jarvis; Tae Wha Graham; Amani el-Kholy; Reginald Gipson; Daniel B Jernigan; Frank Mahoney
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  24     ISSN:  0891-3668     ISO Abbreviation:  Pediatr. Infect. Dis. J.     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-07-06     Completed Date:  2005-08-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  590-4     Citation Subset:  IM    
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, United States Department of Health and Human Services, Atlanta, GA, USA.
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / pharmacology
Blood / microbiology
Culture Media
Drug Contamination*
Drug Resistance, Bacterial
Egypt / epidemiology
Glucose
Humans
Infant, Newborn
Infection Control
Infusions, Intravenous
Intensive Care Units, Neonatal*
Klebsiella Infections / epidemiology*,  microbiology,  mortality
Klebsiella pneumoniae / drug effects,  isolation & purification*
Sepsis / epidemiology*,  microbiology,  mortality
Solutions / administration & dosage
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Culture Media; 0/Solutions; 50-99-7/Glucose

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