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1.
S. N. Pardia M.D. I. C. Verma M.R.C.P. M. Deb M.D. R. A. Bhujwala M.D. 《Indian journal of pediatrics》1980,47(1):81-84
A nursery epidemic ofCitrobacter freundii infection is reported. Seven neonates were affected of which six had diarrhea and one had septicemia All survived except
one who had septicemia. The potential pathogenicity of this organism in newborns is emphasized. 相似文献
2.
Sarah Alsubaie Khawater Bahkali Ali M. Somily Fahad Alzamil Abdulkareem Alrabiaah Abdulkareem Alaska Fatmah Alkhattaf Abdelmageed Kambal Ahmed A. Al‐Qahtani Mohammed N. Al‐Ahdal 《Pediatrics international》2012,54(6):786-792
Background: Infection due to community‐acquired strains of methicillin‐resistant Staphylococcus aureus (CA‐MRSA) has been reported with increasing frequency. Herein is described the nosocomial transmission of CA‐MRSA involving 13 neonates and two mothers in a well‐infant nursery in a teaching hospital in Saudi Arabia. Methods: From October to November 2009, temporally related cases of CA‐MRSA skin and soft‐tissue infection occurred in newborns shortly after discharge from a well‐infant nursery. An outbreak investigation including case identification, review of medical records, staff screening, environmental cultures, pulsed‐field gel electrophoresis, and a case–control study were conducted. Controls were selected from among asymptomatic neonates admitted to the same nursery and matched for the day of admission. Results: Fifteen subjects were found to be CA‐MRSA positive: 13 neonates and two mothers. The crude attack rate among neonates was 5.5% during the outbreak period. All 13 neonates presented with skin and soft‐tissue infection; one of the mothers had mastitis and a breast abscess. The source of the outbreak was not evident. Pulsed‐field gel electrophoresis showed that all of the tested isolates from one strain except one, all contained the staphylococcal cassette chromosome mec (SCCmec) type IV. Conclusion: MRSA strains that initially emerged in the community are now causing disease in health‐care settings. Adherence to standard infection control practices, including consistent hand hygiene, in newborn nurseries is important to prevent transmission in such settings. 相似文献
3.
Objective As infections due to Extended Spectrun β Lactamase (ESβL) producing Klebsiella pneumoniae were increasing in the NICU at Karnataka Institute of Medical Sciences Hospital, Hubli, India, the present study was carried
out to identify any environmental sources and the mode of transmission.
Methods Environmental samples from various sites were collected monthly for a period of six months.
Results ESβL producing K. pneumoniae were isolated from all the sites except room air at least on one occasion. ESβL producing K. pneumoniae was always isolated from one of the incubators, medicine trolley and sink; while at least one of the health care workers
carried it in the hands four out of six times tested. ESβL producing K. pneumoniae with similar antibiogram were also isolated from the clinical samples obtained from the neonates.
Conclusion Widespread use of third generation cephalosporins as a pre-emptive antibiotic for suspected cases of septicaemia may have
contributed to emergence of ESβL producing K. pneumoniae in addition to other risk factors. ESβL producing K. pneumoniae have extensively colonised the environment of the NICU. Transmission of these pathogens to the neonates has probably occurred
through the healthcare workers. Efforts to improve hand hygiene among the healthcare workers and mothers are urgently needed. 相似文献
4.
Bertini G Nicoletti P Scopetti F Manoocher P Dani C Orefici G 《European journal of pediatrics》2006,165(8):530-535
The risk of nosocomial infection due to Staphylococcus aureus in fullterm newborns is higher under hospital conditions where there are overcrowded nurseries and inadequate infection control techniques. We report on an outbreak of skin infection in a Maternity Nursery (May 21, 2000) and the measures undertaken to bring the epidemic under control. These measures included: separating neonates already present in the nursery on August 23, 2000 from ones newly arriving by creating two different cohorts, one of neonates born before this date and one of neonates born later; restricting healthcare workers caring for S. aureus- infected infants from working with non-infected infants; disallowing carrier healthcare workers from caring for patients; introducing contact and droplet precautions (including the routine use of gowns, gloves, and mask); ensuring appropriate disinfection of potential sources of contamination. A representative number of isolates were typed by genomic DNA restriction length polymorphism analysis by means of pulsed-field gel electrophoresis (PFGE). Among the 227 cases of skin lesions, microbiological laboratory analyses confirmed that 175 were staphylococcal infections. The outbreak showed a gradual reduction in magnitude when the overcrowding of the Nursery was reduced by separating the newborns into the two different Nurseries (two cohorts). The genotyping of the strains by PFGE confirmed the nurse-to-newborn transmission of S. aureus. The measures adopted for controlling the S. aureus outbreak can, in retrospect, be assessed to have been very effective. 相似文献
5.
Murat Anil Mehmet Helvaci Nisel Ozkalay Esra Toprak Ayse Berna Anil Mustafa Dilek Neval Agus 《Indian journal of pediatrics》2009,76(6):629-633
Objective To analyze an outbreak caused by a multipl resistant strain of S. typhimurium in a newborn unit in Turkey.
Methods The outbreak occured during the period 15 to 29 March,2005. A newborn infected with S. typhimurium was defined as a case. Newborns who were hospitalized during the outbreak period with no diagnosis of S. typhimurium infections (n=50) constituted the control group I (CG I). The matched patients of the control group II (CG II) (n=20) were
selected from neonates without S. typhimurium infections during the period.
Results Of 22 infants who were affected two died. Cases developed diarrhea (n=20), septicemia (n=5) and meningtis (n=1). The strain
was resistant to ampicillin, ceftriaxone, ceftazidime, amikacin, trimethoprim-sulfamethoxasole and chloromphenicol, susceptible
to meropenem. All of the infected neonates were treated with meropenem. The surveillance cultures were negative. The outbreak
was controlled by approprite therapy and institution of effective control measures. The cases were more exposed to mechanical
ventilation than CG I (p<0.05). The mean additional length of stay in cases was significantly different from CG II (14.9 days
vs. 5.1 days, p<0.05). The mean charges was $1588.78 for a case and $506.94 for a control (P<0.05). Accommodation accounted
for 44.5% of these extra charges.
Conclusion This study increases the understanding of the burden of multidrug-resistant S. typhimurium infection. Nosocomial outbreaks have a major effect on healthcare delivery, costs and outcomes. 相似文献
6.
Increased breastfeeding was suggested as a contributing factor to significant hyperbilirubinemia. The aim of this study was
to identify the risk factors associated with jaundice in exclusively breastfed term neonates. We retrospectively reviewed
all consecutively live-born neonates from August 2009 to July 2010 who had complete outpatient department (OPD) follow-up
at ≤14 days old. Hyperbilirubinemia was defined as a transcutaneous bilirubin (TcB) value of ≥15 mg/dl. During the study period,
there were 718 deliveries, of which 152 neonates were transferred to the special care nursery or neonatal intensive care unit;
566 neonates were discharged from the nursery, and 243 neonates were excluded: 83 did not return to the OPD, 46 were older
than 14 days at OPD follow-up, 44 were <37 weeks of gestational age, and 70 had been fed formula. In total, 323 neonates were
enrolled and classified into the hyperbilirubinemic (114 neonates) and non-hyperbilirubinemic groups (209 neonates). The gender,
gestational age, Apgar score, age at nursery discharge, birth weight, and body weight at nursery discharge and at OPD were
comparable between the two groups. TcB values at nursery discharge were positively correlated with TcB values in the OPD.
Infants with hyperbilirubinemia exhibited significantly greater body weight loss from birth to the OPD follow-up and significantly
less body weight gain from nursery discharge to OPD follow-up. Conclusion High TcB values at nursery discharge and a smaller body weight gain are associated with hyperbilirubinemia in term neonates
who are exclusively breastfed. 相似文献
7.
Atanu Roy P. K. Maiti Sati Adhya Anju Bhattacharya Gargi Chakraborty Ela Ghosh P. Chakraborty 《Indian journal of pediatrics》1993,60(6):799-801
Fifty five clinically diagnosed cases of neonatal septicaemia of the nursery ward, Medical College Hospital Calcutta were
subjected to blood culture on two consecutive days in all cases. Bacterial isolates were found in 34 (61.8%) cases as pure
growth and candida species from 9(16.4%) as pure culture. Remaining 12 samples did not yield any growth. Species distribution
of candida showed C.albicans 6, C.parapsilosis 2, and C.guillermondii 1.
Asphyxia neonatorum was the common feature in all cases of candidaemia. All neonates with candidal infection were low-birth-weight
and premature. C. albicans, the predominant species (66.6%) recovered, was responsible for a localised outbreak of infection
in the nursery. 相似文献
8.
Kam-lun Ellis Hon Kam Lau Cheung William Wong Pak Cheung Ng 《Indian journal of pediatrics》2010,77(9):1033-1035
We report eight cases of neonates (from birth to 25 days) admitted to the neonatal service of a teaching hospital with influenza-like
illness during the outbreak of pandemic H1N1 2009, and discuss their management and infection control issues. Empirical antibiotics
were often promptly initiated and timely stopped when sepsis was ruled out. Also, there was no pandemic H1N1-09 but influenza
A (H3N2, n = 1), parainfluenza (type 3, n = 3) and respiratory syncytial virus (n = 1) have been isolated. The infants recovered spontaneously without any antiviral therapy. There was no outbreak of the
respiratory infections in the neonatal service during the admissions. Respiratory viral infections can occur in neonates although
the clinical course may be milder and nonspecific. Emergency room and frontline staff must be vigilant of the non-specific
clinical features of infections with respiratory viruses in the neonates so that prompt triage and isolation can be implemented
to avoid outbreaks in the neonatal service. 相似文献
9.
Transmission of Salmonella worthington by oropharyngeal suction in hospital neonatal unit 总被引:1,自引:0,他引:1
M A Khan M Abdur-Rab N Israr M Ilyas F Ahmad Z Kundi A Ghafoor 《The Pediatric infectious disease journal》1991,10(9):668-672
An outbreak of Salmonella worthington infection in a neonatal unit occurred in a pediatric ward of Holy Family Hospital, Rawalpindi, Pakistan. The index case was a prematurely born male child from whose clinical specimens S. worthington was recovered. After this finding 40 infants kept in that nursery were included in an investigation. Major symptoms were diarrhea, septicemia and jaundice. Three developed meningitis. Disease morbidity rate was 45% and mortality occurred in 16.6% of the total positive cases. The source of infection was traced to a contaminated rubber tubing of a suction apparatus which was used for oropharyngeal suction of the babies. S. worthington was recovered from the clinical specimens of all 18 babies who received suction. Multiple drug resistance of these S. worthington strains was found. 相似文献
10.
Neonatal gram-negative bacteremia 总被引:4,自引:0,他引:4
A 22 months prospective study of neonatal gram-negative bacteremia was undertaken in a 15 bed NICU to find out the incidence
and antibiotic resistance patterns. Clinically suspected 1326 cases of neonatal sepsis were studied during this period. More
than 25% of the cases were microbiologically positive for sepsis. Among 230 (67.2%) cases of gram-negative bacteremia, the
predominant isolates werePseudomonas aeruginosa (38.3%),Klebsiella pneumoniae (30.4%),Escherichia coli (15.6%) andAcinetobacter sp. (7.8%). Fifty-nine per cent of the neonates were born in hospital while 41% were from community and referral cases.
Lower respiratory tract infection, umbilical sepsis, central intravenous line infection and infection following invasive procedures
were the most commonly identified sources of.septicemia. Prematurity and low birth weight were the main underlying conditions
in 60% of the neonates. Total mortality was 32%. Increased mortality was mainly associated with rmrhropenia, nosocomial infection
and inappropriate antibiotic therapy. Resistance was increasingly noted agains’t many antibiotics. The isolates were predominantly
resistant to extended spectrum cephalosporins (25%-75%), piperacillin (68%-78%), and gentamicin (23%-69%).
The commonest microorganisms causing gram-negative bacteremia werePseudomonas aeruginosa followed byKlebsiella pneumoniae. The community-acquired bacteremia was mainly due to E.coli. The proportion of preterm and low birth weight babies was significantly high, and the major contributing factor in total
mortality. Sensitivity to different antibiotics conclusively proved that a combination of ampicillin + sulbacfam with amikacin
or ampicillin + sulbactam with ciprofloxacin is most effective. 相似文献
11.
P J Hyams G W Counts E Monkus R Feldman L Kicklighter C Gonzalez 《American journal of diseases of children (1960)》1975,129(5):595-599
An outbreak of staphylococcal bacteremia in healthy, full-term neonates occurred in the newborn nursery at a large county hospital not employing prophylactic hexachlorophene bathing. Seven infants had staphylococcal bacteremia and one had omphalitis. Two of the three isolates obtained for phage typing were type 86, and the other was 3c/71. Staphylococcal colonization rate in the nursery was 64% when the outbreak was recognized; 86% of these isolates were type 86. No predominant phage type was isolated from nursery personnel. The outbreak followed a six-month preliminary study that showed a rise in staphylococcal colonization rate from 2.2% with hexachlorophene bathing to 67% with a nonhexachlorophene-containing preparation. In a community survey of infants born during the two months prior to the epidemic, seven of eight babies with lesions were infected with Staphylococcus aureus type 86. 相似文献
12.
A retrospective study was done to review the clinical experience of septic arthritis and osteomyelitis in the newborns in
our centre. Case records of all the neonates born from January 1989 to August 1994 and those admitted to outborn nursery from
1985 to 1993 were reviewed. Diagnosis of septic arthritis/osteomyelitis was made in the presence of relevant clinical signs
and supported by positive culture from blood or joint fluid and abnormal X-ray or ultrasound findings. The incidence of septic
arthritis and osteomyelitis among inborn babies was 1 in 1500. There were 25 neonates with mean gestational age 34.5 (range
27–40) weeks and mean birth weight 2269 (range 990–4750) gms.
Limitation of movement (64%) and local swelling (60%) were commonest presentations. A total of 33 joints were involved in
25 babies. Eight babies (32%) had multiple joint involvement. Hip and knee were the most commonly involved joints (48% each).
In 19 babies (76%) joint involvement occurred in association with a generalized septicemic illness while 6 babies (24%) had
localised signs and symptoms. Joint aspirate was positive for gram stain or culture in 12 (48%) and 10 babies (40%) had positive
blood culture.Klebsiella pneumoniae andStaphylococcus aureus were commonest isolates. Radiological changes were seen in 13 (52%) babies. All were treated with appropriate antibiotics
and open surgical drainage was done in 5 (20%) cases.
Bone and joint infections are important complications in sick septicemic neonates and need early diagnosis, appropriate management
with antibiotics, surgical drainage in selected cases to prevent long term morbidity. 相似文献
13.
We describe an outbreak of Sphingomonas paucimobilis in 13 newborn infants with septicemia and septic shock. Fifteen available isolates were obtained from patients and distilled
water. Pulsed-field gel electrophoresis showed that there was a cross-transmission of S. paucimobilis in eleven patients but these types were not the same the isolate obtained from the distilled water. The outbreak was terminated
by taking appropriate control measures for infection and change of source of distilled water. 相似文献
14.
Sepsis in the newborn 总被引:8,自引:0,他引:8
Systemic infection in the newborn is the commonest cause of neonatal mortality. Data from National Neonatal Perinatal Database
2000 suggest thatKlebsiella pneumoniae andStaphylococcus aureus are the commonest causes of neonatal sepsis in India. Two forms of clinical presentations have been identified. Early onset
sepsis, probably related to perinatal risk factors, usually presents with respiratory distress and pneumonia whthin 72 hours
of age. Late onset sepsis, related to hospital acquired infections, usually presents with septicemia and pneumonia after 72
hours of age. Clinical features of sepsis are non-specific in neonates and a high index of suspicion is required for the timely
diagnosis of sepsis. Although blood culture is the gold standard for the diagnosis of sepsis, reports are available after
48–72 hours. A practical septic screen for the diagnosis of sepsis has been described and some suggestions for antibiotic
use have been included in the protocols. 相似文献
15.
C-reactive protein (CRP), alpha-1-antitrypsin (alpha-1-AT) and alpha-2-macroglobulin (alpha-2-MG) levels were evaluated serially in 25 healthy and 20 septicemic neonates and then compared as early diagnostic aids and prognostic indicators in this illness. Compared to healthy controls, septicemic neonates had significantly higher mean CRP levels (p less than 0.01). Neonates with septicemia, who recovered, had higher mean CRP levels than the group which died (p less than 0.05). As an early diagnostic aid CRP had a low Youden index, whereas for prognosis its index was higher. Septicemic neonates also had significantly higher mean alpha-1-AT levels (p less than 0.05), 12-24 hours after onset of illness, as compared to healthy neonates. Alpha-1-antitrypsin could not be used as an early diagnostic aid in septicemia, but was useful for predicting outcome. Mean alpha-2-macroglobulin levels did not show significant variation in healthy and septicemic neonates. Lower mean alpha-2-MG levels were observed in neonates recovering from septicemia. As an early diagnostic aid alpha-2-MG had a low Youden index, whereas for prognosis its index was higher. CRP had a higher Youden index than alpha-2-MG for early diagnosis of neonatal septicemia and had a higher index than both alpha-1-AT and alpha-2-MG for predicting outcome in septicemia. Serial use of CRP alone is, therefore, recommended for both purposes. 相似文献
16.
Objective To evaluate the occurrence of acute renalfailure (ARF) and the factors associated with it in cases of neonatal sepsis.
Methods The case control study was conducted in the referral neonatal intensive care unit of a tertiary teaching hospital. 200 out
born neonates with sepsis admitted to the nursery from January to July 2003 were evaluated for presence of ARF (cases) or
not (controls). Sepsis was diagnosed on the basis of either a positive sepsis screen (immature: total (I:T) neutrophil ratio
>0.2, μ-ESR> age in days + 2mm or>15 mm, CRP>6mg/dl, TLC<5000 cells/mm3; 2 or more positive) or a positive blood culture in symptomatic neonates. ARF was defined as blood urea nitrogen (BUN) >20mg/dl
on two separate occasions at least 24 hours apart. Oliguria was defined as urine output <1ml/Kg/hr.
Results 52 out of 200 (26%) neonates with sepsis had ARF; only 15% of ARF was oliguric. The mean gestation of neonates with ARF was
similar to those without ARF (36.1±4.1 wks vs. 36.6±3.5 wk; p=0.41). A significantly higher number of babies with ARF weighed
less than 2500 gm as compared to those without ARF (86.5%vs 67.6%; p=0.008). The association of meningitis, disseminated intravascular coagulation (DIC) and shock was also significantly
higher in neonates with ARF (46.8%vs 26.2%, p=0.01; 65.4%vs 20.3%, p<0.001; 71.2%vs 27.0%, p<0.001 respectively). Mortality in neonates who developed ARF was significantly higher (70.2%vs 25%, p<0.001). Factors including gestational age, weight, onset of sepsis, culture positivity, associated meningitis, asphyxia,
shock, prior administration of nephrotoxic drugs were subjected to univariate analysis for prediction of fatality in neonates
with sepsis and ARF; only shock was found to be a significant predictor of fatality (p<0.001). ARF had recovered in 22 out
of 49 neonates in whom data was available; three patients had left against medical advice. The mean duration of recovery in
these 22 neonates was 5.5 days (range 1–14 days). Presence of co-existing morbidities (perinatal asphyxia/congestive heart
failure (CHF)/necrotising enterocolitis (NEC) or nephrotoxic drugs did not alter the frequency of recovery of ARF in septic
neonates (45.5%vs 44.4%, p=0.944; 41%vs 52%, p=0.308 respectively).
Conclusion Renal failure occurred in 26% neonates with sepsis. Although ARF in neonates has been reported to be predominantly oliguric,
it was observed that ARF secondary to neonatal sepsis was predominantly non oliguric. Low birth weight was an important risk
factor for the development of ARF. The mortality being three times higher in neonates with ARF demands a greater awareness
of this entity among practitioners and better management of this condition. 相似文献
17.
S. Pereira B. J. G Pereira O. N. Bhakoo A. Narang V. Sakhuja K. S. Chugh 《Indian journal of pediatrics》1988,55(6):973-978
Twenty outborn neonates were dialysed for ARF over a period of two years. Acute gastroenteritis (60%) and septicemia (90%)
were the leading cause of ARF. Metabolic encephalopathy and uncompensated metabolic acidosis were present in all, and hyperkalemia
in 60 percent of the neonates. Intermittent peritoneal dialysis was the only therapeutic modality employed. The mean duration
of oliguria was 2.3 ± 0.8 days in those who recovered. The serum creatinine returned to normal in a mean of 5.7 ± 1.1 days.
The clinical profile and renal histology were consistent with acute tubular necrosis in all the neonates. The mortality was
75 percent. 相似文献
18.
Saar Hashavya Diana Averbuch Itai Berger Noa Ofek-Shlomai Milena Pitashny Carlos Hidalgo Zivanit Ergaz 《European journal of pediatrics》2011,170(1):111-113
Edwardsiella tarda, a gram-negative bacterium, is a rare pathogen in the neonatal period. We present a term newborn that developed E. tarda septicemia following maternal amnionitis. The severe neurological outcome in this case, as well as in all other reported
cases, highlights the need for meticulous neurological evaluation in neonates presenting with E. tarda septicemia even in the absence of bona fide meningitis. 相似文献
19.
McDonald JR Carriker CM Pien BC Trinh JV Engemann JJ Harrell LJ Oden MA Tanaka DT Goldberg RN Sexton DJ Kaye KS 《The Pediatric infectious disease journal》2007,26(8):678-683
BACKGROUND: After surveillance surveys documented the absence of methicillin-resistant Staphylococcus aureus (MRSA) in our intensive care nursery, an outbreak of MRSA infection occurred there during a 7-month period in 2005. METHODS: Control measures included reinforcement of hand hygiene and contact precautions procedures. Active surveillance cultures were obtained on all neonates, including interinstitutional transfers. A cohort unit was dedicated exclusively for neonates with MRSA. Pulsed-field gel electrophoresis was performed on isolates to determine relatedness. We surveyed transferring hospitals to evaluate MRSA activity and surveillance practices in their nurseries. RESULTS: Twenty-five neonates were colonized with MRSA; 9 of these had clinical infections. Isolates from 18 of 21 neonates from this outbreak and 4 neonates from a previous cluster were identical, including 1 isolate obtained upon transfer from another institution. Admission and discharge logs from a 9-month period showed that 127 of 460 admissions (27.6%) were admitted from 34 hospitals, and 247 of 460 (53.7%) were discharged to 32 hospitals. Among 30 transferring hospitals responding to our survey, MRSA activity occurred in 2 of 28 (7%) level 1 nurseries, 4 of 11 (36%) level 2 nurseries and 6 of 10 (60%) level 3 nurseries. Nine of the 30 hospitals (30%) performed some active surveillance. CONCLUSIONS: Interinstitutional transfer can play a role in the initiation and propagation of MRSA outbreaks in neonatal nurseries. The burden of MRSA in area nurseries and the rate of transfers affect the potential for interhospital spread of MRSA and may justify changes in policy regarding surveillance for MRSA and communication between hospitals. 相似文献