Neonatal Nosocomial Infections

Egyptian 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,
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

1. Factors contributing to Nosocomial

Infection in Egyptian Nurseries
2. Egyptian published Data.
3. MUCH, NCU Data of 2008.
 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

1. Factors contributing to Nosocomial

Infection in Egyptian Nurseries
2. Egyptian published Data.
3. MUCH, NCU Data of 2008.
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.
 i
n
f
J Egypt Public Health Assoc.
a
n
.1990;65:207–220
t
s

Mohamed TA. i
n
Registration of births and infants deaths in Demo
E
village in Fayoum governorate.
g
y
p
t
.

E
a
s
t

M
e
 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 retrieved

E. 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 33
isolates) 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 Journal
Regional 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 Report
Pantoea agglomerans Bloodstream Infection in Preterm
Neonates
Nasser 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

1. Factors contributing to Nosocomial

Infection in Egyptian Nurseries
2. Egyptian published Data.
3. MUCH, NCU Data of 2008.
 NCI RATE

0
5
10
15
20
25
30
a
rc
h
A
p
ri
l

12.8
M
a
y
J

10.7
u
n
e 13.7

J
u
A ly
S u
16.9

e g
p u
s
14

te t
m
b
O e
c r
5.9

N t o
o b

MONTH
v e
e r
9.4

D m
e b
c e
e r
m
14.5

b
J e
a r
n
26.9

F u
a
e ry
b
5.4

ru
a
NCI RATE BY MONTH

ry
10.9
19.2
 Duration
of .Admis Admisn.
Gest. age
Hospital Age wt
Stay

Mean 32.4 7.2 34.7 2.1

Median 28 4 37 1.97
Std deviation 21.6 7.7 4.8 0.8
Max 81 32 17 3.26
Minimum 3 1 23 0.74
Range 84 33 40 4
 Gestational Age

31%
=<32 wk
32-<34
52% 34-<37 wk
=>37 wk
6%

11%
 GENDER

41; Male
44; 48% Female

52%
 Admission Age
10; 12%

34; 40% 1st day

2-<7 days
=>7 days

41; 48%
 Site of Born
13; 15%

Inborn
Outborn

72; 85%
 Type of Delivery

37; 44%
SVD
CS
48; 56%
 0
10
20
30
40
50
60
70
80
90

35
Surgery
50
60

Intubation 25
17
Central line
68

Congenital
malformantion
4342
79

TPN
6
Postive
Negative
 Infection Form

UTI 3

Wound infection 6

LRTI 21

Blood stream infection 63

0 20 40 60 80
 ISOLATED ORGANISMS
1%1%
2%1%1%
3%
3% Klebsiella species
Staphylococcus aureus
5% MRSA
Candida
6% 42% Proteus species
Pseudomonas Species
CoNS

7% E.coli
Enterococci
Streptococcus pyogenes
Bacillus cereus
Citrobacter
13%
Acintobacter Species.

15%
Antibiotic Susceptibility pattern
100

100 81.1
71.4
80 62 59.1
60 38 40.9
28.6
40 19.9
S
20 R
0
0
Vancomycin

Meropenem

Imepenem

Amikacin
Tazocin
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.