Nosocomial Infections In Egypt

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 cultureconfirmed).

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 a n t s

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

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u g u s

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13.7

t m b O e r c t o N b o e v r e m D b e c e e r m b e J r a n u F a e ry b ru a ry

e

A

n

J u

u

J

10

y

ri l 12.8

S

p

rc h

15

M a

A

M a

NCI RATE

NCI RATE BY MONTH

30

25 26.9

20

16.9 19.2

14

5 14.5

10.7 9.4

5.9

MONTH

10.9

5.4

0

Duration of Hospital Stay

.Admis Age

Gest. age

Admisn. wt

32.4

7.2

34.7

2.1

28

4

37

1.97

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

Mean Median Std deviation

Gestational Age

31%

=<32 wk 32-<34

52%

34-<37 wk 6% 11%

=>37 wk

GENDER

44; 52%

41; 48%

Male Female

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% 48; 56%

SVD CS

68

TPN

25

Congenital malformantion

60

Central line

50 35

Intubation

Surgery

90 80 70 60 50 40 30 20 10 0 79

4342 Postive

17 Negative

6

Infection Form 3

UTI

6

Wound infection

21

LRTI

63

Blood stream infection

0

20

40

60

80

ISOLATED ORGANISMS 3%

1%1% 2%1%1% Klebsiella species

3%

Staphylococcus aureus 5%

MRSA Candida

6%

42%

Proteus species Pseudomonas Species CoNS E.coli

7%

Enterococci Streptococcus pyogenes Bacillus cereus Citrobacter 13%

Acintobacter Species. 15%

Antibiotic Susceptibility pattern 100 81.1

100

71.4

80

59.1 38

60 40

19.9

20

40.9

28.6

S R Amikacin

Imepenem

Meropenem

Tazocin

0

Vancomycin

0

62

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.