Healthcare-associated infections in a Newborn Unit in Nigeria

Abstract

Introduction: Due to immaturity of neonatal immune function, prolonged hospitalisation, invasive procedures and inadequate infection control measures, healthcare-associated infections (HAI) remain a perennial problem in neonatal units globally and impact negatively on outcome. It is essential to quantify the burden and assess the risk factors in order to address this problem. Objectives: To determine the prevalence, bacterial aetiology of and risk factors for HAI in the neonatal unit of the University College Hospital, Ibadan, Nigeria. Materials and methods: Fifty-six out of the 435 neonates admitted who developed symptoms or signs of neonatal sepsis after 48 hours of admission or symptom free interval had their clinical history and physical examination recorded. Blood, urine and where indicated, cerebrospinal fluid (CSF) samples were taken for culture and sensitivity before antibiotic therapy. Results: The incidence of HAI was 4.1 % (13 babies) of neonatal admissions, 4.4/1000 patient days (72.2% of infections was septicaemia). There were 7 Gram positive isolates [all Methicillin Resistant Staphylococcus aureus (MRSA)] and 11 Gram negative isolates. The blood culture isolates were MRSA (6), Klebsiella pneumoniae (3), Hafnia alvei (2) and one each of Stenotrophomas maltophilia and Escherichia coli. The two cerebrospinal fluid isolates were Chryseobacterium meningosepticum and Klebsiella ozaenae, other isolates were Escherichia coli -abscess aspirate, MRSA and Escherichia coli urethral catheter tips. MRSA demonstrated 33.3% and 50.0% susceptibility to gentamycin and vancomycin respectively. The Gram negatives demonstrated 81.8%, 45.6% and 90.1% susceptibility to ceftazidime, ciprofloxacin and meropenem respectively. The case fatality rate was 38.9% (7 babies). Conclusion: MRSA and Klebsiella pneumoniae are the common causes of MAI in the neonatal unit and are associated with high mortality.