Background: In spite of advances in antimicrobial therapy over the past few decades’, pneumonia a... more Background: In spite of advances in antimicrobial therapy over the past few decades’, pneumonia and other respiratory tract infections remain an important cause of morbidity and mortality. Aim: To determine the prevalent pathogens responsible for upper and lower respiratory tract infections in our local institution and the population profiles in which these organisms occur. Methods: This was a retrospective analysis of sputum samples sent to the Babcock University Teaching Hospital Laboratory over a period of twelve months from 2014-2015. Sputum samples were gram stained upon receipt in the laboratory and assessed with the Barttlet score. Data analysis was done with EPI INFO version 3.5.1. Results: The mean age of the 155 patients was 36.2+/-18.2 ranging from 4 to 92 years. The predominant organism was Streptococcus pneumonia [n = 69 (44.5%)]. Age < 65 was a significant risk for Streptococcus pneumoniae infection (p= 0.00, O.R=3.72, CI=1.00-13.77, X2=4.34). It was noted that there was a higher likelihood of Streptococcus pneumoniae infections with decreasing age (p=0.00 Coefficient= -9.05, Standard error=2.98, F test=9.25). Conclusion: Streptococcus pneumoniae remains the prime pathogen associated with respiratory tract infections especially for outpatients in our environment, while Extended Spectrum Beta Lactamase producing Klebsiella pneumoniae was seen mainly in inpatients. Streptococcus pneumonia and Klebsiella pneumoniae were the most prevalent pathogen both among in-patients and outpatients. The findings of this study will help in redesigning empiric therapy for clinicians with respect to respiratory tract infections.
Background. Neonatal sepsis is a significant cause of morbidity and mortality in developing count... more Background. Neonatal sepsis is a significant cause of morbidity and mortality in developing countries, accounting for a large proportion of neonatal deaths annually. Every year, 4 million neonates die, and one-third of these deaths is attributed directly to neonatal sepsis. Objectives. To determine the prevalence of neonatal sepsis, characterise and identify causative organisms and identify possible risk factors. Specific objectives were to determine the aetiological agents responsible for neonatal sepsis at Lagos University Teaching Hospital and also to identify the risk factors responsible for the development of neonatal sepsis. Methods. Venous blood pairs were collected from clinically septic admitted neonates and inoculated into BACTEC Peds Plus (BD, USA) bottles aerobically in the BACTEC 9050 system. Organisms were identified using the Microbact 12A/E system and biochemicals. A structured questionnaire was used to collect data for risk factors, which were analysed with the SPSS version 17. Results. Of 250 neonates who were sampled, 85 (34%) had pathogens recovered from their bloodstream, with Klebsiella pneumoniae the predominant organism. Risk factors for sepsis were being delivered outside the hospital (p=0.01), and by frequent changes in antibiotics (p=0.00). Conclusion. The burden of neonatal sepsis is still high in our environment as evidenced by our isolation rate of 34%. A concerted effort needs to be made to reduce this.
ABSTRACT
Background: Hand hygiene has been described as the cornerstone and starting point in all... more ABSTRACT Background: Hand hygiene has been described as the cornerstone and starting point in all infection control programs, with the hands of healthcare staff being the drivers and promoters of infection in critically ill patients. The objectives of this study were to assess healthcare workers compliance with the World Health Organization (WHO) prescribed five moments of hand hygiene as it relates to patient care and to determine the various strata of healthcare workers who are in default of such prescribed practices. Methods: The study was an observational, cross‑sectional one. Hand hygiene compliance was monitored using the hand hygiene observation tool developed by the WHO. A nonidentified observer was used for monitoring compliance with hand hygiene. The observational period was over a 60‑day period from August 2015 to October 2015. Results: One hundred and seventy‑six observations were recorded from healthcare personnel. The highest number of observationswere seen in surgery, n = 40. The following were found to be in noncompliance before patient contact – anesthetist P = 0.00 and the Intensive Care Unit P = 0.00 while compliance was seen with senior nurses (certified registered nurse anesthetist [CRNA]) P = 0.04. Concerning hand hygiene after the removal of gloves, the following were areas of noncompliance – the emergency room P = 0.00, CRNA P = 0.00, dental P = 0.04, and compliance was seen with surgery P = 0.01. With regards to compliance after touching the patient, areas of noncompliance were the anesthetists P = 0.00, as opposed to CRNA P = 0.00, dental P = 0.00, and Medicine Department P = 0.02 that were compliant. Overall, the rates of compliance to hand hygiene were low. Discussion: The findings however from our study show that the rates of compliance in our local center are still low. The reasons for this could include lack of an educational program on hand hygiene; unfortunately, healthcare workers in developing settings see such as ours regard such programs as being mundane. Conclusion: The observance of hand hygiene is still low in our local environment. Handwashing practices in our study show that healthcare workers pay attention to hand hygiene when it appears there is a direct observable threat to their wellbeing. Educational programs need to be developed to address the issue of poor hand hygiene. Key words: Alcohol hand rub, compliance, hand washing, healthcare associated infections, healthcare workers, infection control
Background:
Tuberculosis is the leading cause of death from any
single pathogen and it ... more Background: Tuberculosis is the leading cause of death from any single pathogen and it has consistently continued to be a major public health challenge globally. Data show that Nigeria ranks tenth among the 22 high tuberculosis burden countries. Aim: This study intends to describe the profile of tuberculosis infections in Babcock University Teaching Hospital. Methods: This was a retrospective cross sectional study of patients presenting to the Tuberculosis Laboratory of Babcock University Teaching Hospital. Results: Patients presenting to BUTH were 2.29 times more likely to have a positive AFB sputum smear result when compared to samples from Primary Health Care Centers – P = 0.05, χ2= 3.83, O.R = 2.29, R.R = 1.17, CI = 1.0 – 5.34. Patients presenting to BUTH were more likely to be HIV positive when compared to those from PHC’s p = 0.00, χ2 = 24.74, df = 2. Conclusion:The burden of tuberculosis is still high in our environment and challenges in its rapid and accurate diagnosis still remain. In order to strengthen tuberculosis control, attention needs to be placed on rapid diagnosis and prompt treatment. Key words: Tuberculosis, HIV, Primary Healthcare Centre, ZiehlNeelson stain, Directly Observed Treatment Short Course, pathogens
TITLE: AUTOMATED DIAGNOSIS OF TUBERCULOSIS: CHALLENGES AND PROSPECTS FOR IMPLEMENTATION.
AUTHORS:... more TITLE: AUTOMATED DIAGNOSIS OF TUBERCULOSIS: CHALLENGES AND PROSPECTS FOR IMPLEMENTATION. AUTHORS: SHOBOWALE EO, COKER AO, ADEGUNLE BA. OBJECTIVES: A narrative review of advances in automated diagnostic tests for diagnosis of tuberculosis infections. REVIEW METHODS: Electronic databases were searched from 40 articles for tests on automation in Mycobacterium tuberculosis identification. Studies were selected and evaluated that tested for the performance of new and old methods in automated diagnosis with significant impact on the turnaround time of diagnosis and also positive impact on patient care with respect to outcomes. RESULTS: A total of 40 studies were included. Overall, the gene expert system was found to be superior when applied to respiratory samples as opposed to other body fluids when compared to other test methods. High specificity estimates suggest that Nucleic Acid Amplification Tests (NAATS) should be the first-line test for rapid diagnosis of meningitis, but that they also need to be combined with the result of other tests in order to rule out disease. DISCUSSION: fully automated liquid culture methods overall are superior to mycobacterial culture on solid media, in terms of speed of diagnosis, ease of use and their accuracy with several user friendly systems that can be applied to the Nigerian environment. CONCLUSIONS: The DNA amplification tests provide a reliable way of increasing the specificity of diagnosis. Their superior diagnostic capability has been found to hold up in routine clinical practice, and they could confer several advantages on tuberculosis control programs. KEY WORDS; Mycobacterium tuberculosis, Automated diagnosis, BACTEC 460, Gene Xpert, MGIT 960
Introduction: The increasing rates of antimicrobial resistance on the part of pathogens are gradu... more Introduction: The increasing rates of antimicrobial resistance on the part of pathogens are gradually becoming a pandemic, this has to be curbed to reduce mortality. Background: The vast majority of antimicrobials currently in use are prescribed by Physicians. The Physicians act as a gateway to the control and use of life-saving medications such as antimicrobials, attention must be given towards antimicrobial stewardship and rational antimicrobial use. Methods: This was a cross-sectional survey of clinicians at 3 tertiary hospitals in Nigeria. A self administered structured Questionnaire containing 25 questions was given to the respondents to complete to assess the level of knowledge of physicians in antimicrobial use. Results: The following were found to be statistically significant – Physicians in the Public hospitals were more likely to collect specimens for microbiology analysis before commencing antibiotics – p = 0.02, Odds Ratio (O.R) = 2.61, Risk Ratio (R.R) = 1.47, 95% Confidence Interval (CI) = 1.16 – 5.80, Chi Square (χ2) = 1.47, a slightly higher likelihood of Physicians in the Private Tertiary Hospital having a Clinical Microbiologist in their hospital – p = 0. 00, O.R = 0.08, R.R = 0.25, CI = 0.05 –0.99, χ2 = 4.55. Discussion: Targeting rational interventions via educating physicians on antimicrobial use has had an established positive impact in curbing antimicrobial resistance in hospitals. Conclusion: Training programs on antimicrobial use needs to be strengthened.
Objective: Biosafety is an important element of quality management systems in laboratory practice... more Objective: Biosafety is an important element of quality management systems in laboratory practice as it is a measuring tool for compliance with accreditation and certification standards. Our aim was to assess the practices of laboratory personnel towards biosafety measures in their respective laboratories. Methods: The study design was a quantitative and qualitative cross sectional prospective one obtained with the use of a structured questionnaire. Data analysis was done with Epi Info version 3.4.1 and was presented using frequency tables with chi square calculated for different variables with the significant p value set at ≤ 0.05. Results: There were 63 respondents in the study. Private laboratories fared better in an assessment of their biosafety practices. Comparative variables identified as unsafe biosafety practices between public and private laboratories were non availability of Hepatitis B virus antibody testing, p value 0.01, odds ratio 5.4, consuming food in the laboratory, p value 0.00, odds ratio 0.2., non-use of N95 masks p value 0.04, O.R 3.9 and biosafety cabinet use p value 0.05, O.R 2.8. Discussion: Biosafety practices in Nigeria need to be streamlined in accordance with good laboratory practices in order to forestall workplace accidents and promote a safe environment for testing of clinical human samples. Conclusion: The absence of appropriate biosafety policies and practices is one of the challenges facing health care workers in sub Saharan Africa. There is the need for biosafety to be placed in the front burner of issues in laboratory practice in our respective facilities.
Background: Septic arthritis is an inflammatory process in the joints associated with isolation o... more Background: Septic arthritis is an inflammatory process in the joints associated with isolation of pathogens or a positive Gram stain of the synovial fluid. It is a disease condition with significant complications such as joint destruction and immobility. Individual cases are difficult to manage and frequently necessitate prolonged courses of antibiotics. Aim: The aim of the study was to present our findings with the view towards improving treatment outcomes in similar clinical scenarios. Findings: Septic arthritis in the index patient developed insidiously and was diagnosed after multiple arthrocentesis were performed. It was bilateral and associated with recurrent bouts of fever, joint tenderness reduced mobility and swelling. The predisposing factor in the index patient, a seven year old male was sickle cell disease. Multiple antimicrobial regimens were instituted in the patient with unsatisfactory results. Initial treatment regimens did not appear to be based on bacteriological statistics which resulted in prolonged hospital stay. Culture of the synovial fluid was initially onto brain heart infusion both and subsequently sub-cultured onto chocolate and MacConkey agar. The isolate recovered was Serratia rubideae which was identified using the Microbact 12A kit. Susceptibility studies showed the isolate to be susceptible to only meropenem. The patient was subsequently placed on meropenem for forty two days and recovered with radiologic and clinical evidence of improvement and thereafter discharged home. Conclusion: Close collaboration between the orthopedic surgeon and microbiologist will help to improve treatment outcomes. The Microbact12A kit is recommended in the routine identification of gram negative pathogens. Key words: Septic arthritis, sickle cell disease, meropenem, microbact, arthrocentesis, Serratia rubideae
Background:
Neonatal morbidity and mortality are major public health challenges in our local... more Background: Neonatal morbidity and mortality are major public health challenges in our local environment with a huge percentage of deaths in the neonatal period attributable to sepsis. Aim: The aim of the study was to assess the factors that affect patients’ outcome with respect to sepsis in neonates. Methods: This was a prospective descriptive cross sectional study. Neonates with proven and suspected sepsis were recruited into the study. Outcome was assessed based on the length of hospital stay and mortality. Clinical response to treatment was also assessed. Results: Nine factors were identified as risk factors for mortality, birth weight (< 2500g P = 0.000, OR = 7.214, CI = 2.5 – 21.0), prolonged rupture of membranes (PROM) (P= 0.014, OR = 2.470, 95% CI = 1.2 -5.1), prolonged preterm rupture of membranes (PPROM) P= (0.046. OR = 2.1, 95% CI = 0.9 -4.6) multiple gestation (P= 0.009), an infectious clinical diagnosis (P = 0.046, OR = 0.480), frequent changes in antibiotics ( P = 0.013). Others were a low Apgar score (P= 0.000), presence of organisms in intravenous fluids (P = 0.042, OR = 0.2, 95% CI = 0.02 – 1.3 and the presence of organisms in the blood stream (P = 0.007). Conclusion: This study determined the mortality rate in our environment due to sepsis to be 15.7%. Risk factors for a poor outcome include low birth weight, perinatal period, and maternal illness in pregnancy and isolation of a pathogen from the blood stream. Key words : Neonatal sepsis, prolonged stay, mortality, bactec 9050, microbact 12a, risk factors
Background: In spite of advances in antimicrobial therapy over the past few decades’, pneumonia a... more Background: In spite of advances in antimicrobial therapy over the past few decades’, pneumonia and other respiratory tract infections remain an important cause of morbidity and mortality. Aim: To determine the prevalent pathogens responsible for upper and lower respiratory tract infections in our local institution and the population profiles in which these organisms occur. Methods: This was a retrospective analysis of sputum samples sent to the Babcock University Teaching Hospital Laboratory over a period of twelve months from 2014-2015. Sputum samples were gram stained upon receipt in the laboratory and assessed with the Barttlet score. Data analysis was done with EPI INFO version 3.5.1. Results: The mean age of the 155 patients was 36.2+/-18.2 ranging from 4 to 92 years. The predominant organism was Streptococcus pneumonia [n = 69 (44.5%)]. Age < 65 was a significant risk for Streptococcus pneumoniae infection (p= 0.00, O.R=3.72, CI=1.00-13.77, X2=4.34). It was noted that there was a higher likelihood of Streptococcus pneumoniae infections with decreasing age (p=0.00 Coefficient= -9.05, Standard error=2.98, F test=9.25). Conclusion: Streptococcus pneumoniae remains the prime pathogen associated with respiratory tract infections especially for outpatients in our environment, while Extended Spectrum Beta Lactamase producing Klebsiella pneumoniae was seen mainly in inpatients. Streptococcus pneumonia and Klebsiella pneumoniae were the most prevalent pathogen both among in-patients and outpatients. The findings of this study will help in redesigning empiric therapy for clinicians with respect to respiratory tract infections.
Background. Neonatal sepsis is a significant cause of morbidity and mortality in developing count... more Background. Neonatal sepsis is a significant cause of morbidity and mortality in developing countries, accounting for a large proportion of neonatal deaths annually. Every year, 4 million neonates die, and one-third of these deaths is attributed directly to neonatal sepsis. Objectives. To determine the prevalence of neonatal sepsis, characterise and identify causative organisms and identify possible risk factors. Specific objectives were to determine the aetiological agents responsible for neonatal sepsis at Lagos University Teaching Hospital and also to identify the risk factors responsible for the development of neonatal sepsis. Methods. Venous blood pairs were collected from clinically septic admitted neonates and inoculated into BACTEC Peds Plus (BD, USA) bottles aerobically in the BACTEC 9050 system. Organisms were identified using the Microbact 12A/E system and biochemicals. A structured questionnaire was used to collect data for risk factors, which were analysed with the SPSS version 17. Results. Of 250 neonates who were sampled, 85 (34%) had pathogens recovered from their bloodstream, with Klebsiella pneumoniae the predominant organism. Risk factors for sepsis were being delivered outside the hospital (p=0.01), and by frequent changes in antibiotics (p=0.00). Conclusion. The burden of neonatal sepsis is still high in our environment as evidenced by our isolation rate of 34%. A concerted effort needs to be made to reduce this.
ABSTRACT
Background: Hand hygiene has been described as the cornerstone and starting point in all... more ABSTRACT Background: Hand hygiene has been described as the cornerstone and starting point in all infection control programs, with the hands of healthcare staff being the drivers and promoters of infection in critically ill patients. The objectives of this study were to assess healthcare workers compliance with the World Health Organization (WHO) prescribed five moments of hand hygiene as it relates to patient care and to determine the various strata of healthcare workers who are in default of such prescribed practices. Methods: The study was an observational, cross‑sectional one. Hand hygiene compliance was monitored using the hand hygiene observation tool developed by the WHO. A nonidentified observer was used for monitoring compliance with hand hygiene. The observational period was over a 60‑day period from August 2015 to October 2015. Results: One hundred and seventy‑six observations were recorded from healthcare personnel. The highest number of observationswere seen in surgery, n = 40. The following were found to be in noncompliance before patient contact – anesthetist P = 0.00 and the Intensive Care Unit P = 0.00 while compliance was seen with senior nurses (certified registered nurse anesthetist [CRNA]) P = 0.04. Concerning hand hygiene after the removal of gloves, the following were areas of noncompliance – the emergency room P = 0.00, CRNA P = 0.00, dental P = 0.04, and compliance was seen with surgery P = 0.01. With regards to compliance after touching the patient, areas of noncompliance were the anesthetists P = 0.00, as opposed to CRNA P = 0.00, dental P = 0.00, and Medicine Department P = 0.02 that were compliant. Overall, the rates of compliance to hand hygiene were low. Discussion: The findings however from our study show that the rates of compliance in our local center are still low. The reasons for this could include lack of an educational program on hand hygiene; unfortunately, healthcare workers in developing settings see such as ours regard such programs as being mundane. Conclusion: The observance of hand hygiene is still low in our local environment. Handwashing practices in our study show that healthcare workers pay attention to hand hygiene when it appears there is a direct observable threat to their wellbeing. Educational programs need to be developed to address the issue of poor hand hygiene. Key words: Alcohol hand rub, compliance, hand washing, healthcare associated infections, healthcare workers, infection control
Background:
Tuberculosis is the leading cause of death from any
single pathogen and it ... more Background: Tuberculosis is the leading cause of death from any single pathogen and it has consistently continued to be a major public health challenge globally. Data show that Nigeria ranks tenth among the 22 high tuberculosis burden countries. Aim: This study intends to describe the profile of tuberculosis infections in Babcock University Teaching Hospital. Methods: This was a retrospective cross sectional study of patients presenting to the Tuberculosis Laboratory of Babcock University Teaching Hospital. Results: Patients presenting to BUTH were 2.29 times more likely to have a positive AFB sputum smear result when compared to samples from Primary Health Care Centers – P = 0.05, χ2= 3.83, O.R = 2.29, R.R = 1.17, CI = 1.0 – 5.34. Patients presenting to BUTH were more likely to be HIV positive when compared to those from PHC’s p = 0.00, χ2 = 24.74, df = 2. Conclusion:The burden of tuberculosis is still high in our environment and challenges in its rapid and accurate diagnosis still remain. In order to strengthen tuberculosis control, attention needs to be placed on rapid diagnosis and prompt treatment. Key words: Tuberculosis, HIV, Primary Healthcare Centre, ZiehlNeelson stain, Directly Observed Treatment Short Course, pathogens
TITLE: AUTOMATED DIAGNOSIS OF TUBERCULOSIS: CHALLENGES AND PROSPECTS FOR IMPLEMENTATION.
AUTHORS:... more TITLE: AUTOMATED DIAGNOSIS OF TUBERCULOSIS: CHALLENGES AND PROSPECTS FOR IMPLEMENTATION. AUTHORS: SHOBOWALE EO, COKER AO, ADEGUNLE BA. OBJECTIVES: A narrative review of advances in automated diagnostic tests for diagnosis of tuberculosis infections. REVIEW METHODS: Electronic databases were searched from 40 articles for tests on automation in Mycobacterium tuberculosis identification. Studies were selected and evaluated that tested for the performance of new and old methods in automated diagnosis with significant impact on the turnaround time of diagnosis and also positive impact on patient care with respect to outcomes. RESULTS: A total of 40 studies were included. Overall, the gene expert system was found to be superior when applied to respiratory samples as opposed to other body fluids when compared to other test methods. High specificity estimates suggest that Nucleic Acid Amplification Tests (NAATS) should be the first-line test for rapid diagnosis of meningitis, but that they also need to be combined with the result of other tests in order to rule out disease. DISCUSSION: fully automated liquid culture methods overall are superior to mycobacterial culture on solid media, in terms of speed of diagnosis, ease of use and their accuracy with several user friendly systems that can be applied to the Nigerian environment. CONCLUSIONS: The DNA amplification tests provide a reliable way of increasing the specificity of diagnosis. Their superior diagnostic capability has been found to hold up in routine clinical practice, and they could confer several advantages on tuberculosis control programs. KEY WORDS; Mycobacterium tuberculosis, Automated diagnosis, BACTEC 460, Gene Xpert, MGIT 960
Introduction: The increasing rates of antimicrobial resistance on the part of pathogens are gradu... more Introduction: The increasing rates of antimicrobial resistance on the part of pathogens are gradually becoming a pandemic, this has to be curbed to reduce mortality. Background: The vast majority of antimicrobials currently in use are prescribed by Physicians. The Physicians act as a gateway to the control and use of life-saving medications such as antimicrobials, attention must be given towards antimicrobial stewardship and rational antimicrobial use. Methods: This was a cross-sectional survey of clinicians at 3 tertiary hospitals in Nigeria. A self administered structured Questionnaire containing 25 questions was given to the respondents to complete to assess the level of knowledge of physicians in antimicrobial use. Results: The following were found to be statistically significant – Physicians in the Public hospitals were more likely to collect specimens for microbiology analysis before commencing antibiotics – p = 0.02, Odds Ratio (O.R) = 2.61, Risk Ratio (R.R) = 1.47, 95% Confidence Interval (CI) = 1.16 – 5.80, Chi Square (χ2) = 1.47, a slightly higher likelihood of Physicians in the Private Tertiary Hospital having a Clinical Microbiologist in their hospital – p = 0. 00, O.R = 0.08, R.R = 0.25, CI = 0.05 –0.99, χ2 = 4.55. Discussion: Targeting rational interventions via educating physicians on antimicrobial use has had an established positive impact in curbing antimicrobial resistance in hospitals. Conclusion: Training programs on antimicrobial use needs to be strengthened.
Objective: Biosafety is an important element of quality management systems in laboratory practice... more Objective: Biosafety is an important element of quality management systems in laboratory practice as it is a measuring tool for compliance with accreditation and certification standards. Our aim was to assess the practices of laboratory personnel towards biosafety measures in their respective laboratories. Methods: The study design was a quantitative and qualitative cross sectional prospective one obtained with the use of a structured questionnaire. Data analysis was done with Epi Info version 3.4.1 and was presented using frequency tables with chi square calculated for different variables with the significant p value set at ≤ 0.05. Results: There were 63 respondents in the study. Private laboratories fared better in an assessment of their biosafety practices. Comparative variables identified as unsafe biosafety practices between public and private laboratories were non availability of Hepatitis B virus antibody testing, p value 0.01, odds ratio 5.4, consuming food in the laboratory, p value 0.00, odds ratio 0.2., non-use of N95 masks p value 0.04, O.R 3.9 and biosafety cabinet use p value 0.05, O.R 2.8. Discussion: Biosafety practices in Nigeria need to be streamlined in accordance with good laboratory practices in order to forestall workplace accidents and promote a safe environment for testing of clinical human samples. Conclusion: The absence of appropriate biosafety policies and practices is one of the challenges facing health care workers in sub Saharan Africa. There is the need for biosafety to be placed in the front burner of issues in laboratory practice in our respective facilities.
Background: Septic arthritis is an inflammatory process in the joints associated with isolation o... more Background: Septic arthritis is an inflammatory process in the joints associated with isolation of pathogens or a positive Gram stain of the synovial fluid. It is a disease condition with significant complications such as joint destruction and immobility. Individual cases are difficult to manage and frequently necessitate prolonged courses of antibiotics. Aim: The aim of the study was to present our findings with the view towards improving treatment outcomes in similar clinical scenarios. Findings: Septic arthritis in the index patient developed insidiously and was diagnosed after multiple arthrocentesis were performed. It was bilateral and associated with recurrent bouts of fever, joint tenderness reduced mobility and swelling. The predisposing factor in the index patient, a seven year old male was sickle cell disease. Multiple antimicrobial regimens were instituted in the patient with unsatisfactory results. Initial treatment regimens did not appear to be based on bacteriological statistics which resulted in prolonged hospital stay. Culture of the synovial fluid was initially onto brain heart infusion both and subsequently sub-cultured onto chocolate and MacConkey agar. The isolate recovered was Serratia rubideae which was identified using the Microbact 12A kit. Susceptibility studies showed the isolate to be susceptible to only meropenem. The patient was subsequently placed on meropenem for forty two days and recovered with radiologic and clinical evidence of improvement and thereafter discharged home. Conclusion: Close collaboration between the orthopedic surgeon and microbiologist will help to improve treatment outcomes. The Microbact12A kit is recommended in the routine identification of gram negative pathogens. Key words: Septic arthritis, sickle cell disease, meropenem, microbact, arthrocentesis, Serratia rubideae
Background:
Neonatal morbidity and mortality are major public health challenges in our local... more Background: Neonatal morbidity and mortality are major public health challenges in our local environment with a huge percentage of deaths in the neonatal period attributable to sepsis. Aim: The aim of the study was to assess the factors that affect patients’ outcome with respect to sepsis in neonates. Methods: This was a prospective descriptive cross sectional study. Neonates with proven and suspected sepsis were recruited into the study. Outcome was assessed based on the length of hospital stay and mortality. Clinical response to treatment was also assessed. Results: Nine factors were identified as risk factors for mortality, birth weight (< 2500g P = 0.000, OR = 7.214, CI = 2.5 – 21.0), prolonged rupture of membranes (PROM) (P= 0.014, OR = 2.470, 95% CI = 1.2 -5.1), prolonged preterm rupture of membranes (PPROM) P= (0.046. OR = 2.1, 95% CI = 0.9 -4.6) multiple gestation (P= 0.009), an infectious clinical diagnosis (P = 0.046, OR = 0.480), frequent changes in antibiotics ( P = 0.013). Others were a low Apgar score (P= 0.000), presence of organisms in intravenous fluids (P = 0.042, OR = 0.2, 95% CI = 0.02 – 1.3 and the presence of organisms in the blood stream (P = 0.007). Conclusion: This study determined the mortality rate in our environment due to sepsis to be 15.7%. Risk factors for a poor outcome include low birth weight, perinatal period, and maternal illness in pregnancy and isolation of a pathogen from the blood stream. Key words : Neonatal sepsis, prolonged stay, mortality, bactec 9050, microbact 12a, risk factors
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Aim: To determine the prevalent pathogens responsible for upper and lower respiratory tract infections in our local institution and the population profiles in which these organisms occur.
Methods: This was a retrospective analysis of sputum samples sent to
the Babcock University Teaching Hospital Laboratory over a period of twelve months from 2014-2015. Sputum samples were gram stained upon receipt in the laboratory and assessed with the Barttlet score. Data analysis was done with EPI INFO version 3.5.1.
Results: The mean age of the 155 patients was 36.2+/-18.2 ranging from 4 to 92 years. The predominant organism was Streptococcus pneumonia [n = 69 (44.5%)]. Age < 65 was a significant risk for Streptococcus pneumoniae infection (p= 0.00, O.R=3.72, CI=1.00-13.77, X2=4.34). It was noted that there was a higher likelihood of Streptococcus
pneumoniae infections with decreasing age (p=0.00 Coefficient= -9.05, Standard error=2.98, F test=9.25).
Conclusion: Streptococcus pneumoniae remains the prime pathogen associated with respiratory tract infections especially for outpatients in our environment, while Extended Spectrum Beta Lactamase producing Klebsiella pneumoniae was seen mainly in inpatients. Streptococcus pneumonia and Klebsiella pneumoniae were the most prevalent pathogen both among in-patients and outpatients. The findings of this
study will help in redesigning empiric therapy for clinicians with respect to respiratory tract
infections.
neonatal deaths annually. Every year, 4 million neonates die, and one-third of these deaths is attributed directly to neonatal sepsis.
Objectives. To determine the prevalence of neonatal sepsis, characterise and identify causative organisms and identify possible risk factors.
Specific objectives were to determine the aetiological agents responsible for neonatal sepsis at Lagos University Teaching Hospital and also to identify the risk factors responsible for the development of neonatal sepsis.
Methods. Venous blood pairs were collected from clinically septic admitted neonates and inoculated into BACTEC Peds Plus (BD, USA)
bottles aerobically in the BACTEC 9050 system. Organisms were identified using the Microbact 12A/E system and biochemicals. A
structured questionnaire was used to collect data for risk factors, which were analysed with the SPSS version 17.
Results. Of 250 neonates who were sampled, 85 (34%) had pathogens recovered from their bloodstream, with Klebsiella pneumoniae the
predominant organism. Risk factors for sepsis were being delivered outside the hospital (p=0.01), and by frequent changes in antibiotics (p=0.00).
Conclusion. The burden of neonatal sepsis is still high in our environment as evidenced by our isolation rate of 34%. A concerted effort needs to be made to reduce this.
Background: Hand hygiene has been described as the cornerstone and starting point in all infection control programs, with the hands of healthcare staff being the drivers and promoters of infection in critically ill patients.
The objectives of this study were to assess healthcare workers compliance with the World Health Organization (WHO) prescribed five
moments of hand hygiene as it relates to patient care and to determine the various strata of healthcare workers who are in default of such prescribed practices.
Methods: The study was an observational, cross‑sectional one. Hand hygiene compliance was monitored using the hand hygiene observation tool developed by the WHO. A nonidentified observer was used for monitoring compliance with hand hygiene. The observational period was over a 60‑day period from August 2015 to October 2015.
Results: One hundred and seventy‑six observations were recorded from healthcare personnel. The highest number of observationswere seen in surgery, n = 40. The following were found to be in noncompliance before patient contact – anesthetist P = 0.00 and the Intensive Care Unit P = 0.00 while compliance was seen with senior nurses (certified registered nurse anesthetist [CRNA]) P = 0.04. Concerning hand hygiene after the removal of gloves, the following were areas of noncompliance – the
emergency room P = 0.00, CRNA P = 0.00, dental P = 0.04, and compliance was seen with surgery P = 0.01. With regards to compliance after touching the patient, areas of noncompliance were the anesthetists P = 0.00, as opposed to CRNA P = 0.00, dental P = 0.00, and Medicine Department P = 0.02 that were compliant. Overall, the rates of compliance to hand hygiene were low.
Discussion: The findings however from our study show that the rates of compliance in our local center are still low. The reasons for this could include lack of an educational program on hand hygiene; unfortunately, healthcare workers in developing settings see such as ours regard such programs as being mundane.
Conclusion: The observance of hand hygiene is still low in our local environment. Handwashing practices in our study show that healthcare workers pay attention to hand hygiene when it appears there is a direct observable threat to their wellbeing. Educational programs need to be developed to address the issue of poor hand hygiene.
Key words: Alcohol hand rub, compliance, hand washing, healthcare associated infections, healthcare workers, infection control
Tuberculosis is the leading cause of death from any
single pathogen and it has consistently continued to be a major public health challenge globally. Data show that Nigeria ranks tenth among the 22 high tuberculosis burden countries.
Aim: This study intends to describe the profile of tuberculosis infections in Babcock University Teaching Hospital.
Methods: This was a retrospective cross sectional
study of patients presenting to the Tuberculosis Laboratory of Babcock University Teaching Hospital.
Results: Patients presenting to BUTH were 2.29 times more likely to have a positive AFB sputum smear result when compared to samples from Primary Health Care Centers –
P = 0.05, χ2= 3.83, O.R = 2.29, R.R = 1.17, CI = 1.0 – 5.34. Patients presenting to BUTH were more likely to be HIV positive when compared to those from PHC’s p = 0.00, χ2 = 24.74, df = 2.
Conclusion:The burden of tuberculosis is still high in our environment and challenges in its rapid and accurate diagnosis still remain. In order to strengthen tuberculosis control, attention needs to be placed on rapid diagnosis and prompt treatment.
Key words: Tuberculosis, HIV, Primary Healthcare Centre, ZiehlNeelson stain, Directly Observed Treatment Short Course, pathogens
AUTHORS: SHOBOWALE EO, COKER AO, ADEGUNLE BA.
OBJECTIVES: A narrative review of advances in automated diagnostic tests for diagnosis of tuberculosis infections.
REVIEW METHODS: Electronic databases were searched from 40 articles for tests on automation in Mycobacterium tuberculosis identification. Studies were selected and evaluated that tested for the performance of new and old methods in automated diagnosis with significant impact on the turnaround time of diagnosis and also positive impact on patient care with respect to outcomes.
RESULTS: A total of 40 studies were included. Overall, the gene expert system was found to be superior when applied to respiratory samples as opposed to other body fluids when compared to other test methods. High specificity estimates suggest that Nucleic Acid Amplification Tests (NAATS) should be the first-line test for rapid diagnosis of meningitis, but that they also need to be combined with the result of other tests in order to rule out disease.
DISCUSSION: fully automated liquid culture methods overall are superior to mycobacterial culture on solid media, in terms of speed of diagnosis, ease of use and their accuracy with several user friendly systems that can be applied to the Nigerian environment.
CONCLUSIONS: The DNA amplification tests provide a reliable way of increasing the specificity of diagnosis. Their superior diagnostic capability has been found to hold up in routine clinical practice, and they could confer several advantages on tuberculosis control programs.
KEY WORDS; Mycobacterium tuberculosis, Automated diagnosis, BACTEC 460, Gene Xpert, MGIT 960
Background: The vast majority of antimicrobials currently in use are prescribed by Physicians. The Physicians act as a gateway to the control and use of life-saving medications such as antimicrobials, attention must be given towards antimicrobial stewardship and rational antimicrobial use.
Methods: This was a cross-sectional survey of clinicians at 3 tertiary hospitals in Nigeria. A self administered
structured Questionnaire containing 25 questions was given to the respondents to complete to assess the level of knowledge of physicians in antimicrobial use.
Results: The following were found to be statistically significant – Physicians in the Public hospitals were more likely to collect specimens for microbiology analysis before commencing antibiotics – p = 0.02, Odds Ratio (O.R) = 2.61, Risk Ratio (R.R) = 1.47, 95% Confidence Interval (CI) = 1.16 –
5.80, Chi Square (χ2) = 1.47, a slightly higher likelihood of Physicians in the Private Tertiary Hospital having a Clinical Microbiologist in their hospital – p = 0. 00, O.R = 0.08, R.R = 0.25, CI = 0.05 –0.99, χ2 = 4.55.
Discussion: Targeting rational interventions via educating physicians on antimicrobial use has had an established positive impact in curbing antimicrobial resistance in hospitals.
Conclusion: Training programs on antimicrobial use needs to be strengthened.
measuring tool for compliance with accreditation and certification standards. Our aim was to assess the practices of
laboratory personnel towards biosafety measures in their respective laboratories.
Methods: The study design was a quantitative and qualitative cross sectional prospective one obtained with the
use of a structured questionnaire. Data analysis was done with Epi Info version 3.4.1 and was presented using
frequency tables with chi square calculated for different variables with the significant p value set at ≤ 0.05.
Results: There were 63 respondents in the study. Private laboratories fared better in an assessment of their
biosafety practices. Comparative variables identified as unsafe biosafety practices between public and private
laboratories were non availability of Hepatitis B virus antibody testing, p value 0.01, odds ratio 5.4, consuming food
in the laboratory, p value 0.00, odds ratio 0.2., non-use of N95 masks p value 0.04, O.R 3.9 and biosafety cabinet
use p value 0.05, O.R 2.8.
Discussion: Biosafety practices in Nigeria need to be streamlined in accordance with good laboratory practices
in order to forestall workplace accidents and promote a safe environment for testing of clinical human samples.
Conclusion: The absence of appropriate biosafety policies and practices is one of the challenges facing health
care workers in sub Saharan Africa. There is the need for biosafety to be placed in the front burner of issues in
laboratory practice in our respective facilities.
and frequently necessitate prolonged courses of antibiotics. Aim: The aim of the study was to present our findings with the view towards improving treatment outcomes in similar clinical scenarios.
Findings: Septic arthritis in the index patient developed insidiously and was diagnosed after multiple arthrocentesis were performed. It was bilateral and associated with recurrent bouts of fever, joint tenderness reduced mobility and swelling. The predisposing factor in the index patient, a seven year old male was sickle cell disease. Multiple antimicrobial regimens were instituted in the patient with unsatisfactory results. Initial treatment regimens did
not appear to be based on bacteriological statistics which resulted in prolonged hospital stay.
Culture of the synovial fluid was initially onto brain heart infusion both and subsequently sub-cultured onto chocolate and MacConkey agar. The isolate recovered was Serratia rubideae which was identified using the Microbact 12A kit. Susceptibility studies showed the isolate to be susceptible to only meropenem. The patient was subsequently placed on meropenem for forty two days and recovered with radiologic and clinical evidence of improvement and thereafter discharged home.
Conclusion: Close collaboration between the orthopedic surgeon and microbiologist will help to improve treatment outcomes. The Microbact12A kit is recommended in the routine identification of gram negative pathogens.
Key words: Septic arthritis, sickle cell disease, meropenem, microbact, arthrocentesis, Serratia rubideae
Neonatal morbidity and mortality are major public health challenges in our local environment with a huge percentage of deaths in the neonatal period attributable to sepsis.
Aim:
The aim of the study was to assess the factors that affect
patients’ outcome with respect to sepsis in neonates.
Methods:
This was a prospective descriptive cross sectional study. Neonates with proven and suspected
sepsis were recruited into the study. Outcome was assessed based on the length of hospital stay and mortality. Clinical response to treatment was also assessed.
Results:
Nine factors were identified as risk factors for mortality, birth weight (< 2500g P = 0.000, OR = 7.214, CI = 2.5 – 21.0), prolonged rupture of membranes (PROM) (P= 0.014, OR = 2.470, 95% CI = 1.2 -5.1), prolonged preterm rupture of membranes (PPROM) P= (0.046. OR = 2.1, 95% CI = 0.9 -4.6) multiple gestation (P= 0.009), an infectious clinical diagnosis (P = 0.046, OR = 0.480), frequent changes in antibiotics (
P = 0.013). Others were a low Apgar score (P= 0.000), presence of organisms in intravenous fluids (P = 0.042, OR = 0.2, 95% CI = 0.02 – 1.3 and the presence of
organisms in the blood stream (P = 0.007).
Conclusion: This study determined the mortality rate in our environment due to sepsis to be 15.7%. Risk factors for a poor outcome include low birth weight, perinatal period, and maternal illness in pregnancy
and isolation of a pathogen from the blood stream.
Key words
: Neonatal sepsis, prolonged stay, mortality, bactec 9050, microbact 12a, risk factors
Aim: To determine the prevalent pathogens responsible for upper and lower respiratory tract infections in our local institution and the population profiles in which these organisms occur.
Methods: This was a retrospective analysis of sputum samples sent to
the Babcock University Teaching Hospital Laboratory over a period of twelve months from 2014-2015. Sputum samples were gram stained upon receipt in the laboratory and assessed with the Barttlet score. Data analysis was done with EPI INFO version 3.5.1.
Results: The mean age of the 155 patients was 36.2+/-18.2 ranging from 4 to 92 years. The predominant organism was Streptococcus pneumonia [n = 69 (44.5%)]. Age < 65 was a significant risk for Streptococcus pneumoniae infection (p= 0.00, O.R=3.72, CI=1.00-13.77, X2=4.34). It was noted that there was a higher likelihood of Streptococcus
pneumoniae infections with decreasing age (p=0.00 Coefficient= -9.05, Standard error=2.98, F test=9.25).
Conclusion: Streptococcus pneumoniae remains the prime pathogen associated with respiratory tract infections especially for outpatients in our environment, while Extended Spectrum Beta Lactamase producing Klebsiella pneumoniae was seen mainly in inpatients. Streptococcus pneumonia and Klebsiella pneumoniae were the most prevalent pathogen both among in-patients and outpatients. The findings of this
study will help in redesigning empiric therapy for clinicians with respect to respiratory tract
infections.
neonatal deaths annually. Every year, 4 million neonates die, and one-third of these deaths is attributed directly to neonatal sepsis.
Objectives. To determine the prevalence of neonatal sepsis, characterise and identify causative organisms and identify possible risk factors.
Specific objectives were to determine the aetiological agents responsible for neonatal sepsis at Lagos University Teaching Hospital and also to identify the risk factors responsible for the development of neonatal sepsis.
Methods. Venous blood pairs were collected from clinically septic admitted neonates and inoculated into BACTEC Peds Plus (BD, USA)
bottles aerobically in the BACTEC 9050 system. Organisms were identified using the Microbact 12A/E system and biochemicals. A
structured questionnaire was used to collect data for risk factors, which were analysed with the SPSS version 17.
Results. Of 250 neonates who were sampled, 85 (34%) had pathogens recovered from their bloodstream, with Klebsiella pneumoniae the
predominant organism. Risk factors for sepsis were being delivered outside the hospital (p=0.01), and by frequent changes in antibiotics (p=0.00).
Conclusion. The burden of neonatal sepsis is still high in our environment as evidenced by our isolation rate of 34%. A concerted effort needs to be made to reduce this.
Background: Hand hygiene has been described as the cornerstone and starting point in all infection control programs, with the hands of healthcare staff being the drivers and promoters of infection in critically ill patients.
The objectives of this study were to assess healthcare workers compliance with the World Health Organization (WHO) prescribed five
moments of hand hygiene as it relates to patient care and to determine the various strata of healthcare workers who are in default of such prescribed practices.
Methods: The study was an observational, cross‑sectional one. Hand hygiene compliance was monitored using the hand hygiene observation tool developed by the WHO. A nonidentified observer was used for monitoring compliance with hand hygiene. The observational period was over a 60‑day period from August 2015 to October 2015.
Results: One hundred and seventy‑six observations were recorded from healthcare personnel. The highest number of observationswere seen in surgery, n = 40. The following were found to be in noncompliance before patient contact – anesthetist P = 0.00 and the Intensive Care Unit P = 0.00 while compliance was seen with senior nurses (certified registered nurse anesthetist [CRNA]) P = 0.04. Concerning hand hygiene after the removal of gloves, the following were areas of noncompliance – the
emergency room P = 0.00, CRNA P = 0.00, dental P = 0.04, and compliance was seen with surgery P = 0.01. With regards to compliance after touching the patient, areas of noncompliance were the anesthetists P = 0.00, as opposed to CRNA P = 0.00, dental P = 0.00, and Medicine Department P = 0.02 that were compliant. Overall, the rates of compliance to hand hygiene were low.
Discussion: The findings however from our study show that the rates of compliance in our local center are still low. The reasons for this could include lack of an educational program on hand hygiene; unfortunately, healthcare workers in developing settings see such as ours regard such programs as being mundane.
Conclusion: The observance of hand hygiene is still low in our local environment. Handwashing practices in our study show that healthcare workers pay attention to hand hygiene when it appears there is a direct observable threat to their wellbeing. Educational programs need to be developed to address the issue of poor hand hygiene.
Key words: Alcohol hand rub, compliance, hand washing, healthcare associated infections, healthcare workers, infection control
Tuberculosis is the leading cause of death from any
single pathogen and it has consistently continued to be a major public health challenge globally. Data show that Nigeria ranks tenth among the 22 high tuberculosis burden countries.
Aim: This study intends to describe the profile of tuberculosis infections in Babcock University Teaching Hospital.
Methods: This was a retrospective cross sectional
study of patients presenting to the Tuberculosis Laboratory of Babcock University Teaching Hospital.
Results: Patients presenting to BUTH were 2.29 times more likely to have a positive AFB sputum smear result when compared to samples from Primary Health Care Centers –
P = 0.05, χ2= 3.83, O.R = 2.29, R.R = 1.17, CI = 1.0 – 5.34. Patients presenting to BUTH were more likely to be HIV positive when compared to those from PHC’s p = 0.00, χ2 = 24.74, df = 2.
Conclusion:The burden of tuberculosis is still high in our environment and challenges in its rapid and accurate diagnosis still remain. In order to strengthen tuberculosis control, attention needs to be placed on rapid diagnosis and prompt treatment.
Key words: Tuberculosis, HIV, Primary Healthcare Centre, ZiehlNeelson stain, Directly Observed Treatment Short Course, pathogens
AUTHORS: SHOBOWALE EO, COKER AO, ADEGUNLE BA.
OBJECTIVES: A narrative review of advances in automated diagnostic tests for diagnosis of tuberculosis infections.
REVIEW METHODS: Electronic databases were searched from 40 articles for tests on automation in Mycobacterium tuberculosis identification. Studies were selected and evaluated that tested for the performance of new and old methods in automated diagnosis with significant impact on the turnaround time of diagnosis and also positive impact on patient care with respect to outcomes.
RESULTS: A total of 40 studies were included. Overall, the gene expert system was found to be superior when applied to respiratory samples as opposed to other body fluids when compared to other test methods. High specificity estimates suggest that Nucleic Acid Amplification Tests (NAATS) should be the first-line test for rapid diagnosis of meningitis, but that they also need to be combined with the result of other tests in order to rule out disease.
DISCUSSION: fully automated liquid culture methods overall are superior to mycobacterial culture on solid media, in terms of speed of diagnosis, ease of use and their accuracy with several user friendly systems that can be applied to the Nigerian environment.
CONCLUSIONS: The DNA amplification tests provide a reliable way of increasing the specificity of diagnosis. Their superior diagnostic capability has been found to hold up in routine clinical practice, and they could confer several advantages on tuberculosis control programs.
KEY WORDS; Mycobacterium tuberculosis, Automated diagnosis, BACTEC 460, Gene Xpert, MGIT 960
Background: The vast majority of antimicrobials currently in use are prescribed by Physicians. The Physicians act as a gateway to the control and use of life-saving medications such as antimicrobials, attention must be given towards antimicrobial stewardship and rational antimicrobial use.
Methods: This was a cross-sectional survey of clinicians at 3 tertiary hospitals in Nigeria. A self administered
structured Questionnaire containing 25 questions was given to the respondents to complete to assess the level of knowledge of physicians in antimicrobial use.
Results: The following were found to be statistically significant – Physicians in the Public hospitals were more likely to collect specimens for microbiology analysis before commencing antibiotics – p = 0.02, Odds Ratio (O.R) = 2.61, Risk Ratio (R.R) = 1.47, 95% Confidence Interval (CI) = 1.16 –
5.80, Chi Square (χ2) = 1.47, a slightly higher likelihood of Physicians in the Private Tertiary Hospital having a Clinical Microbiologist in their hospital – p = 0. 00, O.R = 0.08, R.R = 0.25, CI = 0.05 –0.99, χ2 = 4.55.
Discussion: Targeting rational interventions via educating physicians on antimicrobial use has had an established positive impact in curbing antimicrobial resistance in hospitals.
Conclusion: Training programs on antimicrobial use needs to be strengthened.
measuring tool for compliance with accreditation and certification standards. Our aim was to assess the practices of
laboratory personnel towards biosafety measures in their respective laboratories.
Methods: The study design was a quantitative and qualitative cross sectional prospective one obtained with the
use of a structured questionnaire. Data analysis was done with Epi Info version 3.4.1 and was presented using
frequency tables with chi square calculated for different variables with the significant p value set at ≤ 0.05.
Results: There were 63 respondents in the study. Private laboratories fared better in an assessment of their
biosafety practices. Comparative variables identified as unsafe biosafety practices between public and private
laboratories were non availability of Hepatitis B virus antibody testing, p value 0.01, odds ratio 5.4, consuming food
in the laboratory, p value 0.00, odds ratio 0.2., non-use of N95 masks p value 0.04, O.R 3.9 and biosafety cabinet
use p value 0.05, O.R 2.8.
Discussion: Biosafety practices in Nigeria need to be streamlined in accordance with good laboratory practices
in order to forestall workplace accidents and promote a safe environment for testing of clinical human samples.
Conclusion: The absence of appropriate biosafety policies and practices is one of the challenges facing health
care workers in sub Saharan Africa. There is the need for biosafety to be placed in the front burner of issues in
laboratory practice in our respective facilities.
and frequently necessitate prolonged courses of antibiotics. Aim: The aim of the study was to present our findings with the view towards improving treatment outcomes in similar clinical scenarios.
Findings: Septic arthritis in the index patient developed insidiously and was diagnosed after multiple arthrocentesis were performed. It was bilateral and associated with recurrent bouts of fever, joint tenderness reduced mobility and swelling. The predisposing factor in the index patient, a seven year old male was sickle cell disease. Multiple antimicrobial regimens were instituted in the patient with unsatisfactory results. Initial treatment regimens did
not appear to be based on bacteriological statistics which resulted in prolonged hospital stay.
Culture of the synovial fluid was initially onto brain heart infusion both and subsequently sub-cultured onto chocolate and MacConkey agar. The isolate recovered was Serratia rubideae which was identified using the Microbact 12A kit. Susceptibility studies showed the isolate to be susceptible to only meropenem. The patient was subsequently placed on meropenem for forty two days and recovered with radiologic and clinical evidence of improvement and thereafter discharged home.
Conclusion: Close collaboration between the orthopedic surgeon and microbiologist will help to improve treatment outcomes. The Microbact12A kit is recommended in the routine identification of gram negative pathogens.
Key words: Septic arthritis, sickle cell disease, meropenem, microbact, arthrocentesis, Serratia rubideae
Neonatal morbidity and mortality are major public health challenges in our local environment with a huge percentage of deaths in the neonatal period attributable to sepsis.
Aim:
The aim of the study was to assess the factors that affect
patients’ outcome with respect to sepsis in neonates.
Methods:
This was a prospective descriptive cross sectional study. Neonates with proven and suspected
sepsis were recruited into the study. Outcome was assessed based on the length of hospital stay and mortality. Clinical response to treatment was also assessed.
Results:
Nine factors were identified as risk factors for mortality, birth weight (< 2500g P = 0.000, OR = 7.214, CI = 2.5 – 21.0), prolonged rupture of membranes (PROM) (P= 0.014, OR = 2.470, 95% CI = 1.2 -5.1), prolonged preterm rupture of membranes (PPROM) P= (0.046. OR = 2.1, 95% CI = 0.9 -4.6) multiple gestation (P= 0.009), an infectious clinical diagnosis (P = 0.046, OR = 0.480), frequent changes in antibiotics (
P = 0.013). Others were a low Apgar score (P= 0.000), presence of organisms in intravenous fluids (P = 0.042, OR = 0.2, 95% CI = 0.02 – 1.3 and the presence of
organisms in the blood stream (P = 0.007).
Conclusion: This study determined the mortality rate in our environment due to sepsis to be 15.7%. Risk factors for a poor outcome include low birth weight, perinatal period, and maternal illness in pregnancy
and isolation of a pathogen from the blood stream.
Key words
: Neonatal sepsis, prolonged stay, mortality, bactec 9050, microbact 12a, risk factors