Infectious disease exposures and outbreaks at a South African neonatal unit with review of neonatal outbreak epidemiology in Africa
Infectious disease exposures and outbreaks at a South African neonatal unit with review of neonatal outbreak epidemiology in Africa
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DOI：
10.1016/j.ijid.2017.01.026
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发表时间：
2017-04-01
影响因子：
8.4
通讯作者：
Mehtar, S.
中科院分区：
文献类型：
--
作者：
Dramowski, A.;Aucamp, M.;Mehtar, S.
背景：住院新生儿易受感染，病原体暴露于宫内、产中和产后。由于过度拥挤、人手不足和共用设备，非洲新生儿病房暴发的风险很高。方法：描述开普敦泰格伯格儿童医院儿科传染病和感染预防(IP)小组参加的新生儿暴发情况(2008年5月1日至2016年4月30日)，病原体、暴发规模、死亡率、来源和暴发控制措施。对1996年1月1日至2016年1月1日从非洲报告的新生儿疫情进行了回顾，以结合该地区已发表的文献联系作者的经验。结果：在8年的时间里，共记录了13起疫情，148名婴儿(11例死亡，7%死亡)，病原体包括轮状病毒、流感病毒、麻疹病毒和多重耐药细菌(粘质沙雷氏菌、鲍曼不动杆菌、耐甲氧西林金黄色葡萄球菌和耐万古霉素肠球菌)。虽然很少查明感染源，但大多数疫情都与知识产权做法的违规行为有关。严格的以传播为基础的预防措施、工作人员/家长教育和临床实践的改变控制了疫情的爆发。从非洲新生儿文献中，确定了20起疫情，涉及524名婴儿(177例死亡，34%死亡)；50%的疫情是由产超广谱β-内酰胺酶的肺炎克雷伯菌引起的。结论：非洲新生儿住院期间暴发频繁，但报告较少，死亡率高，以革兰氏阴性菌为主。通常涉及知识产权实践中的违规行为，只有不到50%的病例确认了暴发源。迫切需要在非洲新生儿病房改进知识产权做法和解决抗菌素耐药性的方案。(三)2017年提交人(S)。爱思唯尔有限公司代表国际传染病学会出版。
Background: Hospitalized neonates are vulnerable to infection, with pathogen exposures occurring in utero, intrapartum, and postnatally. African neonatal units are at high risk of outbreaks owing to overcrowding, understaffing, and shared equipment.Methods: Neonatal outbreaks attended by the paediatric infectious diseases and infection prevention (IP) teams at Tygerberg Children's Hospital, Cape Town (May 1, 2008 to April 30, 2016) are described, pathogens, outbreak size, mortality, source, and outbreak control measures. Neonatal outbreaks reported from Africa (January 1, 1996 to January 1, 2016) were reviewed to contextualize the authors' experience within the published literature from the region.Results: Thirteen outbreaks affecting 148 babies (11 deaths; 7% mortality) over an 8-year period were documented, with pathogens including rotavirus, influenza virus, measles virus, and multidrug-resistant bacteria (Serratia marcescens, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci). Although the infection source was seldom identified, most outbreaks were associated with breaches in IP practices. Stringent transmission-based precautions, staff/parent education, and changes to clinical practices contained the outbreaks. From the African neonatal literature, 20 outbreaks affecting 524 babies (177 deaths; 34% mortality) were identified; 50% of outbreaks were caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae.Conclusions: Outbreaks in hospitalized African neonates are frequent but under-reported, with high mortality and a predominance of Gram-negative bacteria. Breaches in IP practice are commonly implicated, with the outbreak source confirmed in less than 50% of cases. Programmes to improve IP practice and address antimicrobial resistance in African neonatal units are urgently required. (C) 2017 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.