The epidemiology of sepsis in a district hospital emergency centre in Durban, KwaZulu natal

Introduction :Sepsis is one of the leading causes of death worldwide. There is a paucity of data describing the epidemiology of sepsis in emergency centres in developing countries. This study aims to describe the clinical profile and management of patients presenting with sepsis in this setting.Methods:A retrospective chart review was conducted in an Emergency Centre (EC) of a district hospital in Durban from December 2015 to February 2016. All patients with a diagnosis of an infection that met the Surviving Sepsis Campaign criteria for sepsis syndrome were included in the study.Results:A total of 1195 patients who were diagnosed with an infection were screened. Of these, 52 of them met the inclusion criteria for the study. The criteria for severesepsis was met in 40.3% (n 23) and 1.9% (n 1) met the criteria for septic shock. More than half of the patients were HIV positive and 30.7% did not know their HIV status. The most common sites of infection were respiratory tract, gastrointestinal and central nervous system respectively. Most patients were admitted to the general medical ward. The inpatient mortality rate was 15% for general medical ward admissions.Conclusion:A better understanding of the demographic and clinical profile of sepsis syndrome in South African ECs is required to guide clinical and operational policy development

Aetiology and Risk Factors for Neonatal Sepsis at the Lagos University Teaching Hospital; Idi-Araba; Lagos; Nigeria

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

Effect of clean intermittent catherization on lower urinary tract : an experimental study

Objective To investigate the effect of clean intermittent catheterization (CIC) on the lower urinary tract in experimental animals. Patients and Methods: Eight male spinalized cats were subjected to CIC for a period of 6 - 9 weeks. A urine specimen for culture was obtained weekly. A pathological examination of the proximal and distal urethra and the bladder was performed. Results Urinary tract infection was detected in all cats starting from the second week. It responded to antibiotics but recurrence occurred after discontinuing the treatment. One animal died in the 4th week from fibrinopurulent peritonitis caused by necrotizeng ulcerative cystitis. False passage occurred in another cat at the end of the 6th week. It was managed by fixation of a urethral catheter for a week; and CIC was then continued for another two weeks. Pathological examination showed a thickening of the urethral wall that progressed with the duration of CIC. Microscopic examination of the urethra showed epithelial hyperaemia; ulceration and an inflammatory reaction with oedema as well as an inflammatory reaction of the lamina propria. The muscular layer showed progressive hypertrophy with continuing CIC. The bladder wall showed epithelial ulceration; Brunn nests and squamous metaplasia with islands of degenerated cells. Conclusion Recurrent urinary tract infection; local traumatic reactions of the urethral and bladder wall; especially epithelial damage of the mucosa; and false passages are common complications occurring with CIC in the experimental animal. Although the situation in the experimental animal has no relevance in humans; yet; it may throw light on some aspects of possible complications of long-term CIC