ABSTRACT
Background and Aims: Neonatal sepsis is an important cause of morbidity and mortality in Nigeria and in most parts of the world. Consequently, we determined the prevalence of the common bacterial pathogens of neonatal sepsis, their antibiotic susceptibility profiles, antibiotic regimen used in treatment and their clinical outcomes in a resource limited environment. Study Design: This was a prospective cross sectional study. Place and Duration of Study: Study was conducted in the Special Care Baby Unit (SCBU), Department of Paediatrics and the Department of Medical Microbiology of Jos University Teaching Hospital (JUTH), Jos, Nigeria between May to December 2011. Methodology: Biological samples were collected from 218 neonates suspected of sepsis (119 male, 99 female). The WHO and the Integrated Management of Childhood Illnesses (IMCI) criteria for suspicion of sepsis were used to select subjects into the study. Samples were processed and analyzed by standard methods in the microbiology laboratory. Antibiotic susceptibility testing was done. The antibiotic regimen used for therapy and subsequent clinical outcomes were documented. Results: Prevalence of culture proven sepsis was 34.4% (75/218). The common isolates were Klebsiella pneumoniae (32%), Staphylococcus aureus (30.7%) and Escherichia coli (10.7%). More than 60% of the K. pneumoniae isolates were resistant to the antibiotics tested. The E. coli and Enterobacter isolates were 100% sensitive to meropenem. The Gram positive isolates were most sensitive to ciprofloxacin (85%). Resistance of S. aureus was 6% to cefotaxime and 61% to ampicillin. A total of 173 (79.4%) neonates were discharged home, 15 (6.8%) were discharged against medical advice and 30 (13.8%) died on admission. The antibiotic regimen with the least mortality was a combination of ciprofloxacin and gentamicin. Conclusion: The cultures in this study showed variable antibiogram with complicated patterns of resistance. In all cases of suspected neonatal sepsis, we recommend culture and sensitivity tests to identify the causative pathogen and initiate specific antibiotic therapy. However, cefotaxime in combination with gentamicin is recommended as first line empirical therapy.
ABSTRACT
The patterns of childhood acquired heart diseases (AHD) vary in different parts of the world and may evolve over time. We aimed to compare the pattern of childhood AHD in our institution to the historical and contemporary patterns in other parts of the country; and to highlight possible regional differences and changes in trend. Materials and Methods: Pediatric echocardiography records spanning a period of 10 years were reviewed. Echocardiography records of children with echocardiographic or irrefutable clinical diagnoses of AHD were identified and relevant data extracted from their records. Results: One hundred and seventy five children were diagnosed with AHD during the period; including seven that had coexisting congenital heart disease (CHD). They were aged 4 weeks to 18 years (mean 9.84?4.5 years) and comprised 80 (45.7) males and 95 (54.3) females. Rheumatic heart disease (RHD) was the cause of the AHD in 101 (58.0) children; followed by dilated cardiomyopathy (33 cases; 18.9) which was the most frequent AHD in younger (under 5 years) children. Other AHD encountered were cor pulmonale in 16 (9.1); pericardial disease in 15 (8.6); infective endocarditis in 8 (4.6) and aortic aneurysms in 2 (1.1) children. Only one case each of endomyocardial fibrosis (EMF) and Kawasaki Disease were seen during the period. Conclusions: The majority of childhood acquired heart diseases in our environment are still of infectious aeitology; with RHD remaining the most frequent; particularly in older children. Community-based screening and multicenter collaborative studies will help to better describe the pattern of AHD in our country. More vigorous pursuit of the Millennium development goals will contribute to reducing the burden of childhood acquired heart diseases in the country