Outbreak of Serratia Marcescens in the newborn care unit in a local tertiary hospital

@#Objectives: This study was performed to investigate the Serratia marcescens outbreak in the Newborn Care Unit of a tertiary hospital. Methods: This is a retrospective, descriptive study. Charts of all neonates with S. marcescens growth in their blood culture were retrieved from the Records Section of the Baguio General Hospital and Medical Center (BHGMC) from July 2002 to July 2003. During the outbreak period, the following interventions were performed: 1) orientation and re- orientation of the entire health care team, especially, the staff of the unit on infection control and prevention; 2) aerobic culture of possibly contaminated hands of concerned staff and equipment of both the delivery room and the intensive care unit; 3) closing of the pediatric newborn care unit for general cleaning and disinfection. Results: Of the 132 cases reported to have grown S. marcescens in their blood cultures, 63 (48%) charts were available for review: 63% were term; 51% male; 81% were appropriate for gestational age; and 30% had birth weights of 2500 to 2999 grams and delivered via normal spontaneous delivery. The most common reasons for admission were: respiratory distress syndrome (5%), multiple congenital anomalies (5%), congenital heart disease (5%), urinary tract infection (5%), severe asphyxia (3%), and pneumonia (3%). The clinical manifestations seen during the first 4 days of life were respiratory distress (51%), poor suck (25%), bleeding (22%), jaundice (6%), sclerema (5%), and vomiting (5%). Blood transfusion (46%), such as fresh frozen plasma and packed red blood cells, was the prevalent invasive procedure done, followed by endotracheal intubation (41%), and umbilical catheterization (38%). Eighteen out of 63 cases died with a case fatality rate of 29%; 28% died of septic shock. S. marcescens showed 100% sensitivity to Piperacillin-Tazobactam, Cefepime, Imipenem, and Meropenem. Environmental cultures showed isolation of S. marcescens from the suction machines used in the aseptic and septic areas of the neonatal intensive care unit. Furthermore, this study showed that the following factors contributed to the occurrence of an outbreak: paucity of manpower, lack of equipment and area assigned for the pediatric newborn care unit. Conclusion: This investigation showed that the S. marcescens outbreak in the pediatric newborn care unit has been associated with environmental contamination and breakdown in infection control measures such as overcrowding, understaffing, and other major disruptions of routine nursery care, particularly hand hygiene.

The use of meropenem among neonates: A one-year retrospective study in the nursery of local tertiary hospital

@#Objectives: This study was conducted to determine profile of neonates being treated with meropenem as well as to assess its clinical efficacy in the treatment of neonatal infections. Methods: This is a retrospective review of the records of sick neonates admitted at the Newborn Care Unit of a tertiary hospital and treated with meropenem. Those discharged against advice were excluded. Frequency and percentage were used in comparing the following variables: sex, 5-minute APGAR score, age of gestation, birth weight, type of infection, culture results, treatment outcome, and adverse reactions. Results: There were 34 charts available for review, but two were excluded. There were 62.5 % females and 37.5 % males: 28.1 % of them had a 5-minute APGAR score of 10; 37.5 % had 9; 21.9% had 8; and 12.5 % had 7. Sixty-two percent (62.5%) of the subjects were between 32 to 35 weeks age of gestation: 46.9 % were of low birth weight; 34.4 % were of very low birth weight; and 18.7 % had normal weights. Sepsis was the most common indication in the use of meropenem, followed by sepsis with pneumonia, pneumonia then sepsis with meningitis. Majority (68.75%) of the patients had no growth in their blood while 60% had no growth in the CSF. Enterobacter aerogenes (15.6%) was the most common blood isolate while Enterobacter gergeviae (20%) and Klebsiella pneumoniae (20%) were the isolates in the CSF culture. Treatment outcomes were favorable; 84.4% were improved, while 9.4% were unimproved and shifted to other antibiotics, and 6.2% died. Conclusion: The use of meropenem is effective in the treatment of life-threatening infections among newborns.

Terror in the air: Meningococcal disease outbreak in the Philippines

Introduction: Meningococcal disease is caused by Neisseria meningitidis that can present as fever or respiratory infection developing into a fulminant course. In February 2005, WHO experts confirmed that the Cordillera Administrative Region of the Philippines experienced an outbreak of Serogroup A Meningococcal Disease where there was an unusually large proportion of meningococcemia cases. Objectives: This study aims to describe the clinical profile of pediatric patients discharged from a tertiary hospital with a diagnosis of meningococcal disease and to identify the etiologic agent. Methodology: This is a retrospective descriptive study involving chart review of patients 0-18 years of age discharged from October 2004 to October 2006 with a diagnosis of either meningococcemia, meningococcal meningitis or both. Results: There were 217 discharges with this diagnosis. Of these, 100 (46.08%) belonged to the 0-18 years of age, 47% of who were male, 64% were Baguio residents, 28% were 0-1 year old, 19% were between 2-5 years old and 26% were 15-18 years old. 100% had a history of fever and 90% had rashes. 51% had a discharge diagnosis of Meningococcemia. 32% died due to septic shock, DIC. The etiologic agent was identified as Neisseria meningitidis. Conclusion: Of the study population, 53% were female. Children 0-5 years of age were most affected (47%). 100% had a history of fever. 32% died of septic shock. 62% were confirmed by laboratory. The culprit of this epidemic was a hypervirulent strain of Neisseria meningitidis Serogroup A Subtype A 1.9 sensitive to Penicillin.