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

Correlation of H2O2 Production of Lactobacillus species with Nugent Scores of Young Nigerian Women.

Aim: To correlate H2O2 production of Lactobacillus species with the Nugent scores of young Nigerian women in order to assess their vaginal health. Study Design: Cross-sectional study. Place and Duration of Study: Departments of Medical Microbiology & Parasitology, Biochemistry and Obstetrics and Gynaecology, College of Medicine of the University of Lagos, between May and august 2009. Methodology: Ninety- seven isolates of Lactobacillus from eighty-two women without Bacterial vaginosis (BV) and fifteen women with BV were used for the study. BV was diagnosed using Nugent scoring method. Lactobacilli were isolated using MRS agar and categorized into facultative anaerobes and strict anaerobes. Hydrogen peroxide was detected and measured by titration using dilute sulphuric acid and reaction stopped with potassium permanganate. Results: Out of 97 isolates studied, 76 (78%) were facultative anaerobes, while 21 (22%) were strict anaerobes. The facultative anaerobes were obtained from 11 of 15 women with BV and 65 of 82 women without BV. Forty- nine (50.51%) of the 97 isolates produced H2O2. Forty- four of the H2O2 producers were from women without BV while five were from women with BV. Majority (67%) of the strains obtained from women with BV were non-hydrogen peroxide producing. Proportion of H2O2 producing Lactobacillus by Nugent score were 70%, 43% and 33% in negative, intermediate and BV Nugent scores respectively. There was no significant difference between the mean concentrations of H2O2 production in the various Nugent scores. Conclusion: The overall rate of hydrogen peroxide production was low. While the rates of hydrogen peroxide production correlated with Nugent scores, being highest in negative Nugent scores and lowest with BV scores, the concentration of hydrogen peroxide produced had no association with Nugent scores. The Nigerian women studied might have a relatively high susceptibility rate to vaginal infections.

Detecting Nosocomial Intrinsic Infections through Relating Bacterial Pathogens of Incision

Surgical procedures often lead to both intrinsic and extrinsic infections. In order to improve on recovery of patients; investigations were carried out on samples collected from patients during and after surgery. Laboratory analysis was performed on wound swabs from incision; colon segments; scrapes; tissues; pus and catheter specimen urine. The samples were cultured on MacConkey and Blood agar and incubated aerobically at 370C for 16-24 hours. Thereafter; isolates were identified using standard microbiological methods. Results showed that isolates from wound were also found on endogenous indicators of surgery. Klebsiella species from incision was 15 (18.75) while those from colon segment was 30(37.6); scrapes 8(16) and pus 3(7.5). Acinetobacter species found on incision was 15(7.5) and pus 7(2.3). Pseudomonas species was distributed on incision 5(2.5); colon segment 4(5); tissue 3(1.6); scrapes 5(10) and pus was 5(12.5). Staphylococcus aureus which was isolated from incision was 2(1); while scrapes and pus were 5(10) and 7(17.5) respectively. Catheter associated urinary tract infections yielded significant bacteriuria (64.7); almost twice the rate of non-significant bacteriuria (35.3); indicating the need to remove all catheters as soon as possible. Antibiogram of isolates of Klebsiella pneumoniae with resistance pattern: ApGnNaNt; Escherichia coli (ApCtNaTtCm) and S. aureus (ApChCxErPn) with plasmid sizes in the range (30.2-52.51Kb) were common to both indicators and wound; showing that the pathogens were the same clusters. This study demonstrated surgical procedures as precursory to intrinsic infections and that bacterial pathogens found on wounds and endogenous indicators of surgery are links to intrinsic infection. The study therefore emphasizes the need to culture wounds promptly to effect speedy recovery of patients who have undergone surgery

Laboratory Survey of Significant Bacteriuria in a Family Practice Clinic - Is the Spectrum of Causative Agents Changing?

Urinary tract infection correlates with significant bacteriuria. Empiric and definitive therapy depends on the sensitivity pattern of the causative agents; so it is essential to keep abreast of changes in the causative organisms. This study was carried out to determine the causative agents of significant bacteriuria and their antibiotic sensitivity pattern. Mid stream urine specimens were collected from all patients attending the Family Medicine Clinic of the Lagos State University Teaching Hospital; Ikeja Lagos in July and August of 2005. The urine specimens were transported on ice to the Medical Microbiology and Parasitology Department of the College of Medicine; Idi-Araba. Significant bacteriuria was determined by the standard loop method. Culture was performed on MacConkey agar (oxoid) and blood agar base (Oxoid) and Isolates were identified by standard laboratory methods. Antibiotic sensitivity was by disc diffusion method. Four hundred and fifty urine specimens surveyed for bacteria were from 251 females (55.8) and 199 males (44.2) with age range 13 to 89 years. Ninety four patients (20.9) had significant bacteriuria and 14 were symptomatic; making the prevalence rate of symptomatic bacteriuria 3.1. Out of 91 patients who had been on antibiotics; a significantly higher proportion (52) had bacteriuria while only 13.4 of those who had not been on antibiotics had bacteriuria. Klebsiella and Enterobacter species were more commonly isolated than E. coli. Most of the isolates were resistant to cotrimoxazole (89); tetracycline (69.1) and amoxicillin (88.1) and amoxicillin (88.1). Sensitivity rates to the urinary antiseptics ranged from 54.2 to 55.9. Many of the bacteria were sensitive to ofloxacin (92.9)); ciprofloxacin (84.7); cefotaxime(72.9); ceftriaxone(86.4) and ceftazidime( 88.1). Sensitivity to the aminoglycosides ranged from 57.7 to 59.3

Comparative evaluation of direct stool smear and formol-ether concentration methods in the identification of Cryptosporidium species

Cryptosporidium is a common cause of diarrhoea in patients with Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). Unfortunately this pathogen is not often checked for in Microbiology laboratories because the formol-ether stool concentration method for identification of Cryptosporidium is cumbersome and may not be routinely undertaken in very busy laboratories and in laboratories with inadequate personnel. This study was therefore carried out to compare the outcome of direct stool examination and formol-ether concentration method with the aim of finding a non-cumbersome method of examining for Cryptosporidiumspecies routinely in stools when it is indicated. Fresh stool specimens of 193 HIV positive and 200 HIV negative patients (control) attending clinic at the Lagos University Teaching Hospital (LUTH) were processed within two hours of collection using direct stool smear and formol-ether concentration methods. Permanently stained slides were prepared using Kinyoun acid-fast stains. Cryptosporidium oocysts were found in 35 (18.1) of HIV seropositive patients using direct stool smear method and in 36 (18.7) using formol-ether concentration method. There was no statistical difference between the two methods (p 0.05; xz = 0.012; df = 1 at 95 confidence limit critical ratio = 3.841). No Cryptosporidiumwas identified in the control (HIV negative) patients using either method. Cryptosporidium oocysts can be routinely checked for in the Microbiology laboratories using either direct stool smear or formol-ether concentration stool method with comparable sensitivity