ETD Collection

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Subject: search.filters.subject.Sepsis

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    Maternal mortality due to sepsis after caesarean section at Chris Hani Baragwanath Hospital from 1997-2014
    (2017) Dlamini, Zandile Barbara
    Background Pregnancy related sepsis is one of the leading direct causes of preventable maternal morbidity and mortality. Evidence shows that caesarean section increases the risk of developing sepsis threefold compared to vaginal deliveries. Maternal death from sepsis after caesarean section can be prevented by proper monitoring of patients from the antenatal period, during labour and delivery and by early recognition and aggressive treatment of puerperal sepsis. This study was conducted to determine the frequency of maternal death from sepsis after caesarean section at Chris Hani Baragwanath Academic Hospital, and to identify associated factors including the role of HIV infection. Methods This was a retrospective descriptive study of maternal death due to sepsis after caesarean section at Chris Hani Baragwanath Academic Hospital from January 1997 to December 2014. Maternal death records of women who died of sepsis after caesarean section were obtained from the maternal death data base in the Department of Obstetrics and Gynaecology at the hospital. Results There were 108 299 caesarean sections performed during the study period, and 24 women died from sepsis after caesarean section from 1997 to 2014. These deaths made up 3.6% of the 661 maternal deaths at the hospital in this period. Three women presented as referrals, and 21 had their operations done at Chris Hani Baragwanath. The frequency of maternal death from sepsis after caesarean section at the hospital was 0.02% or 19.4/100 000 caesarean sections. The mean age of the women was 28.8 years, with three (12.5%) less than 20 years of age. Twenty women (83.3%) had emergency caesareans. The most common indication for caesarean section was Prolonged labour (50%). Sixteen (66.7%) women were HIV-infected. Twenty women (83.3%) required surgical intervention for puerperal sepsis after caesarean section. Conclusion On average, one to two women die each year at Chris Hani Baragwanath Academic Hospital from puerperal sepsis associated with caesarean section. This study showed that sepsis after caesarean section was more commonly observed with emergency than with elective procedures, and that prolonged labour was the most frequently associated obstetric indication. HIV infected women were more susceptible to death from sepsis after caesarean section, compared with HIV uninfected women. Obstetricians and midwives need to be skilled in the prevention, identification and treatment of life-threatening sepsis after caesarean section.
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    Epidemiology of acinetobacter sepsis in infants admitted to a neonatal unit
    (2016) Thomas, Reenu
    Background: Acinetobacter baumannii (A. baumannii) is emerging as one of the pathogens causing sepsis in neonates. Prevalence, antibiotic susceptibilities and case-fatality rate (CFR) of A. baumannii in the neonatal units are not well known. Objective: To determine the prevalence, antibiotic susceptibility patterns and CFR of A. baumannii infection in neonates. Methods: Medical records of neonates admitted to Chris Hani Baragwanath Academic Hospital from 1st October 2007 to 31st October 2011 with a positive blood or cerebrospinal fluid culture due to A. baumannii were reviewed for demographic characteristics, clinical presentation, laboratory findings, antibiotic susceptibility and outcome. Results: There were 399 isolates of A. baumannii, with a prevalence of 4.3/1000 live births or 2/ 1000 patient-days, and accounting for 13% of all bacterial and fungal isolates. Antimicrobial susceptibility results were available for 379 isolates and only 155 medical records could be retrieved for analysis. The mean gestational age and birth weight of infected neonates was 30 weeks and 1400 grams respectively. Thirty seven (24%) were isolated from neonates with early onset sepsis and 118 (76%) from those with late onset sepsis. Sixty four percent of isolates were susceptible to Cephalosporins, 21% to Aminoglycosides and 17% were multi-drug resistant (MDR) isolates. The CFR was 32%. Factors associated with mortality were presence of a central venous catheter prior to onset of sepsis (49% vs 31%, p=0.03); need for ventilatory support (62% vs 36%, p=0.005) and inotropic support (57% vs 17%, p<0.001). Conclusions: A. baumannii is a common pathogen causing sepsis in neonates, with 17% of them being MDR. It is associated with high CFR. These findings highlight the need for strict enforcement of infection control and antibiotic stewardship practices.
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    Evaluation of culture-proven neonatal sepsis at a tertiary care hospital in South Africa
    (2015) Lebea, Mamaila Martha
    Background: Organisms causing neonatal sepsis differ in different regions and also change with time in the same area. The antibiotic susceptibility of microorganisms also changes with time, with emergence of multidrug resistant organisms. A periodic survey of the causes of sepsis and their antibiotic sensitivity patterns is essential in the design of effective infection control programs and in guiding empiric antibiotic therapy. Aim: To evaluate the epidemiology of culture-proven neonatal sepsis and to describe the clinical characteristics of patients with neonatal sepsis at a tertiary care hospital in South Africa over a one year period. Methods: This was a retrospective descriptive study conducted in the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Clinical and laboratory data of patients, admitted to the CMJAH neonatal unit between 1 January 2012 and 31 December 2012 with positive blood cultures were reviewed. Results: During this time there were 196 patients with blood-culture proven neonatal sepsis (NNS). This gave an incidence of 10.26 per 100 admissions. Late-onset sepsis (LOS) accounted for 83.7% of cases of NNS. Of the 196 patients with NNS, 117 (59.39%) were males. The median gestational age for patients with NNS was 30 weeks and the median birth weight was 1300g. HIV exposure was present in 30.67 % of patients. Predominant isolates were Klebsiella pneumioniae (32.20%), coagulase-negative staphylococci (23.72%) and methicillin-resistant Staphylococcus aureus (13.13%). The majority of the isolated K.pneumoniae were extended beta-lactamase-producing (ESBL) with resistance to ampicillin and gentamicin. Conclusion: Neonatal sepsis is an important cause of mortality at CMJAH neonatal unit. Compared to previous audits in the unit, the incidence of NNS in the unit is on the increase while mortality from NNS has remained relatively constant. LOS was more common than EOS at CMJAH. A changing pattern of bacteria isolated has been observed. Gramnegative microorganisms comprised the majority of the neonatal sepsis, with ESBL Klebsiella pneumoniae and A. baumannii being the most prevalent. Coagulase negative staphylococcus remains an important cause of NNS, and is the most prevalent grampositive organism isolated. Resistance to the first-line antibiotic regimen for both EOS and LOS is significant. Due to the changing pattern of bacteria isolated and changing patterns in antibiotic sensitivity, recommendations are made regarding early empiric antibiotic therapy.