exudates and Sepsis

We report a case of meningitis and one of fatal septicaemia in neonates due to Burkholderia pseudomallei and review the literature on neonatal melioidosis. Pneumonia was the primary presentation and was complicated by shock in the latter case. The epidemiological findings suggest that the cases reported from Malaysia were community-acquired in contrast with those from the USA and Thailand.

Topics: Burkholderia pseudomallei; Humans; Infant, Newborn; Malaysia; Male; Melioidosis; Meningitis, Bacterial; Sepsis

The addition of glutamine to parenteral nutrition (PN) in neonates has not shown significant benefits as compared to adults thus far. This study aimed to determine the potential benefits of the addition of glutamine to neonatal PN in a tertiary hospital in a middle-income country.. This was a double-blinded randomised controlled trial. Babies who were admitted to the neonatal intensive care unit (NICU) and who required PN were eligible for inclusion in the study. The subjects were randomised to receive either glutamine-added PN (intervention) or standard PN (control). The most important outcomes included time to full enteral nutrition, incidence of sepsis and necrotising enterocolitis (NEC), clinical or culture-proven sepsis.. Out of 270 subjects, 132 were randomised to the intervention group and 138, to the control group. Baseline data were comparable in both groups. The median time taken to reach full enteral nutrition was similar for both intervention and control groups (six days in each group, p-value is 0.52). The incidences of NEC, clinical sepsis and culture-proven sepsis did not differ significantly in the intervention and control groups (5.8 vs. 7.1 percent, p-value is 0.68; 15.7 percent vs. 10.2 percent, p-value is 0.21 and 16.5 percent vs. 15.7 percent, p-value is 0.38, respectively). Other outcomes such as duration of ventilation, duration of NICU stay and a subgroup analysis for preterm and term babies also showed no statistically significant differences.. Addition of glutamine to neonatal PN was not shown to improve outcome.

Topics: Double-Blind Method; Enteral Nutrition; Female; Glutamine; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Intensive Care, Neonatal; Malaysia; Male; Parenteral Nutrition; Respiratory Tract Infections; Sepsis; Treatment Outcome

In South East Asia,

Topics: Adult; Animals; Fresh Water; Humans; Malaysia; Risk Factors; Sepsis; Streptococcus agalactiae

Life-threatening infections significantly impact the care of children undergoing therapy for acute lymphoblastic leukemia (ALL) who are at risk of severe sepsis due to both host and treatment factors. Our aim was to develop a life-threatening infection risk prediction model that would allow remote rapid triage of patients to reduce time to first dose of antibiotics and sepsis-related mortality.. A retrospective analysis of 2068 fever episodes during ALL therapy was used for model building and subsequent internal validation.. Three hundred and seventy-seven patients were treated for ALL in two institutions with comparable critical and supportive care resources. A total of 55 patients accounted for 71 admissions to the critical care unit for sepsis that led to eight septic deaths during a 16-year study period. A retrospective analysis of risk factors for sepsis enabled us to build a model focused on 13 variables that discriminated admissions requiring critical care well: area under the receiver operating characteristic curve of .82; 95% CI .76-.87, p<.001, and Brier score of .033. Significant univariate predictors included neutropenia, presence of symptoms of abdominal pain, diarrhea, fever during induction or steroid-based phases, and the lack of any localizing source of infection at time of presentation.. We have developed a risk prediction model that can reliably identify ALL patients undergoing treatment who are at a higher risk of life-threatening sepsis. Clinical applicability can potentially be extended to low-middle income settings, and its utility should be further studied in real-world settings.

Topics: Anti-Bacterial Agents; Child; Clinical Trials as Topic; Fever; Humans; Malaysia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Sepsis; Singapore

Neonatal invasive Group A Streptococcus (GAS) infection is a rare occurrence nowadays. Prior maternal vaginal colonization is an important factor in early neonatal disease. We report a case of invasive and fatal infection in a neonate. At Day 1 of life, a term baby was found to be lethargic, with poor feeding, and later became unresponsive. Consequently, the baby was immediately brought to the Emergency Department of Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan via ambulance. Despite the active resuscitation efforts in the hospital, the baby died. An autopsy was carried out to determine the cause of death. The mother was noted to have puerperal pyrexia secondary to vaginal discharge. Her high vaginal swab culture was positive for GAS. GAS was also isolated from the intracardiac blood, pleural fluid, peritoneal fluid, and umbilical swab of the baby, giving evidence to the aetiology of the mortality. Vaginal colonization of GAS is an important factor for high morbidity and mortality for both mother and infant due to its invasiveness and virulence.

Topics: Female; Humans; Infant; Infant, Newborn; Malaysia; Morbidity; Sepsis; Streptococcal Infections; Streptococcus

Risk of readmissions is an important quality indicator for stroke care. Such information is limited among low- and middle-income countries. We assessed the trends for 28-day readmissions after a stroke in Malaysia from 2008 to 2015 and evaluated the causes and factors associated with readmissions in 2015.. Using the national hospital admission records database, we included all stroke patients who were discharged alive between 2008 and 2015 for this secondary data analysis. The risk of readmissions was described in proportion and trends. Reasons were coded according to the International Classification of Diseases, 10th Edition. Multivariable logistic regression was performed to identify factors associated with readmissions.. Among 151729 patients, 11 to 13% were readmitted within 28 days post-discharge from their stroke events each year. The trend was constant for ischemic stroke but decreasing for hemorrhagic stroke. The leading causes for readmissions were recurrent stroke (32.1%), pneumonia (13.0%) and sepsis (4.8%). The risk of 28-day readmission was higher among those with stroke of hemorrhagic (adjusted odds ratio (AOR): 1.52) and subarachnoid hemorrhage (AOR: 2.56) subtypes, and length of index admission >3 days (AOR: 1.48), but lower among younger age groups of 35-64 (AORs: 0.61-0.75), p values <0.001.. The risk of 28-day readmission remained constant from 2008 to 2015, where one in eight stroke patients required readmission, mainly attributable to preventable causes. Age, ethnicity, stroke subtypes and duration of the index admission influenced the risk of readmission. Efforts should focus on minimizing potentially preventable admissions, especially among those at higher risk.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Female; Humans; Malaysia; Male; Middle Aged; Odds Ratio; Patient Discharge; Patient Readmission; Pneumonia; Recurrence; Risk Factors; Sepsis; Stroke; Young Adult

There was limited study available on successful intervention for central-line-associated bloodstream infection (CLABSI) done at nonintensive care unit (ICU) and resources-limited setting. The objective of this study was to design, implement and evaluate a strategy to reduce CLABSI rate in non-ICU settings at general medical wards of Hospital Tuanku Ja'afar Seremban.. Preinterventional study was conducted in one-month period of January 2019, followed by intervention period from February to March 2019. Postintervention study was conducted from April to July 2019. The CLABSI rates were compared between pre and postintervention periods. A multifaceted intervention bundle was implemented, which comprised (1) educational program for healthcare workers, (2) weekly audit and feedback and (3) implementation of central line bundle of care.. CLABSI rates were reduced by a multifaceted intervention bundle, even in non-ICU and resource-limited setting. This includes a preinterventional study to identify the risk factors followed by a local adaption of the recommended care bundles. This study recommends resources-limited hospitals to design a strategy that is suitable for their own local setting to reduce CLABSI.. This study demonstrated the feasibility of a multifaceted intervention bundle that was locally adapted with an evidence-based approach to reduce CLABSI rate in non-ICU and resource-limited setting.

Topics: Adult; Catheters; Evidence-Based Practice; Health Resources; Hospital Units; Humans; Infection Control; Malaysia; Patient Care Bundles; Quality Assurance, Health Care; Sepsis

The diagnosis of leptospirosis remains a challenge due to its non-specific symptoms and the biphasic nature of the illness. A comprehensive diagnosis that includes both molecular (polymerase chain reaction (PCR)) and serology is vital for early detection of leptospirosis and to avoid misdiagnosis. However, not all samples could be subjected to both tests (serology and molecular) due to budget limitation, infrastructure, and technical expertise at least in resource-limited countries. We evaluated the usefulness of testing the clinically suspected leptospirosis cases with both techniques on all samples collected from the patients on the day of admission. Among the 165 patient's blood/serum samples tested (from three hospitals in Central Malaysia), 43 (26%) showed positivity by microscopic agglutination test (MAT), 63 (38%) by PCR, while 14 (8%) were positive by both MAT and PCR. For PCR, we tested two molecular targets (lipL32 by qPCR and 16S rDNA or rrs by nested PCR) and detected lipL32 in 47 (29%) and rrs gene in 63 (38%) patients. The use of more than one target gene for PCR increased the detection rates. Hence, a highly sensitive multiplex PCR targeting more than one diagnostic marker is recommended for the early detection of Leptospira in suspected patients. When the frequencies for positivity detected either by MAT or PCR combined, leptospirosis was diagnosed in a total of 92 (56%) patients, a higher frequency compared to when samples were only tested by a single method (MAT or PCR). The results from this study suggest the inclusion of both serology and molecular methods for every first sample irrespective of the days post-onset of symptoms (DPO) collected from patients for early diagnosis of leptospirosis.

Topics: Agglutination Tests; Diagnostic Errors; DNA, Bacterial; Early Diagnosis; Feasibility Studies; Humans; Leptospira; Leptospirosis; Malaysia; Polymerase Chain Reaction; RNA, Ribosomal, 16S; Sensitivity and Specificity; Sepsis; Time Factors

This is a retrospective audit of all patients admitted to the surgical unit for urosepsis from June 2014 to June 2015 at the General Surgery Unit of Hospital Sultan Ismail, Malaysia. Demographics, comorbidities, presenting symptoms, length of stay (LOS), mortality, and associated risk factors were recorded. There were 35 patients treated for urosepsis with a male preponderance of 21/35 patients. Hypertension (n=18) and diabetes (n=10) were the two most common comorbidities. There were five deaths (mortality rate=14.3%) and the main bacterium cultured was Escherichia coli. Age >65, presence of underlying comorbid disease, presence of cancer, urine and blood culture positivity had higher incidence of death but were not statistically significant for urosepsis mortality. However, this result is limited by the small sample size and single centre retrospective data.

Topics: Aged; Clinical Audit; Cohort Studies; Disease Progression; Female; Hospital Mortality; Humans; Incidence; Malaysia; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Assessment; Sepsis; Surgery Department, Hospital; Survival Rate; Treatment Outcome; Urinary Tract Infections

An emergency department (ED) is often the first point of medical contact for sepsis patient, which plays an important role in early identification and management of high-risk septic patients. The present study was aim to evaluate emergency personnel's knowledge and attitude toward identification and management of systemic inflammatory response syndrome (SIRS) and sepsis.. This cross-sectional study was conducted in a tertiary teaching hospital and recruited all emergency personnel. A validated questionnaire on knowledge and attitude towards identification and management of SIRS/sepsis was distributed among 120 emergency personnel. Data were analyzed using descriptive and inferential statistics.. Overall finding founds emergency nurses and assistant medical officer appeared to have moderate knowledge in several important areas of SIRS/sepsis identification and management. Majority of the emergency personnel have neutral attitudes, as they do not give enough importance towards identification of patients with SIRS and sepsis. The present study finding found that knowledge of clinical criteria and management of SIRS/sepsis was highest among assistant medical officers (p=0.02) and bachelor's degree holders (p=0.02) with emergency experience more than 5 years (p=0.03). A trend toward an increase in knowledge of SIRS and sepsis is significantly correlated with positive attitudes.. The emergency personnel demonstrated a moderate knowledge and neutral attitude toward identification and management of SIRS and sepsis. Therefore, the awareness and knowledge of SIRS and sepsis should be enhanced among emergency personnel in order to improve outcome.

Topics: Adult; Analysis of Variance; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Sepsis; Surveys and Questionnaires; Systemic Inflammatory Response Syndrome; Tertiary Care Centers

Sepsis is the leading cause of intensive care unit (ICU) admission. Plasma Neutrophil Gelatinase Associated-Lipocalin (NGAL) is a promising biomarker for acute kidney injury (AKI) detection; however, it is also increased with inflammation and few studies have been conducted in non-Caucasian populations and/or in developing economies. Therefore, we evaluated plasma NGAL's diagnostic performance in the presence of sepsis and systemic inflammatory response syndrome (SIRS) in a Malaysian ICU cohort.. This is a prospective observational study on patients with SIRS. Plasma creatinine (pCr) and NGAL were measured on ICU admission. Patients were classified according to the occurrence of AKI and sepsis.. Of 225 patients recruited, 129 (57%) had sepsis of whom 67 (52%) also had AKI. 96 patients (43%) had non-infectious SIRS, of whom 20 (21%) also had AKI. NGAL concentrations were higher in AKI patients within both the sepsis and non-infectious SIRS cohorts (both P < 0.0001). The diagnostic area under curve for AKI was 0.81 (95%CI: 0.74 to 0.87). The optimal cut-off was higher in sepsis compared to non-infectious SIRS patients (454 versus 176 ng/mL). Addition of NGAL to a clinical model comprising age, pCr, medical admission category and SAPS II score increased the mean risk of those with AKI by 4% and reduced the mean risk of those without AKI by 3%.. Acute kidney injury is more common with sepsis than non-infectious SIRS. Plasma NGAL was diagnostic of AKI in both subgroups. The optimal cut-off for diagnosing AKI was higher in sepsis than in non-infectious SIRS. Addition of plasma NGAL improved the clinical model used to diagnose AKI.

Topics: Acute Kidney Injury; Adult; Aged; Area Under Curve; Biomarkers; Creatinine; Female; Humans; Intensive Care Units; Kaplan-Meier Estimate; Lipocalin-2; Malaysia; Male; Middle Aged; Patient Admission; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; ROC Curve; Sepsis; Systemic Inflammatory Response Syndrome; Time Factors; Up-Regulation

Doripenem has been recently introduced in Malaysia and is used for severe infections in the intensive care unit. However, limited data currently exist to guide optimal dosing in this scenario. We aimed to describe the population pharmacokinetics of doripenem in Malaysian critically ill patients with sepsis and use Monte Carlo dosing simulations to develop clinically relevant dosing guidelines for these patients. In this pharmacokinetic study, 12 critically ill adult patients with sepsis receiving 500 mg of doripenem every 8 h as a 1-hour infusion were enrolled. Serial blood samples were collected on 2 different days, and population pharmacokinetic analysis was performed using a nonlinear mixed-effects modeling approach. A two-compartment linear model with between-subject and between-occasion variability on clearance was adequate in describing the data. The typical volume of distribution and clearance of doripenem in this cohort were 0.47 liters/kg and 0.14 liters/kg/h, respectively. Doripenem clearance was significantly influenced by patients' creatinine clearance (CL(CR)), such that a 30-ml/min increase in the estimated CL(CR) would increase doripenem CL by 52%. Monte Carlo dosing simulations suggested that, for pathogens with a MIC of 8 mg/liter, a dose of 1,000 mg every 8 h as a 4-h infusion is optimal for patients with a CL(CR) of 30 to 100 ml/min, while a dose of 2,000 mg every 8 h as a 4-h infusion is best for patients manifesting a CL(CR) of >100 ml/min. Findings from this study suggest that, for doripenem usage in Malaysian critically ill patients, an alternative dosing approach may be meritorious, particularly when multidrug resistance pathogens are involved.

Topics: Acinetobacter baumannii; Adult; Aged; Anti-Bacterial Agents; Carbapenems; Creatinine; Critical Illness; Doripenem; Female; Gram-Negative Bacterial Infections; Humans; Intensive Care Units; Malaysia; Male; Microbial Sensitivity Tests; Middle Aged; Models, Statistical; Monte Carlo Method; Prospective Studies; Pseudomonas aeruginosa; Sepsis; Survival Analysis

This study aimed to determine whether patient loads, infant status on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis rates in very-low-birth-weight (VLBW) infants in the Malaysian National Neonatal Registry (MNNR).. This was a retrospective study of 3,880 VLBW (≤ 1,500 g) infants admitted to 34 neonatal intensive care units (NICUs) in the MNNR. Sepsis was diagnosed in symptomatic infants with positive blood culture.. Sepsis developed in 623 (16.1%) infants; 61 (9.8%) had early-onset sepsis (EOS) and 562 (90.2%) had late-onset sepsis (LOS). The median EOS rate of all NICUs was 1.0% (interquartile range [IQR] 0%, 2.0%). Compared with NICUs reporting no EOS (n = 14), NICUs reporting EOS (n = 20) had significantly higher patient loads (total live births, admissions, VLBW infants, outborns); more mothers with a history of abortions, and antenatal steroids and intrapartum antibiotic use; more infants requiring resuscitation procedures at birth; higher rates of surfactant therapy, pneumonia and insertion of central venous catheters. The median LOS rate of all NICUs was 14.5% (IQR 7.8%, 19.2%). Compared with NICUs with LOS rates below the first quartile (n = 8), those above the third quartile (n = 8) used less intrapartum antibiotics, and had significantly bigger and more mature infants, more outborns, as well as a higher number of sick infants requiring ventilator support and total parenteral nutrition.. Patient loads, resuscitation at birth, status of infants on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis.

Topics: Follow-Up Studies; Humans; Incidence; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Malaysia; Retrospective Studies; Risk Factors; Sepsis; Survival Rate

This study aimed to determine the incidence of hypoxic-ischaemic encephalopathy (HIE) and predictors of HIE mortality in Malaysian neonatal intensive care units (NICUs).. This was a retrospective study of data from 37 NICUs in the Malaysian National Neonatal Registry in 2012. All newborns with gestational age ≥ 36 weeks, without major congenital malformations and fulfilling the criteria of HIE were included.. There were 285,454 live births in these hospitals. HIE was reported in 919 newborns and 768 of them were inborn, with a HIE incidence of 2.59 per 1,000 live births/hospital (95% confidence interval [CI] 2.03, 3.14). A total of 144 (15.7%) affected newborns died. Logistic regression analysis showed that the significant predictors of death were: chest compression at birth (adjusted odds ratio [OR] 2.27, 95% CI 1.27, 4.05; p = 0.003), being outborn (adjusted OR 2.65, 95% CI 1.36, 5.13; p = 0.004), meconium aspiration syndrome (MAS) (adjusted OR 2.16, 95% CI 1.05, 4.47; p = 0.038), persistent pulmonary hypertension of the newborn (PPHN) (adjusted OR 4.39, 95% CI 1.85, 10.43; p = 0.001), sepsis (adjusted OR 4.46, 95% CI 1.38, 14.40; p = 0.013), pneumothorax (adjusted OR 4.77, 95% CI 1.76, 12.95; p = 0.002) and severe HIE (adjusted OR 42.41, 95% CI 18.55, 96.96; p < 0.0001).. The incidence of HIE in Malaysian NICUs was similar to that reported in developed countries. Affected newborns with severe grade of HIE, chest compression at birth, MAS, PPHN, sepsis or pneumothorax, and those who were outborn were more likely to die before discharge.

Topics: Female; Gestational Age; Humans; Hypoxia-Ischemia, Brain; Incidence; Infant, Newborn; Intensive Care Units, Neonatal; Malaysia; Male; Patient Discharge; Prospective Studies; Regression Analysis; Retrospective Studies; Sepsis

This case-control study aimed to determine whether catheter use was significantly associated with coagulase-negative staphylococci (CoNS) colonisation and/or sepsis in neonates.. Weekly swabs of the nose, umbilicus, rectum, wounds, eye discharge and intravenous catheter tips (after removal) of infants admitted to the neonatal intensive care unit of Universiti Kebangsaan Malaysia Medical Centre, Malaysia, were cultured. CoNS sepsis was diagnosed if pure growth of CoNS was cultured from the peripheral blood specimen of symptomatic infants. For each infant with CoNS colonisation or sepsis, a control infant was retrospectively and randomly selected from unaffected infants in the ward. Multivariate analyses were performed to determine whether catheter use was a significant risk factor.. CoNS colonisation was detected in 113 (8.7%) infants. CoNS sepsis was found in 12 (10.6%) infants with CoNS colonisation and 7 (0.6%) infants without CoNS colonisation. Multivariate analysis showed that the following were significantly associated with CoNS colonisation: conjunctivitis (adjusted odds ratio [OR] 8.2, 95% confidence interval [CI] 1.9–34.8, p = 0.005); central venous catheters (adjusted OR 5.8, 95% CI 1.9–17.8, p = 0.002); and nasopharyngeal and/or oral suctioning more than twice in the 48 hours before positive culture (adjusted OR 7.3, 95% CI 3.3–16.2, p < 0.001). Exposure to frequent nasopharyngeal and/or oral suctioning (adjusted OR 20.8, 95% CI 3.5–125.3, p = 0.001) was the only significant factor associated with CoNS sepsis.. Infants requiring more than two nasopharyngeal and/or oral suctions in the previous 48 hours were found to have a higher risk of developing CoNS colonisation and sepsis.

Topics: Case-Control Studies; Catheterization; Catheterization, Central Venous; Coagulase; Female; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Intubation, Gastrointestinal; Malaysia; Male; Multivariate Analysis; Retrospective Studies; Risk Factors; Sepsis; Staphylococcal Infections; Staphylococcus; Suction

Studies on pulse oximetry screening for neonatal sepsis and respiratory disease in a middle-income country are lacking. Newborn screening for critical congenital heart disease (CCHD) using pulse oximetry is an effective and life-saving strategy in developed countries. While most studies have reported false-positive results during CCHD screening, they have not elaborated on the detected disease types. We studied the effectiveness and outcomes of pulse oximetry newborn screening for non-cardiac hypoxemic diseases such as neonatal sepsis, respiratory diseases, and CCHD in a middle-income country.. In a pilot study performed at the University Malaya Medical Centre (UMMC), Malaysia, all apparently healthy term newborns, delivered at UMMC were screened pre-discharge using pulse oximetry. Echocardiography was performed for newborns that had positive screening results on two separate occasions, 1-h apart. Newborns with normal echocardiograms were evaluated and treated for other non-cardiac diseases. Fifteen of 5247 term newborns had positive screening results. The median age at screening was 20 h. Thirteen newborns (0.24%) had significant non-cardiac diseases: sepsis (n = 2) and respiratory diseases (n = 11) that required hospitalization and treatment. The remaining two newborns with normal antenatal ultrasonograms had positive screening test and confirmed to have CCHD. Another 18 newborns with negative screening test were later admitted for treatment of sepsis (n = 16) and penumonia (n = 2). All newborns were treated and alive at the end of the study. The sensitivity and specificity of pulse oximetry screening for non-cardiac diseases were 42% and 99.9% respectively, and 100% and 99.7% for CCHD, respectively.. Routine pulse oximetry screening test was effective in identifying newborns with CCHD and other hypoxemia illnesses, which may led to potential life-threatening condition. This study showed that the expanded use of pulse oximetry has immediate implications for low- and middle-income countries contemplating strategies to reduce neonatal mortality and morbidity.. ASD, atrial septal defect; CCHD, critical congenital heart disease; CRP, C-reactive protein; CXR, chest radiographs; NDI, neurodevelopment impairment; PPHN, persistent pulmonary hypertension of the newborn; PDA, patent ductus arteriosus; PFO, patent foramen ovale; TGA, transposition of great artery; TTN, transient tachypnoea of the newborn; VSD, ventricular septal defect.

Topics: Female; Heart Defects, Congenital; Humans; Hypoxia; Infant, Newborn; Malaysia; Male; Neonatal Screening; Oximetry; Sepsis; Socioeconomic Factors

Neonatal sepsis is a major cause of neonatal deaths in Asia but data remain scarce. We aimed to investigate the causative organisms and antibiotic resistance in neonatal care units in China, Malaysia, Hong Kong and Thailand.. Prospective cohort study of neonatal sepsis defined as positive culture of a single potentially pathogenic organism from blood or cerebrospinal fluid differentiated into early-onset sepsis (EOS) occurring <3 days of birth and late-onset sepsis (LOS) ≥3 days after birth.. During the study period, there were 963 episodes of neonatal sepsis. The incidence of EOS was 0.62 (95% CI 0.45 to 0.82) per 1000 live births or 4.91 (95% CI 4.22 to 5.68) per 1000 admissions while the incidence of LOS was 5.00 (95% CI 4.51 to 5.53) per 1000 live births or 21.22 (95% CI 19.79 to 22.77) per 1000 admissions. The incidence of Group B Streptococcus (GBS) sepsis was low but remained the most common single pathogen for EOS among inborn babies. Klebsiella spp. was the most common Gram-negative organism causing most deaths. The case-fatality was 7.0% (95% CI 3.9% to 12.0%) for EOS and 16.0% (95% CI 13.7% to 19.0%) for LOS, and was significantly different between participating units after adjusting for potential confounders. Of all Gram-negative organisms, 47%, 37% and 32% were resistant to third-generation cephalosporins, gentamicin or both, respectively.. The pattern of EOS in Asian settings is similar to that in industrialised countries with low incidence of GBS sepsis. The important features of neonatal sepsis in Asia are the burden of Klebsiella spp. and high level of antibiotic resistance. These should be addressed while developing measures to reduce neonatal mortality due to infection.

Topics: China; Cohort Studies; Drug Resistance, Microbial; Female; Hong Kong; Humans; Incidence; Infant Mortality; Infant, Newborn; Malaysia; Male; Prospective Studies; Sepsis; Thailand

To describe nurses' perceptions of evidence-based recommendations to prevent complications in a Malaysian intensive care unit.. Ventilator-associated pneumonia, catheter-related blood stream infection and pressure ulcer are three frequent adverse events in the intensive care unit. Implementing evidenced-based practice is critical in prevention of these complications.. A qualitative focus group study.. Focus groups were conducted with nurses in the intensive care unit of a regional hospital in Malaysia following evidence-based interventions. Focus group transcripts were analysed using the method of thematic analyses.. Thirty-four nurses participated in eight focus groups. The main themes derived from the interviews: (1) nurses' knowledge impacts on the change process; (2) initial resistance, ambivalence and movement to acceptance; and (3) hierarchical organisational structure can hinder the change process.. Enhancing nurses' knowledge and attitudes of evidence-based practice, providing them with tools to monitor their clinical practice, and empowering them to change practice are likely to be important in influencing clinical outcomes. Increasing the emphasis on evidence-based practice in nursing curricula and engaging in cultural change processes in the workplace are necessary to improve clinical outcomes.. These findings provide valuable information for implementing clinical practice improvement interventions.

Topics: Adult; Focus Groups; Humans; Intensive Care Units; Malaysia; Nursing Assessment; Nursing Staff, Hospital; Pneumonia, Ventilator-Associated; Pressure Ulcer; Sepsis

Prototheca wickerhamii isolated from blood of 61-year-old kidney transplant patient was described. Although it is classified as an alga (genus Chlorella), the disease, protothecosis, is included under mycoses because of its clinical pathological presentations. Colony characteristics of P. wickerhamii are indistinguishable from other yeast-like organisms like Cryptococcus and Candida. Fortunately, commercial identification system for yeast can be used to identify this organism to the species level. Electron microscopy demonstrated "morula" or daisy-like appearance of its endosporulating sporangia. The organism was sensitive to amphotericin B by E test method. Even though human protothecosis is uncommon, it cannot be ignored because it is emerging as an opportunistic infection in immunosuppressed individuals. To our knowledge, this is the first reported case of disseminated algaemia due to P. wickerhamii in Malaysia.

Topics: Fatal Outcome; Humans; Kidney Transplantation; Malaysia; Male; Middle Aged; Prototheca; Sepsis

We have analysed DNA fingerprinting patterns by pulsed-field gel electrophoresis (PFGE) of 52 unrelated Burkholderia pseudomallei strains isolated from septicemic and localized infections from Malaysian subjects. A total of 38 PFGE types were observed among 36 septicemic and 16 localized strains with no predominant pattern. Type 25 was seen in 2 epidemiologically related strains, suggesting human to human transmission. Twelve PFGE types were shared among 26 strains (21 septicemic and 5 localized) showing close genetic relatedness with coefficient of similarity of 0.81 to 1.0. The other 26 strains (15 septicemic and 11 localized) were unrelated as shown by the similarity coefficient of < 0.8. This study showed that our B. pseudomallei strains in Malaysia were mainly heterogenous with no predominant type both in septicemic or localized strains.

Topics: Adult; Aged; Burkholderia pseudomallei; DNA Fingerprinting; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Malaysia; Male; Melioidosis; Middle Aged; Sepsis; Young Adult

Cytomegalovirus (CMV) infection can present with severe manifestations that are associated with significant morbidity and mortality, especially in immunocompromised patients. CMV infections in immunocompetent patients are usually transient and do not exhibit many symptoms. However, in some patients, the manifestations can be severe. We report CMV colitis in two immunocompetent patients; one in a young man who was critically ill with septicaemia and significant non-bloody diarrhoea that responded to specific CMV treatment, and another in an elderly woman who presented with nonspecific abdominal pain and fever that resolved without specific CMV treatment.

Topics: Abdominal Pain; Adult; Biopsy; Colitis; Colon; Critical Care; Cytomegalovirus Infections; Diarrhea; Female; Humans; Inflammation; Malaysia; Male; Middle Aged; Sepsis

An understanding of common pathogens and their antibiotic sensitivity patterns is critical for proper management of sepsis in Emergency Department (ED). The goal of the study was to identify common organisms isolated from blood cultures of patients attended to ED and their antimicrobial susceptibility. Beginning from 2002, all cases of positive blood culture collected by the ED, Hospital Universiti Sains Malaysia (HUSM) were recorded and analysed. Over the period of eight years, we documented 995 cases of positive blood cultures. Of these samples, 549 (55.2%) were Gram-negative bacteria; 419 (42.1%) were Gram-positive bacteria; 10 (1.0%) were anaerobic organisms; 10 (1.0%) were fungus; and 7 (0.7%) cases were mixed organisms. Gram-negative bacteria were observed to develop more resistance to antimicrobial agents, especially those commonly used in an outpatient setting with less than 80% sensitivity to ampicillin, cotrimoxazole and ciprofloxacin. By contrast, there has been no marked change in the sensitivity trends of Gram-positive bacteria over the same period. In conclusion, ED physicians are more equipped to initiate empirical antimicrobial therapy especially when dealing with possibility of Gram-negative sepsis.

Topics: Anti-Bacterial Agents; Bacteria; Blood; Drug Resistance, Bacterial; Emergency Service, Hospital; Humans; Malaysia; Microbial Sensitivity Tests; Prevalence; Retrospective Studies; Sepsis

The present study determined the pharmacokinetic profile of vancomycin in premature Malaysian infants. A one-compartment infusion model with first-order elimination was fitted to serum vancomycin concentration data (n = 835 points) obtained retrospectively from the drug monitoring records of 116 premature newborn infants. Vancomycin concentrations were estimated by a fluorescence polarization immunoassay. Population and individual estimates of clearance and distribution volume and the factors which affected the variability observed for the values of these parameters were obtained using a population pharmacokinetic modeling approach. The predictive performance of the population model was evaluated by visual inspections of diagnostic plots and nonparametric bootstrapping with replacement. Dosing guidelines targeting a value of > or =400 for the area under the concentration-time curve over 24 h in the steady state divided by the MIC (AUC(24)/MIC ratio) were explored using Monte Carlo simulation. Body size (weight), postmenstrual age, and small-for-gestational-age status are important factors explaining the between-subject variability of vancomycin pharmacokinetic parameter values for premature neonates. The typical population parameter estimates of clearance and distribution volume for a 1-kg premature appropriate-for-gestational-age neonate with a postmenstrual age of 30 weeks were 0.0426 liters/h and 0.523 liters, respectively. There was a 20% reduction in clearance for small-for-gestational-age infants compared to the level for the appropriate-for-gestational-age control. Dosage regimens based on a priori target response values were formulated. In conclusion, the pharmacokinetic parameter values for vancomycin in premature Malaysian neonates were estimated. Improved dosage regimens based on a priori target response values were formulated by incorporating body size, postmenstrual age, and small-for-gestational-age status, using Monte Carlo simulations with the model-estimated pharmacokinetic parameter values.

Topics: Anti-Bacterial Agents; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Small for Gestational Age; Malaysia; Models, Biological; Monte Carlo Method; Retrospective Studies; Sepsis; Statistics, Nonparametric; Vancomycin

An outbreak of Burkholderia cepacia septicaemia occurred in our neonatal unit over a 9-week period in 2001, affecting 23 babies and two died. A second outbreak lasting 8 days occurred a year later, affecting five babies.. Neonatal Intensive Care Unit, Kuala Terengganu Hospital.. To review the patient characteristics and the risk factors for septicaemia in the first outbreak.. Retrospective review of records and in the first outbreak a case-control analysis with 23 matched controls for risk factors for septicaemia.. In the first outbreak, median birthweight was 1670 g (range 860-3760) and median gestational age was 32 weeks (range 27-41). There were 32 episodes of septicaemia, and five and two patients had two and three episodes, respectively. The mortality rate was 6.3% per septicaemic episode. Multiple logistic regression showed the presence of a prior long line was associated with first septicaemic episode (OR 7.07, 95% CI 1.37-36.47 with P = 0.019) but not prior assisted ventilation. The organism was isolated from the water of an oxygen humidifier in the delivery room, three ventilator water traps and one humidifier water trap in the neonatal unit. In the second outbreak, six episodes of septicaemia occurred in five neonates with median birthweight 2060 g and median gestational age 32.5 weeks. The organism was isolated from two ventilator water traps.. These two outbreaks of Burkholderia cepacia subsided with general infection control measures. The sources of these two outbreaks were not identified.

Topics: Burkholderia cepacia; Burkholderia Infections; Case-Control Studies; Cross Infection; Disease Outbreaks; Female; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Logistic Models; Malaysia; Male; Retrospective Studies; Risk Factors; Sepsis; Ventilators, Mechanical

Patients with poorly controlled diabetes mellitus have an increased risk of lower limb infection and gangrene. In Malaysia, they frequently present late and are often in septic shock with multi-organ dysfunction. We report on two patients who presented for lower limb amputation in a desperate attempt to control sepsis and save their lives. Both patients were classified as ASA 5. Both patients had successfully undergone surgery under low dose unilateral spinal anaesthesia. The anaesthetic management of these critically ill patients in view of limited resources is discussed.

Topics: Acute Disease; Amputation, Surgical; Anesthesia, Spinal; Diabetes Complications; Diabetic Foot; Humans; Malaysia; Male; Middle Aged; Sepsis

Bloodstream infections are an important cause of morbidity and mortality among hospitalized patients and the surveillance of etiological agents in these infections is important for their prevention and treatment. Data on common organisms isolated from blood cultures from Malaysia are limited, and our aim was to identify the common bloodstream isolates in hospitalized patients at the University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia.. A retrospective analysis was conducted over a 1-year period from January to December 2004 by reviewing laboratory reports of patients from the UMMC. The clinical significance of the isolates was not analyzed.. Coagulase-negative staphylococci were the most common organisms isolated, accounting for 33.0% of the total blood culture isolates, followed by Staphylococcus aureus (10.4%) and Escherichia coli (9.7%). The incidence of methicillin-resistant S. aureus, and extended-spectrum beta-lactamase-producing E. coli and Klebsiella spp. bacteremia was low (2.3% and 1.8% of total isolates, respectively). Non-albicans Candida were the most common fungal isolates.. The high number of coagulase-negative staphylococci should motivate clinicians and microbiologists to re-examine blood culture techniques in our institution. We recommend that further studies be carried out to establish the true significance of this organism among blood culture isolates.

Topics: Bacteria; Bacterial Infections; beta-Lactamases; Blood; Coagulase; Fungi; Hospitals, Teaching; Humans; Malaysia; Methicillin Resistance; Mycoses; Retrospective Studies; Sepsis

This report describes a pregnant lady in early trimester that was admitted with fever and left loin pain and was initially treated as presumed pyelonephritis. Subsequently she was found to have infective endocarditis with vegetation on the mitral valve. The course of her illness was complicated by acute pulmonary edema and septic embolization to the cerebellum. A decompressive craniectomy and resection of the lateral lobe of cerebellum was performed. Although the presenting features and risk factors are well described, the atypical presentations of infective endocarditis in pregnancy remain a diagnostic challenge for the treating physician. This report highlights the importance of rapid detection of endocarditis in pregnancy and the treatment of systemic complications.

Topics: Adult; Cerebellar Diseases; Embolism; Endocarditis; Female; Humans; Malaysia; Pregnancy; Sepsis

A prospective study was conducted to determine the proportion of patients who received an antibiotic within 12 hours of admission to the medical wards. During the four-week study, 234 patients were admitted to medical wards from casualty; 68 patients (29%) received an antibiotic. The survey indicated that antibiotics were inappropriate in 22-65% of those treated. This study also shows that as many as 67% of patients who received intravenous antibiotics could have been equally well treated with oral preparations.

Topics: Anti-Bacterial Agents; Decision Making; Hospitalization; Hospitals, Teaching; Humans; Malaysia; Medical Audit; Prospective Studies; Sepsis; Unnecessary Procedures

This study aims to determine the prevalence of and risk factors associated with retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants. All premature VLBW infants, admitted into the neonatal intensive care unit of the University Hospital Kuala Lumpur, were screened from 4 weeks of life. Perinatal and neonatal data were retrieved from the infants' medical notes. Between August 1994 and July 1996, 100 infants had their eyes examined serially. Of the 15 (15%) infants with ROP, all were less than 31 weeks gestation, and only 1 infant had birth weight above 1250 g. Five (5%) infants had severe ROP; 4 infants underwent cryotherapy for stage 3 threshold disease. Infants with ROP, as compared to infants without ROP, had lower birth weight [mean (SEM) 993 (50) g versus 1205 (22) g, P < 0.001], lower gestational age [mean (SEM) 28.0 (0.4) weeks versus 30.1 (0.2) weeks, P < 0.001], higher rates of patent ductus arteriosus and chronic lung disease, greater number of radiographic examinations and episodes of late-onset suspected/confirmed sepsis, and required longer duration of supplemental oxygen, ventilation, xanthine, antibiotics and intralipid use, but were slower to establish full enteral feeds. On multivariate logistic regression analysis, birth weight < or = 1000 g [OR 2.38, 95% CI 1.25, 4.55, P = 0.009] and gestational age < or = 28 weeks [OR 2.86, 95% CI 1.47, 5.56, P = 0.002] were significant predictors of increased risk of this disease. In conclusion, ROP is strongly associated with smaller, more immature and sicker neonates. Prevention of prematurity would help reduce the incidence of this disease.

Topics: Anti-Bacterial Agents; Birth Weight; Bronchodilator Agents; Chronic Disease; Cryotherapy; Ductus Arteriosus, Patent; Enteral Nutrition; Fat Emulsions, Intravenous; Gestational Age; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Intensive Care, Neonatal; Logistic Models; Lung Diseases; Malaysia; Mass Screening; Multivariate Analysis; Oxygen Inhalation Therapy; Prevalence; Respiration, Artificial; Retinopathy of Prematurity; Retrospective Studies; Risk Factors; Sepsis; Xanthine

To determine the survival rates and risk factors associated with mortality in premature very low birth weight or VLBW (< or = 1500 grams) infants.. This is a part-retrospective and part-prospective study of VLBW infants admitted into the Special Care Nursery, University Hospital Kuala Lumpur, between August 1994 and July 1996.. Of the 184 infants without lethal congenital malformations, 144 (78%) infants survived till discharge. The causes of death included respiratory diseases (63%), infections (30%), gastrointestinal abnormalities (5%) and intracerebral haemorrhage (2%). On multivariate logistic regression analysis, birth weight of 1 kg or less [odds ratio (OR) 3.88, 95% Confidence Interval (CI) 2.22, 6.67, p < 0.001], gestational age of 28 weeks or less [OR 1.78, 95% CI 1.03, 3.03, p = 0.038], ventilatory support [OR 2.68, 95% CI 1.46, 4.92, p = 0.002] and male gender [OR 1.83, 95% CI 1.10, 3.06, p = 0.021] were significant predictive factors for increased mortality. In a subgroup of 87 infants who were ventilated for severe respiratory distress syndrome, their survival was predicted by birth weight above 1 kg, gestational age greater than 28 weeks, appropriate for gestational age and surfactant replacement therapy.. Mortality remains high for the very low birth weight and very premature infants. Prolonging the duration of pregnancy and administrating exogenous surfactant to ventilated infants with RDS are two important measures to improve survival amongst VLBW infants.

Topics: Birth Weight; Cause of Death; Cerebral Hemorrhage; Confidence Intervals; Female; Forecasting; Gastroschisis; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Logistic Models; Malaysia; Male; Odds Ratio; Patient Discharge; Pregnancy; Prospective Studies; Pulmonary Surfactants; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Risk Factors; Sepsis; Sex Factors; Survival Rate

Retropharyngeal abscess (RPA) is relatively rare today. A study of 17 cases of RPA treated at our hospital in the past 10 years showed a shift in the disease from children below 6 years of age (41%) to older children and adults (58%). Upper respiratory tract infection (URTI) was found to be the commonest (52%) aetiological predisposing factor in all age groups. Other aetiological factors were septicaemia (11%) in children below the age of 6 years and trauma due to foreign body (35%) in the older children and adult age groups. Klebsiella, Staphylococcus and Streptococcus were the commonest species of microorganisms grown from pus. The changing clinical trends, microbiology, choice of antibiotics, usefulness of radiology, and complications of this potentially fatal illness are discussed.

Topics: Adolescent; Adult; Age Distribution; Anti-Bacterial Agents; Bacterial Infections; Causality; Child; Drug Resistance, Microbial; Female; Foreign Bodies; Hospitals, University; Humans; Malaysia; Male; Microbial Sensitivity Tests; Radiography; Respiratory Tract Infections; Retropharyngeal Abscess; Retrospective Studies; Sepsis

A case-control study of antecedents of neonatal septicaemia was performed using 50 cases of neonatal septicaemia and 73 comparison infants from a Malaysian hospital nursery. Multivariate analysis indicated the following independent risk factors: maternal primiparity, pre-eclampsia, prolonged rupture of membranes, twin pregnancy, prematurity, assisted ventilation, umbilical catheterization, and formula feeding. Although the spectrum of causative organisms varied between our study and past studies from Western countries, the risk factors for developing neonatal septicaemia were strikingly similar. Therefore, preventative guidelines based on risk factors described in Western countries, should help reduce the incidence of neonatal septicaemia at this Malaysian hospital.

Topics: Case-Control Studies; Chi-Square Distribution; Female; Humans; Infant; Infant, Newborn; Logistic Models; Malaysia; Male; Multivariate Analysis; Nurseries, Hospital; Odds Ratio; Pregnancy; Pregnancy Complications; Risk Factors; Sepsis

Infectious complications are the major cause of morbidity and mortality in children with malignancy. Empirical antimicrobial therapy in the management of fever of unknown origin should be tailored to local bacteriological data and antibiotic sensitivity patterns. Five-hundred-and-fifty-nine cases of culture-proven septicaemia occurring in pediatric cancer patients between 1990 and 1994 were retrospectively analysed and compared with a similar study done in our centre between 1976 and 1979. A wide spectrum of organisms was isolated. Staphylococcus epidermidis, Staphylococcus aureus, and Klebsiella pneumoniae were the most common and consistent bacteria isolated during the 5 year period. More than 70 per cent of the staphylococci were sensitive to methicillin and universally sensitive to vancomycin. However, a worrying trend of ceftazidime-resistance amongst gram-negative organisms was found. In these situations, the use of imipenem is recommended as resistance to this antimicrobial agent was exceedingly rare.

Topics: Bacteria; Bacterial Infections; Chi-Square Distribution; Child; Child, Preschool; Female; Fever; Humans; Immunocompromised Host; Infant; Malaysia; Male; Neoplasms; Retrospective Studies; Sepsis

A study carried out in the Maternity Hospital, Kuala Lumpur over a 6 year period from 1986 to 1991, showed that the annual rates of septicaemia ranged from 5.2 to 10.2/100 admissions. Septicaemia accounted for between 11.0 to 30.4% of all neonatal deaths. The case fatality ratios ranged from 23.0 to 52.2%, being highest in 1989 when basic facilities were compromised. Low birthweight neonates accounted for 55.5% of those with septicaemia. The most common causative organisms were Staphylococcus epidermidis and Staphylococcus aureus in 1986 and 1987, but from 1988 Klebsiella species became the most common. More than 50% of neonatal septicaemia occurred after the age of 2 days. The results of the study demonstrated the dynamism of infection control: when control measures introduced earlier were not sustained, outbreaks of nosocomial infection recurred or worsened.. From January 1, 1986 to December 31, 1991, data were collected on neonatal septicemia at the Maternity Hospital, Kuala Lumpur, Malaysia, to monitor the trend of the infection and to determine whether any remedial steps reduced the infection rate. Of the 155,935 live births during this period, 8.8% were admitted to the special care nursery (SCN). Septicemia accounted for 5.2-10.2/100 admissions. 392 neonates (2.5/1000 live births) died from bacteriologically proven septicemia during this period, accounting for 11% (1991) to 30.4% (1989) of all neonatal deaths. Case rates of septicemia were highest in the very low birth weight babies who constituted 28.2% of the septicemia cases (low birth weight babies constituted 55.5%). During 1986 and the early part of 1987, disposable endotracheal tubes and mucus extraction suction catheters were reused in the labor rooms and the SCN after being soaked in Hibitane, and there were only 3 mucus suction systems available in the SCN. Septicemia outbreaks reduced in late 1987 after 4 new mucus suction systems were acquired, and the practice of reusing disposables was abandoned. During 1989, constant use of the mucus suction apparatus caused frequent breakdowns, and the water supply for hand washing was interrupted frequently; therefore, septicemia increased again. A reduction was accomplished in 1991 with the establishment of a regular water supply, disposable hand towels, and the purchase of new suction systems. Thus, the varying annual septicemia rates in the SCN ran parallel to the availability of infection control facilities. Staphylococcus epidermidis and staphylococcus aureus were the most common causative organisms in 1986 and 1987, and the Klebsiella series became the most common after 1988. More than half of the neonatal septicemia occurred after the age of 2 days; the low birth weight babies who remained in the SCN the longest were the most susceptible. This study shows that simple control measures can be very effective in reducing the incidence of septicemia.

Topics: Cross Infection; Female; Hospitals, Maternity; Hospitals, Urban; Humans; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Infection Control; Malaysia; Male; Retrospective Studies; Sepsis

Topics: Adult; Developing Countries; Female; Follow-Up Studies; Humans; Kidney Transplantation; Malaysia; Male; Retrospective Studies; Sepsis; Tissue Donors

Between January 1989 to April 1990 (16 months), a prospective observational study was carried out on 329 consecutive very low birthweight (VLBW) less than or equal to 1500 grams) Malaysian neonates born in the Maternity Hospital, Kuala Lumpur before their first discharge from the hospital. The objectives of the study were to determine the common causes of early morbidity and mortality of this group of Malaysian neonates. The study shows that the incidence of Malaysian VLBW neonates was 9.9 per 1000 livebirths (95% confidence intervals 9.0 to 10.8). The mean duration of stay in the hospital was 19.3 days (SD = 21.4). One hundred and ninety-six (59.6 percent) of the VLBW neonates died. They accounted for 60 percent (196/334) of all neonatal deaths in the hospital during the study period. Mortality was significantly higher in neonates of birthweight less than 1000 grams (p less than 0.01) and of gestation of less than 33 weeks (p less than 0.001). The three most common clinical problems were respiratory distress syndrome (RDS) (72.6 percent), septicemia (28.0 percent) and intraventricular haemorrhage (IVH) (21.9 percent). Death occurred in 71.1 percent of the septicemic patients. The most common causative organisms of septicemia were multiresistant klebsiella (52.3 percent) and multiresistant acinetobacter (14.7 percent). RDS (33.2 percent), septicemia (29.6%) and IVH (17.9 percent) were the three most common causes of death. Improvement in the nursing staff situation and basic neonatal care facilities in this hospital and prevention of premature delivery could help to decrease morbidity and mortality in this group of neonates.. Data on 329 consecutive very low birth weight (VLBW) (=or 1500 g) neonates born at the Kuala Lumpur Maternity Hospital in Malaysia were analyzed between January 1989 and April 1990 to determine causes of morbidity and mortality so the hospital could pinpoint priority areas to improve outcome in the time period before the hospital would actually upgrade its facilities. 95.7% of these newborns were born prematurely. The incidence of VLBW newborns was 9.9/1000 live births. The stay in the hospital after birth ranged from 1-127 days (mean 19.3 days). The mortality rate for the VLBW neonates was 59.6% (196). VLBW deaths made up 60% of all neonatal deaths in this hospital. Mortality risk factors included a birth weight of at most 1000 g (p .001) and gestational age less than 33 weeks (p .01). The 3 most frequent causes of death of the VLBW neonates included respiratory distress syndrome (33.2%), septicemia (29.6%), and intraventricular hemorrhage (17.9%). 67% of the VLBW infants with septicemia acquired the infection through poor hospital practices, as indicated by the fact that the most common pathogens were multiresistant Klebsiella (52.3%) and multiresistant Acinetobacter (14.7%). Overcrowding of the special care nursery and shortage of nurses contributed to these suboptimal practices. Further, 71,1% of the VLBW newborns with septicemia died and most of them (89.1%) weighed more than 1000 g at birth. These results indicated the need for this hospital to take steps to improve the staffing situation and to provide an adequate number of incubators and ventilators.

Topics: Cause of Death; Developing Countries; Hospitals, Maternity; Humans; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Malaysia; Prospective Studies; Sepsis; Treatment Outcome

Over a 12 months period, out of 25,411 livebirths, 155 neonates (6.1 per 1000 livebirths) had proven septicemia by blood culture. The mortality rate was 26.5%. Septicemia was more common among the very low birthweight and preterm neonates of gestation of 30 weeks or less. 45.8% of the septicemia occurred during the first 48 hours of life. Staphylococcus epidermidis was the most common causative organism. However, mortality was highest among neonates who acquired multiresistant nosocomial infection during the later part of neonatal life.

Topics: Cross Infection; Hospitals, Maternity; Hospitals, Special; Humans; Infant, Newborn; Malaysia; Prospective Studies; Sepsis; Staphylococcal Infections; Staphylococcus epidermidis

A retrospective study of 84 cases of neonatal septicaemia admitted into a neonatal unit in a rural area of Malaysia for 1 year between 1st September 1985 to 31st August 1986 was carried out to determine the spectrum of micro-organisms and predisposing factors in relation to early and late onset septicaemia. The incidence of neonatal septicaemia was 2.13 per 1,000 live-births per year and the case fatality was 41.7% with higher case fatality in those who were premature, those who presented as early onset and those who had gram negative septicaemia. The mean age of onset of septicaemia was 7.8 days (range from 2 hours to 27 days). Forty four (52%) neonates had early onset septicaemia with mean age of onset at 2.7 days; forty (48%) neonates had late onset septicaemia presenting at 13.6 days of life. Gram negative organisms such as Klebsiella, Pseudomonas, sp., E. coli and Streptococcus, especially group B Streptococcus were the major organisms in the early onset septicaemia. Staphylococcus aureus and Staphylococcus epidermidis were the major organisms responsible for the late onset septicaemia. Obstetrical factors played an important role in early onset septicaemia. Prematurity was the most common predisposing factor. Invasive diagnostic and therapeutic procedures including surgery highlighted once again the importance of these procedures in predisposing the newborn to infection.

Topics: Bacteria; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Malaysia; Male; Risk Factors; Sepsis

Topics: Female; Hospitals, University; Humans; Infant, Newborn; Infant, Premature, Diseases; Malaysia; Methicillin; Penicillin Resistance; Sepsis; Staphylococcal Infections; Staphylococcus aureus

A 13-year old boy with acute lymphoblastic leukemia on chemotherapy developed neutropenia and acute cellulitis progressing to fulminating septicemia due to Pseudomonas pseudomallei. Septicemic melioidosis should be considered in the differential diagnosis of a febrile illness in children who are susceptible to infections.

Topics: Acute Disease; Adolescent; Diagnosis, Differential; Humans; Leukemia, Lymphoid; Malaysia; Male; Melioidosis; Sepsis

Topics: Adjuvants, Immunologic; Animals; Bacterial Vaccines; Buffaloes; Cattle; Cattle Diseases; Hemorrhage; Malaysia; Oils; Oxytetracycline; Pasteurella Infections; Sepsis; Sulfamethazine; Vaccination