High prevalence of fecal carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric unit in Madagascar

<p>Abstract</p> <p>Background</p> <p>Extended-spectrum β-lactamase (ESBL)-producing <it>Enterobacteriaceae </it>have spread worldwide but there are few reports on carriage in hospitals in low-income countries. ESBL-producing <it>Enterobacteriaceae </it>(ESBL-PE) have been increasingly isolated from nosocomial infections in Antananarivo, Madagascar.</p> <p>Methods</p> <p>we conducted a prevalence survey in a pediatric unit from March to April 2008 Patient rectal swabs were sampled on the first and the last day of hospitalization. Medical staff and environment were also sampled. Rectal and environmental swabs were immediately plated onto Drigalski agar supplemented with 3 mg/liter of ceftriaxon.</p> <p>Results</p> <p>Fecal carriage was detected in 21.2% of 244 infants on admission and 57.1% of 154 on discharge, after more than 48 hours of hospitalization (p < 0.001). The species most frequently detected on admission were <it>Escherichia coli and Klebsiella pneumoniae </it>(36.9%), whereas, on discharge, <it>K. pneumoniae </it>was the species most frequently detected (52.7%). ESBL-associated resistances were related to trimethoprim-sulfamethoxazole (91.3%), gentamicin (76.1%), ciprofloxacin (50.0%), but not to amikacin and imipenem. The increased prevalence of carriage during hospitalization was related to standard antimicrobial therapy.</p> <p>Conclusion</p> <p>The significant emergence of multidrug-resistant enteric pathogens in Malagasy hospitals poses a serious health threat requiring the implementation of surveillance and control measures for nosocomial infections.</p

Childhood dysglycemia: prevalence and outcome in a referral hospital.

INTRODUCTION: Hypoglycemia is a defining feature of severe malaria and several other infectious diseases in children but the prevalence, significance, and prognosis of abnormal blood glucose, including hyperglycemia, have rarely been addressed in severely ill children in non-malaria endemic areas. METHODS: In Madagascar, consecutive children (1 month-15 years) admitted to the pediatric ward of a referral hospital, were categorized using the integrated management of childhood illness (IMCI). Samples were taken once on admission for measuring blood glucose concentration. Glycemia levels (hypoglycemia <2.2 mmol/l; low glycemia: 2.2-4.4 mmol/l; normoglycemia >4.4-8.3 mmol/l; and hyperglycemia >8.3 mmol/l) were related to the IMCI algorithm and case fatality. Factors associated with blood glucose concentration and case fatality were analysed using univariate and multivariate analysis. RESULTS: Of 420 children, 48.1% (n = 202) were severely ill; 3.1% (n = 13) had hypoglycemia; 20.0% (n = 84) low glycemia; 65.9% (n = 277) normoglycemia; and 10.9% (n = 46) hyperglycemia. In univariate analysis, hypoglycemia and hyperglycemia both showed significant increase in the risk of death, as compared to normal blood glucose (RR: 12.2, 95% CI: 6.2-23.7 and RR: 2.5, 95% CI: 1.0-6.2, respectively). Children with low glycemia had no increased risk of death (RR: 1.2, 95% CI: 0.4-3.2) despite a poorer IMCI status on admission. After logistic regression, hypoglycemia (RR: 19.4, 95% CI: 5.0-.74.7, hepatomegaly (RR: 12.2, 95% CI: 3.3-44.9) and coma (RR: 4.8, 95% CI: 1.3-17.6) were the features on admission associated with an increased risk of death. CONCLUSIONS: Dysglycemia in non-neonates is associated with increased mortality. These findings underline the need for the use of rapid screening tests to initiate early treatment. Alternative treatments such as oral or sublingual administration of glucose should be developed in structures with limited resources

Baseline glycemia and children features and in-hospital mortality (univariate analysis)^*.

*<p>Only significant factors, Fischer's exact test when expected value of cell value is <5. CI: confidence interval.</p

Case fatality according to blood glucose concentration of 420 admitted to Pediatrics.

<p>Mean and [95% confidence interval (95% CI)].</p>*<p>Died during hospitalization or left critically ill and expected to died.</p>**<p>Children were transferred to nutrition rehabilitation centre after improvement of acute status, 7 children left the hospital without notice, their outcome is unknown.</p

Socio-demographic characteristics of children on admission in Pediatrics.

<p>Mean and [95% confidence interval (95% CI)].</p

Medical characteristics of children according to IMCI algorithm.

<p>IMCI: integrated management of childhood illness.</p>*<p>Weight for height, or height for age, or weight for age ≤3 Standard Deviation (WHO 2006) among children less than 59 months.</p><p>14 had kwashiorkor (1 hypo, 2 low glycemia, 10 normoglycemia, 1 hyperglycemia, 1 hyperglycemia had marastic-kwashiorkor).</p

Enrolment flow chart.

<p>Enrolment flow chart.</p

Assessment of the Infant Feeding Age 1 to 12 Months in a Hospital Setting in Antananarivo

IntroductionIn developing countries such as Madagascar, malnutrition remains a major public health problem. Our objective was to study the feeding of infants aged 1 to 12 months, passing through the pediatric ward of the Joseph Raseta Befelatanana University Hospital Center.MethodsWe conducted a prospective cross-sectional survey based on interviews with mothers of visiting or hospitalized children over a period of 3 months.ResultsOne hundred mothers were interviewed; 46 of the babies were less than 6 months old. The rate of exclusive breastfeeding for children under 6 months of age is 83%. During diversification, the socio-economic level is the most discriminated factor causing errors with a p < 0.01845 for vegetable intake and p < 0.02419 for meat intake. It was mainly the error in oil or butter intake that was correlated with poor nutritional status of children during the diversification period with a p < 0.0077.ConclusionMany of the errors found during diversification affected the nutritional status of children. A nutritional education adapted to the Malagasy context would be essential