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Beta-Lactams and Aminoglycosides in Neonates at the University Hospital of Cocody in Ivory Coast

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Beta-Lactams and Aminoglycosides in Neonates at the University Hospital of Cocody in Ivory Coast , N° 5, Vol. 1: 20-27 N’guessan-Irié et al., 2016 Beta-lactams and Aminoglycosides in Neonates at the University Hospital of Cocody in Ivory Coast. ß-lactamines et Aminosides utilisés en Néonatalogie au Centre Hospitalier Universitaire de Cocody en Côte d’Ivoire. Geneviève N’guessan-Irié 1,2* , Madeleine Amorissani-Folquet 3,4 , Gisèle Siransy-Kouakou 1,5 , Cyprien Kouakou 3,4 , Landry Kouakou 1 1Département de Pharmacologie, UFR Sciences Pharmaceutiques et Biologiques, Université Félix Houphouët-Boigny, email : [email protected], [email protected], [email protected] ; 2Service de Pharmacie, Centre Hospitalier et Universitaire de Cocody ; 3Service de Pédiatrie, Centre Hospitalier et Universitaire de Cocody, email : [email protected], [email protected] ; 4Département de Pédiatrie, UFR Sciences Médicales d’Abidjan, Université Félix Houphouët-Boigny ; 5Service de Pharmacologie Clinique, Centre Hospitalier et Universitaire de Cocody. *Author for correspondence: [email protected] Postal address: 08 BP 3163 Abidjan 08; Phone: +225 07 98 81 57 Abstract RESUME Aim : In Ivory Coast, neonatal infections are very Objectif : en Côte d’Ivoire, les infections néonatales frequent. However the antibacterial therapy of these sont très fréquentes. Cependant leur prise en charge ne diseases is not still the object of a national consensus. fait pas encore l’objet de consensus national. Il paraît Then it seems important to make the current situation of alors judicieux de faire l’état des lieux de antibacterial therapy in neonates in reference Hospitals l’antibiothérapie en Néonatalogie dans les hôpitaux de like the University Hospital of Cocody. The aim of this référence comme le centre hospitalier et universitaire study was to analyze the practice of antibacterial care in (CHU) de Cocody. L’objectif de cette étude était neonatal infections there with regard to international d’analyser l’antibiothérapie néonatale au CHU de recommendations, if need be, to make propositions for Cocody au regard des recommandations internationales improvement. Methods : Two hundred and fourteen en vue de faire des propositions pour l’améliorer. neonates hospitalized for infection except parasitic or Méthode : 214 nouveau-nés hospitalisés pour infection, viral disorders were recruited for seven-month excepté les parasitoses et viroses, ont été recrutés pour transversal study. Hospital practices were observed and une étude transversale de sept mois. Les pratiques detailed antibacterial therapy was noted. Results : hospitalières et le détail des antibiothérapies ont été Antibacterial therapy was dominated by double- notés. Résultats : le traitement a été dominé par la bi- antibacterial therapy (98.13%). This concerned in first antibiothérapie (98,13%). En première intention : intention Amoxicillin 100 Mg/Kg twice a day or Amoxicilline 100 mg/kg deux fois par jour ou Ceftriaxone 100 Mg/Kg once a day in direct intravenous Ceftriaxone 100 mg/kg une fois par jour en injection injection + Netilmicin or Gentamycin 5 Mg/Kg once a intraveineuse directe + Nétilmicine ou Gentamycine 5 day in intramuscular injection; in second intention mg/kg une fois par jour en injection intramusculaire ; en (sepsis or altered general state): Cefotaxim 50-75 deuxième intention (sepsis ou état général altéré) : Mg/Kg twice a day in direct intravenous injection + Céfotaxime 50-75 mg/kg deux fois par jour en injection Netilmicin or Gentamycin 5 Mg/Kg once a day in intraveineuse directe + Nétilmicine ou Gentamycine 5 intramuscular injection. Third-generation mg/kg une fois par jour en injection intramusculaire. cephalosporins were more prescribed at forward Les céphalosporines de troisième génération ont été plus neonates than at the premature ones ( χ2 = 5.58); prescrites aux nouveau-nés à terme qu’aux prématurés antibacterial therapy was generally driven hanging three (χ2 = 5,58) ; l’antibiothérapie a généralement duré trois in ten days (90.19%); 77.1% of neonates presented a à dix jours (90,19%); 77,1% des nouveau-nés ont regularity in therapy administrations. bénéficié d’une régularité d’administration des Conclusions : Intramuscular injections of antibiotiques. Conclusion : l’injection intramusculaire aminoglycosides and irregularities in some therapy des aminosides et les irrégularités d’administration des administrations must be corrected to promote an optimal antibiotiques doivent être corrigées pour optimiser la pharmacotherapeutics. pharmacothérapeutique. Key-words : Antibacterial therapy, Ivory Coast, Mots-clés : Antibiothérapie, Côte d’Ivoire, Infections Neonatal infections. néonatales. 20 Annales des Sciences de la Santé, ISSN: 2421 -8936 , N° 5, Vol. 1: 20-27 N’guessan-Irié et al., 2016 INTRODUCTION the French recommendations? If not, what In neonatal pathology, infection constitutes a propositions could help improving the situation, not only frequent, but also serious. antibiotic coverage of the neonates? Such were Its incidence is from 0.5 to 1% of the births in the objectives assigned to this study. industrialized countries with approximately 5 million deaths a year (Aujard, 2011), I- METHODS corresponding to mortality from 6 to 10% at a- Population of study the forward neonates and of 30% at the The neonates, hospitalized in the neonatal premature neonates (Arsac, 2007). In block of the Pediatrics department of the developing countries, the situation is more University Hospital of Cocody for neonatal worrisome: indeed, the incidence is higher, infection, constituted our population of study. that is 3 in 5% (Aujard, 2011). In Ivory Coast, We adopted the mode of sampling by infections had 27.5% prevalence in neonates at convenience, and so recruited for the period of the University Hospital of Yopougon with our study 214 neonates (a very representative 24.6% mortality (Akaffou et al, 1998). More sample). than ten years later, prevalence and mortality b- Frame of study rates are still high. Indeed further studies Investigations were led in the neonatal block showed that neonatal infections represent of the Pediatrics department of the University 22.7% prevalence at the University Hospital of Hospital of Cocody in Abidjan (Ivory Coast’s Cocody with 15.5% mortality. All this economic capital). The University Hospital of epidemiological information shows the scale Cocody belongs to the highest level of the of neonatal infections in Ivory Coast, requiring national sanitary pyramid. The neonatal block optimal therapeutic coverage for reaching the includes a room of systematic screening of fourth Millennium Development Goal, namely HIV, a resuscitation room, a room of "to reduce childhood mortality". However the hospitalization for the forward neonates, a care of neonatal infections is not still the room of hospitalization for the premature object of a national consensus. International neonates, a room for kangaroo care and a room recommendations, in particular the French for dietetics. ones, remain reference tables. Does the driving The unit of care in neonatology is equipped of the antibacterial therapy in neonatal with fifteen cradles, fourteen incubators, four infections at the University Hospital of tables of resuscitation, three devices of Cocody follow good therapeutic approach? Is phototherapy, four heaters, two vacuum this antibacterial therapy in compliance with cleaners, a mobile trolley for the care, an 21 Annales des Sciences de la Santé, ISSN: 2421 -8936 , N° 5, Vol. 1: 20-27 N’guessan-Irié et al., 2016 electric baby scales, and thirteen sources of antibacterial therapy, the beginning and the oxygen end of the therapy. c- Type of study e- Statistical Analyses It was about a transverse study with Discrete data are presented as absolute and descriptive and analytical aim over a period of relative values (n [%]).We used the Chi -square seven months going from September, 2013 till test (degree of freedom = 1) to analyze the link March, 2014. between the gestational age and the used d- Study selection antibiotic molecules. Two -tailed p-values < Inclusion criteria included: 0.05 were considered to indicate statistical 1) Neonates from 0 to 28 days of life; significance in all tests. 2) Hospitalized in the neonatal block from September 1st, 2013 till March 31st, 2014; II- RESULTS 3) With neonatal infection; Antibacterial prescription 4) Followed therapeutically until their release Over the 214 newborn children, 210 received a of hospitalization. double-antibiotic treatment and 3 received a Non-inclusion criteria included: triple-antibiotic treatment. We noted a case 1) Neonates admitted in the department during where the regimen was neither a double - the same period but who presented a parasitic antibacterial therapy, nor a triple -antibacterial infection with a positive thick drop; and/or therapy: this only case was classified other. 2) Arisen from mother known HIV positive. Progress of the study We obtained an authorizati on of investigation with the Pediatrics department head. Besides, data were collected taken in any anonymity and confidentiality, according to ethical and business ethical considerations. Observation of hospital practices and interviews of the health worke rs and the mothers allowed filling investigation forms to supply the following Figure 1: distribution of the neonates according to the regimen of antibacterial information: clinical signs of the neonate at therapy entry, biological and radiological realized analyses, the clinical diagnosis, the detailed 22 Annales des Sciences de la Santé, ISSN: 2421 -8936 ,
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