A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in partial fulfillment of the requirements for the degree
of
Master of Science in Medicine in Pharmaceutical Affairs
Johannesburg, May 2012 / ABSTRACT
Introduction
Nosocomial infections which occur after 72 hours in hospitalised neonates cause morbidity
and mortality particularly in very low birth weight neonates admitted to a neonatal intensive
care unit (NICU). Prolonged hospitalisation and use of sophisticated, expensive antibiotics
lead to spiraling costs. Prevention of nosocomial infections are of the essence to contain
expenditure and prevent life-threatening complications in vulnerable neonates. A
prospective, descriptive study was undertaken to determine the cost of antibiotics used in
the neonatal unit at Kalafong Hospital for nosocomial infections.
Patients and Methods
Neonates with nosocomial infections admitted consecutively to the neonatal unit were
studied prospectively by documenting the birth weight, site of infection, pathogen,
outcome, admission to the NICU and antibiotics administered. The cost related to
antibiotic use was determined for each antibiotic, for individual neonates (expressed as the
mean and standard deviation) and for the group as a whole.
Results
Over a period of seven months (1/1/2011 - 31/7/2011) 682 neonates with a mean birth
weight of 2375g, ±868g were admitted to the neonatal unit for ~72 hours of whom 53/682
(7.8%) developed a nosocomial infection and of the 53 who developed a nosocomial
infection, eight demised (15.1 %). Of the remaining 629 neonates who did not develop a
nosocomial infection, 15/629 (2.4%) demised (p=0.7). Nosocomial infection occurred in
21/36 (58%) neonates <1 OOOg vs 22/646 (3.4%) ~1 OOOg (p<0.01 ).Of 199/682 neonates
admitted to the NICU, 42/199 (21.1 %) developed a nosocomial infection vs 11/483 (2 .3%) not admitted to the NICU (p=<0.01 ). Of 22 pathogens cultured from blood, coagulase
negative Staphylococcus aureus was the most common (7/22). The total cost of second
line antimicrobials (meropenem, vancomycin and fluconazole) for the study period of
seven months was R27 032.00 of which an amount of R1 0 321.00 was spent on neonates
weighing <1000g. The mean cost per neonate was R563.77±283 for meropenem (n=51),
R70.23±32 for vancomycin (n=5) and R78.66±53 for fluconazole (n=6) of which drug
wastage comprised at least 50% in each instance.
Conclusions
Extremely low birth weight ( <1 OOOg) and admission to the NICU place neonates at risk of
nosocomial infection at Kalafong Hospital. Meropenem was the most commonly used
second line) antibiotic followed by vancomycin and fluconazole. Pharmaceutical
curtailment of expenditure generated by nosocomial infections should be addressed by the
manufacture of vials with a lower concentration of drug for neonates to minimise wastage.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/13834 |
| Date | 05 1900 |
| Creators | Kitambala, Sentime |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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