Conclusion
Au vu de nos résultats, nous avons tiré les
conclusions suivantes ; l'incidence de l'infection néonatale est de
96,8% ; les manifestations cliniques les plus fréquentes sont la
fièvre, les troubles neurologiques et la détresse respiratoire.
L'écologie bactérienne est dominée par les bacilles Gram
négatif dans 56% des cas avec 52,6% à la période
néonatale précoce et 66,7% à la période
néonatale tardive. Les antibiotiques les plus sensibles étaient
l'imipenème et l'amikacine. Le taux de décès est de
33,6%.
Recommandations
Au terme de cette étude, nous recommandons de :
? Renforcer la compétence du personnel médical
dans la prise en charge des femmes en âge de procréer, des femmes
enceintes et des nouveau-nés.
? Réduire le coût des bilans paracliniques afin
de permettre à tous les nouveau-nés de voir leur suivi et leur
prise en charge ciblée et améliorée.
? Renforcer les séances d'information, éducation
et communication (IEC) sur le suivi de la femme enceinte pendant la grossesse
et la prise en charge du nouveau-né à l'accouchement, de mettre
un accent pendant les consultations prénatales (CPN sur les
règles d'hygiène du nouveau-né à domicile.
? Etre rigoureux sur l'asepsie en salle d'accouchement et en
néonatologie, en particulier pendant les soins afin de réduire la
survenue des infections du nouveau-né.
? Utilisation rationnelle des antibiotiques afin d'éviter
la sélection des germes résistants
aux antibiotiques usuels.
Thèse de doctorat en médecine
présentée par KEMEZE ZEUFACK Sandrine
Page xviii
PRELIMINAIRES
SUMMARY
Page xix
Thèse de doctorat en médecine
présentée par KEMEZE ZEUFACK Sandrine
Thèse de doctorat en médecine
présentée par KEMEZE ZEUFACK Sandrine
PRELIMINAIRES
Introduction and Objective
The World Health Organization (WHO) estimates the overall
occurrence of neonatal deaths to 2.8 million in 2013, of which 47.6% are due to
the neonatal infection. In Cameroon, according to the 2011 4th multiple
indicators health survey of the population (EDS-MICS), the neonatal mortality
rate was estimated at 31 per thousand. In 2014 the mortality rate associated
with neonatal infections was estimated at 54.93% at the Douala Laquintinie
Hospital. Our objective was to determine the epidemiological, clinical,
bacteriological and outcome of neonatal bacterial sepsis at the Douala
Laquintinie hospital.
Methodology
We conducted a prospective and descriptive study over a period
of four months, from the 1st March to the 30th June 2015, in the
neonatal unit of the Douala Laquintinie hospital. All symptomatic newborns with
or without anamnestic criteria and all asymptomatic infants with at least one
risk of infection and having at least one positive culture or an abnormal blood
count or a positive C-reactive protein were included in our study
Results
During our study period we admitted a total of 310 newborns,
of which 300 were retained for neonatal infection, giving an incidence of
96.8%. The infection was early-onset in 94% of the patient. The most frequent
risk factors were unexplained preterm birth <35 weeks of gestational age
(45.1%), neonatal resuscitation in questionable aseptic conditions (34.8%), and
prolonged rupture of membranes =12 hours (32.7 %). Fever, neurological
disorders and respiratory distress were the most frequent clinical signs
encountered in 56%, 48.8% and 43.1% respectively of the newborns.
Septicemia was the most represented clinical picture in 88.2%
of the neonates; Gram-negative bacteria were the most frequently encountered
germs, in 56% of the patients, with 52.6% in early neonatal period and 66.7% in
late neonatal period. Imipenem and amikacin were antibiotics having the best
sensitivities on both Gram-negative and Gram-positive bacteria, and with a
respective overall sensitivity of 95% and 66.7% respectively.
The outcome was favorable in 66.4% of patients, and the
overall mortality was 33.6%. We noted 83.5% of deaths in the early neonatal
period and 16.5% in the late neonatal period. Conclusion
Based on our results, we draw the following conclusions: the
incidence of neonatal sepsis was 96.8%; the most common clinical manifestations
were fever, neurological disorders and respiratory distress. The bacterial
ecology was dominated by Gram-negative bacilli with
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PRELIMINAIRES
52.6% in the early neonatal period and 66.7% in the late
neonatal period. The most sensitive antibiotics were imipenem and amikacin. The
mortality rate was 33.6%.
Recommendations
At the end of this study, we recommend the following:
? Enhance the capacity of medical personnel in the care of
women at childbearing age, pregnant women and newborns.
? Reduce cost of the paraclinical investigations sheets to
enable all newborns to be better managed and monitored.
? Strengthen information, education and communication (IEC)
during antenatal visits on the care and follow up of pregnant women during
pregnancy and the neonates at delivery. Emphasis should also be placed on the
hygiene of the newborns at home after delivery. .
? Enforce rigorous aseptic measures in the delivery room and
neonatology unit, especially during treatment proceduces cares in order to
reduce the incidence of neonatal sepsis.
? Ensure rational use of antibiotics in order to prevent the
selection of resistant bacterial strains.
Thèse de doctorat en médecine
présentée par KEMEZE ZEUFACK Sandrine
Page xxi
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