Retrospective review of antimicrobial use for gastroschisis patients in Kigali, Rwanda: can improved stewardship reduce late inpatient deaths?

Author:

Diehl Thomas M.1,Davis James R.2,Nsengiyumva Alice3,Igiraneza Deborah4,Hong Philip2,Umutoni Rosine3,Neal Dan2,Ndibanje Alain Jules4,Bunogerane Gisèle Juru4,Petroze Robin T.2,Ntaganda Edmond4

Affiliation:

1. University of Wisconsin

2. University of Florida

3. University of Rwanda

4. University Teaching Hospital-Kigali

Abstract

Abstract PurposeGastroschisis mortality is 75-100% in low-resource settings. In Rwanda, late deaths are often due to sepsis. We aimed to understand the effect of antimicrobial use on survival.MethodsWe conducted a retrospective review of gastroschisis patients at a tertiary hospital in Kigali, Rwanda between January 2016—June 2019. Demographics, antimicrobial use, culture data, and outcome were abstracted. Descriptive and univariate analyses were conducted to assess factors associated with improved survival.ResultsAmong 92 gastroschisis patients, mortality was 77%(n=71); 23%(n=21) died within 48 hours. 98%(n=90) of patients received antibiotics on arrival. Positive blood cultures were obtained in 41%(n=38). Patients spent 86%(SD=20%) of hospital stay on antibiotics and 38%(n=35) received second-line agents. There was no difference in age at arrival, birth weight, gestational age, silo complications, or antimicrobial selection between survivors and non-survivors. Late death patients spent more total hospital days and post-abdominal closure days on antibiotics (p<0.001) compared to survivors. There was no difference in the proportion of hospital stay on second-line antibiotics (p=0.1).ConclusionFrequent late deaths due to sepsis, prolonged antibiotic courses, and regular use of second-line antibiotic agents were identified in this retrospective cohort of gastroschisis patients. Future studies are needed to evaluate antimicrobial resistance in Rwanda.

Publisher

Research Square Platform LLC

Reference34 articles.

1. Countdown to 2015: a decade of tracking progress for maternal, newborn, and child survival;Victora CG;Lancet

2. WHO. Newborns: improving survival and well-being. https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality. Accessed 24 Feb 2022

3. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015;GBD 2015 Child Mortality Collaborators;Lancet

4. UNICEF. Neonatal mortality. In: UNICEF DATA. https://data.unicef.org/topic/child-survival/neonatal-mortality/. Accessed 27 Jan 2022

5. Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings;Wright N;Wellcome Open Res

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