Skip Navigation

Electronic Letters to:

Articles:
Olbeg Y. Désinor, Jorge Luis Zuazo Silva, and Marie José Dallemand Ménos
Neonatal Sepsis and Meningitis in Haiti
J Trop Pediatr 2004; 50: 48-50 [Abstract] [PDF]
*E-letters: Submit a response to this article

Electronic letters published:

[Read eLetter] Response to Neonatal Sepsis and Meningitis in Haiti
Steve Piecuch   (2 December 2005)
[Read eLetter] Epidemiology of Sepsis and Meningitis in Pediatric Patients in Haiti
Steve Piecuch, MD, MPH   (2 December 2005)

Response to Neonatal Sepsis and Meningitis in Haiti 2 December 2005
Previous eLetter Top
Steve Piecuch,
Clinical Associate Professor of Pediatrics
State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, New York, USA

Send e-letter to journal:
Re: Response to Neonatal Sepsis and Meningitis in Haiti

Desinor, Silva and Menos recently reported on the etiology of neonatal sepsis and meningitis at the State University of Haiti. (1) A similar investigation consisting of a 25 month review of the microbiology laboratory records for pediatric patients at the Hospital Albert Schweitzer was performed. Hospital Albert Schweitzer, located in the Artibonite Valley of Haiti, serves a diverse patient population which includes residents of small cities and towns as well as of rural areas. Malnutrition and delays in accessing health care are not uncommon. Cultures were processed using standard laboratory techniques. Salmonella typhi (ST) and non-typhoid salmonellae (NTS) were responsible for 67% of bloodstream infections in children. Staphylococcus aureus (SA) was also common, probably due to the presence of skin lesions in children with malnutrition and scabies. Vaccination against pneumococcus (PN) and Haemophilus (HM) was not generally available and most cases of meningitis were due to these two organisms; Neisseria (NS) caused 1 case of meningitis. Escherichia coli (EC) and other Gram-negative organisms (OGN) such as Klebsiella (KB), Proteus, Enterobacter, Pseudomonas, Citrobacter and Shigella were responsible for 20% of cases of bloodstream infection and 13% of cases of meningitis. Cloxacillin, ampicillin, chloramphenicol and gentamicin were generally available for parenteral treatment of serious infections; access to more broad-spectrum agents such as third- generation cephalosporins was limited because of financial constraints. Among salmonellae, 9% were resistant to ampicillin and 2% were resistant to both ampicillin and chloramphenicol. No pneumococcal resistance to ampicillin or chloramphenicol was identified; 1 Haemophilus was resistant to both ampicillin and chloramphenicol. Resistance among E. coli and other Gram-negative organisms was particularly problematic. Of these, 56% were resistant to ampicillin, 31% to chloramphenicol and 21% to gentamicin. Resistance to ampicillin and chloramphenicol was seen in 23%; 8% were resistant to chloramphenicol and gentamicin and 6% to ampicillin, chloramphenicol and gentamicin. Initial combination therapy with chloramphenicol and gentamicin is advisable in seriously ill pediatric patients in Haiti with possible infection due to E. coli and other Gram- negative organisms. Cloxacillin, chloramphenicol and gentamicin would be a reasonable empiric regimen to cover both Gram-positive and Gram-negative organisms while awaiting culture results. Expanded-spectrum agents such as third-generation cephalosporins and carbapenems are needed in Haiti to treat serious infections due to resistant organisms. It is critical that hospitals in Haiti develop protocols for the judicious use of such agents, so that effective, non-toxic treatment may be provided without exhausting limited resources.

1. Desinor OY, Silva JL, Menos MJ. Neonatal Sepsis and Meningitis in Haiti. J Trop Pediatr 2004; 50:48-50.

Conflict of Interest:

None declared
Epidemiology of Sepsis and Meningitis in Pediatric Patients in Haiti 2 December 2005
Next eLetter Top
Steve Piecuch, MD, MPH,
Clinical Associate Professor of Pediatrics
State University of New York-Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203

Send e-letter to journal:
Re: Epidemiology of Sepsis and Meningitis in Pediatric Patients in Haiti

Desinor, Silva and Menos recently reported on the etiology of neonatal sepsis and meningitis at the State University of Haiti. (1) A similar investigation consisting of a 25 month review of the microbiology laboratory records for pediatric patients at the Hospital Albert Schweitzer was performed in 2002. Hospital Albert Schweitzer, located in the Artibonite Valley of Haiti, serves a diverse patient population which includes residents of small cities and towns as well as of rural areas. Malnutrition and delays in accessing health care are not uncommon. Cultures were processed using standard laboratory techniques.

There were 289 positive blood cultures. Thirty-nine were due to Gram- positive organisms: Staphylococcus aureus (33) and Streptococcus pneumoniae (6). Two hundred fifty were due to Gram-negative organisms: Non-typhoid salmonellae (175), Salmonella typhi (18), Escherichia coli (28), Klebsiella (12) and other Gram-negative organisms (17). S. typhi and non-typhoid salmonellae were responsible for 67% of bloodstream infections in children. S. aureus was also common, possibly due to the presence of skin lesions in children with malnutrition and scabies. There were 38 positive cerebrospinal fluid cultures. Twenty-four were due to S. pneumoniae. Fourteen were due to Gram-negative organisms: Haemophilus (8), Neisseria (1), E. coli (2) and other Gram-negative organisms (3). Vaccination against S. pneumoniae and Haemophilus was not generally available and it is not surprising that most cases of meningitis were due to these two organisms. Excluding salmonellae, Haemophilus and Neisseria, E. coli and other Gram-negative organisms such as Klebsiella, Proteus, Enterobacter, Pseudomonas, Citrobacter and Shigella were responsible for 20% of cases of bloodstream infection and 13% of cases of meningitis.

Cloxacillin, ampicillin, chloramphenicol and gentamicin were generally available for parenteral treatment of serious infections during the study period. Access to agents with a broader spectrum of coverage such as third-generation cephalosporins was limited because of financial constraints. Among salmonellae, 9% were resistant to ampicillin and 2% were resistant to both ampicillin and chloramphenicol. No pneumococcal resistance to ampicillin or chloramphenicol was identified; 1 Haemophilus was resistant to both ampicillin and chloramphenicol. Resistance among E. coli and other Gram-negative organisms was particularly problematic. Of these, 56% were resistant to ampicillin, 31% to chloramphenicol and 21% to gentamicin. Resistance to the combination of ampicillin and chloramphenicol was seen in 23%; 8% were resistant to chloramphenicol and gentamicin and 6% to ampicillin, chloramphenicol and gentamicin.

Initial combination therapy with chloramphenicol and gentamicin is advisable in seriously ill pediatric patients in Haiti with possible infection due to E. coli and other Gram-negative organisms. Cloxacillin, chloramphenicol and gentamicin would be a reasonable empiric regimen to cover both Gram-positive and Gram-negative organisms while awaiting culture results. Expanded-spectrum agents such as third-generation cephalosporins and carbapenems are needed in Haiti to treat serious infections due to resistant organisms. It is critical that hospitals in Haiti develop protocols for the judicious use of such agents, so that effective, non-toxic treatment may be provided without exhausting limited resources.

1. Desinor OY, Silva JL, Menos MJ. Neonatal Sepsis and Meningitis in Haiti. J Trop Pediatr 2004; 50:48-50.

Conflict of Interest:

None declared