title: Incidence and etiology of omphalitis in Pakistan: a community-based cohort study.
abstract: BACKGROUND
  Although omphalitis (umbilical infections) among newborns is common and a major cause of neonatal deaths in developing countries, information on its burden and etiology from community settings is lacking. This study aimed to determine the incidence and etiology of omphalitis in newborns in high neonatal mortality settings in Karachi, Pakistan.
  
  
  METHODS
  Trained community health workers surveyed all new births in three low-income areas from September 2004 to August 2007. Pus samples from the umbilical stumps were obtained from babies with pre-defined signs of illness and subjected to culture and antimicrobial susceptibility testing.
  
  
  RESULTS
  Among 6904 births, 1501 (21.7%) newborns were diagnosed with omphalitis. Of these, 325 (21.6%) were classified as mild, 1042 (69.4%) as moderate, and 134 (8.9%) as severe; 141 (9.3%) were associated with clinical signs of sepsis. The incidence of omphalitis was 217.4/1000 live births; moderate-severe omphalitis 170.3 per 1000 live births; and associated with sepsis 20.4 per 1000 live births. Of 853 infants with purulent umbilical discharge, 64% yielded 583 isolates. The most common pathogens were Staphylococcus aureus, of which 291 (95.7%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 13 (4.2%) methicillin-resistant S. aureus (MRSA); Streptococcus pyogenes 105 (18%); Group B beta-hemolytic streptococci 59 (10 %); Pseudomonas spp., 52 (8.9 %); Aeromonas spp. 19 (3.2%); and Klebsiella spp. 12 (2%).
  
  
  CONCLUSIONS
  A high burden of omphalitis can be associated with sepsis among newborns in low-income communities in Pakistan. S. aureus is the most common pathogen isolated from umbilical pus. Appropriate low-cost prevention strategies need to be implemented.
authors.affiliation: Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Fatima
authors.initials: F
authors.lastname: Mir
authors.forename: Shiyam Sundar
authors.initials: SS
authors.lastname: Tikmani
authors.forename: Sadia
authors.initials: S
authors.lastname: Shakoor
authors.forename: Haider Javed
authors.initials: HJ
authors.lastname: Warraich
authors.forename: Shazia
authors.initials: S
authors.lastname: Sultana
authors.forename: Syed Asad
authors.initials: SA
authors.lastname: Ali
authors.forename: Anita K M
authors.initials: AK
authors.lastname: Zaidi
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008826:Microbial Sensitivity Tests; D010154:Pakistan / Q000453:epidemiology; D012871:Skin Diseases / Q000453:epidemiology* / Q000473:pathology; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000473:pathology; D014472:Umbilicus / Q000382:microbiology / Q000473:pathology*
chemical_list: D000900:Anti-Bacterial Agents