Abstract
This is a report on a case of neonatal sepsis and clinical management with multiple antibiotic therapy in a neonatal intensive care unit (NICU) in Brazil. A preterm baby boy was born by caesarean section at 34 weeks and two days of gestation from an oligodramnious pregnancy with intrauterine growth restriction. After respiratory failure detection, the baby was intubated and placed on mechanical ventilation for respiratory failure and was shifted to NICU. Ampicillin and gentamicin were instituted empirically. Enterobacter spp-induced severe sepsis was diagnosed. Included in the antibiotic therapy were oxacycline, amikacin, cefepime, tazocin, meropen and teicoplanin. After sixty days in NICU, clinical and laboratory parameters were normalized and the baby recovered. The empirical long-term antibiotic treatment and the use of broad spectrum antibiotics, as observed in the present case, should be carefully considered in newborns admitted to NICU. Keywords: Sepsis, Newborn, Respiratory failure, Multiple antibiotic therapy
Highlights
Neonatal bacterial sepsis, classified as early or late onset, is a major cause of morbidity and mortality, for premature neonates, being an important public health concerns worldwide [1]
[3].Early onset neonatal sepsis (EOS) occurs in the first three days of life, which is typically caused by organisms transmitted vertically from the mother to the infant before or at the time of birth [4]; while late onset neonatal sepsis (LOS), an infection occurring after day 3 of life, is more likely to be caused by pathogens acquired during the course of hospital care
We report a clinical course of antibiotic therapy occurred in a neonatal intensive care unit (NICU) from Brazil
Summary
Neonatal bacterial sepsis, classified as early or late onset, is a major cause of morbidity and mortality, for premature neonates, being an important public health concerns worldwide [1]. Bacteria like Klebsiella spp., Escherichia coli, and Staphylococcus aureus are reported to be the main cause reason of neonatal sepsis within the first week of life [7]. Empiric antibiotic therapy in newborns is based on combinations of cephalosporin, ampicillin and gentamicin [9,10]. At 9th day, the results of blood culture were not yet available, bradycardia was detected and antibiotic therapy was changed to oxacilin (50 mg, i.v., 12 h) and amikacin (28 mg, i.v., 24 h), suggesting low efficacy of gentamicin and ampicillin combination and urine culture was negative. Using the Naranjo Adverse Drug Reaction Probability Scale, it was observed that a “possible adverse drug reaction” (score 4), related to a continuous thrombocytopenia.From 30th and following days, clinical and laboratory parameters were normalized. Diagnosis of sepsis was based on having at least two clinical signs of sepsis (core temperature > 38.5 °C, tachycardia/bradycardia or tachypnea) and one positive laboratory parameter linked to sepsis, i.e., white blood cell count and a Creactive protein (CRP)
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