Neonatal Sepsis from 2014 to 2024: The Resurgence of Gram-Negative Rods.

Neonatal sepsis is a major cause of mortality and morbidity in newborn, particularly in developing countries. The spectrum of bacteria which causes neonatal sepsis varies in different parts of the world. The organisms responsible for early onset and late onset sepsis are different. The objective of the study was undertaken to determine the pattern of bacterial isolates responsible for early and late onset neonatal sepsis based on the presence of one or more clinical signs, and its outcome. A cross- sectional prospective study was carried out in the special care baby unit (SCABU) from November 2008 to September 2009 under department of Paediatrics and Neonatology, BIRDEM General Hospital, Dhaka, Bangladesh. Organisms were isolated from 8.9% of collected blood samples. The male female ratio of culture proven sepsis was 1.7:1. Most of the culture proven septic neonates(71.88%) were preterm & 65.63% had low birth weight. The most frequent clinical presentations of patients with culture-proven sepsis were poor moro reflex (92.2%), feeding intolerance (90.6%), jaundice (87.5%), abdominal distention (76.6%), and lathergy (73.4%). The Gram positive and Gram negative bacteria accounted for 6 (9.4% ) and 58 (90.6%) of the isolates respectively. Around two third of the culture-proven septic neonates (70.3%) presented with early onset sepsis, while 29.7% presented with late onset sepsis. Klebsiella pneumoniae was the most common pathogen both in early onset (31.25%) and late onset (6.25%) sepsis. Serratia (18.75%) was the second most common pathogen in early onset sepsis. Total mortality rate was 9.38%. Preterm, low birth weight and Gram negative sepsis contributes majority of mortality. Gram negative organism especially Klebsiella pneumoniae contributed highest in early onset sepsis and neonatal death (6.25%) due to sepsis. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21306 Medicine Today 2014 Vol.26(1): 18-21

Neonatal sepsis is a major cause of mortality and morbidity in newborn. The spectrum of bacteria which causes neonatal sepsis varies in different parts of the world. The organisms responsible for early onset and late onset sepsis are different. The objective of the study was undertaken to determine the pattern of bacterial isolates responsible for early and late onset neonatal sepsis. A prospective descriptive study over the period of one year was conducted at the Department of Neonatal Intensive care unit of Ad-din Women’s Medical College and Hospital, Dhaka, Bangladesh.Organisms were isolated from 8.7% of collected blood samples. The male female ratio of culture proven sepsis was 1.7:1. More than half (52.8%) of the evaluated neonates were preterm. & 56.3% had low birth weight. The gram positive and gram negative bacteria accounted for 24.1% and 75.9% of the isolates respectively. Around three fourth of the neonates (75.8%) presented with early onset sepsis, while 24.2% presented with late onset sepsis. Acinetobacter was the most common pathogen both in early onset (70%) and late onset (30%) sepsis. Pseudomonas (89.4%) was the second most common pathogen in early onset sepsis. Total mortality rate was 5.7%. Pre term, low birth weight and gram negative sepsis contributes majority of mortality.Gram negative organism especially Acinetobacter found to be commonest cause of sepsis. Pseudomonas was second most common but contributed highest in late onset sepsis and neonatal death due to sepsis. DOI: http://dx.doi.org/10.3329/cbmj.v2i1.14184 Community Based Medical Journal Vol.2(1) 2013 49-54

Sepsis is a major cause of death in neonates. Knowledge about epidemiology, risk factors, causative pathogens and outcome of neonatal sepsis is important to improve neonatal care. For Germany, only few data on neonatal sepsis in very low birth weight (VLBW) infants exist. Data from 14,926 preterm infants with birth weight <1500 g and gestational age between 22 0/7 weeks and 31 6/7 collected between January 2009 and December 2017 were analyzed for frequency of early-onset sepsis (EOS) and late-onset sepsis (LOS) and for causative pathogens. Risk factors for the development of EOS and LOS and outcomes after EOS and LOS were analyzed by multivariate logistic regression models. EOS occurred in 1.1% of infants and LOS in 11.9%. Escherichia coli was the most common pathogen in EOS, coagulase-negative staphylococci in LOS. Multidrug-resistant organisms were detected in 8.4% of EOS and 3.9% of LOS cases. Risk factors for EOS were lower gestational age, intra-amniotic infection and spontaneous delivery. Risk factors for LOS were lower gestational age, small for gestational age, central lines, endotracheal ventilation and history of EOS. Both EOS and LOS were independently associated with adverse neonatal outcome. These data from a large German neonatal cohort confirm neonatal sepsis as the most common cause of morbidity and mortality in VLBW infants, as well as E. coli and coagulase-negative staphylococci as the most prevalent pathogens. Multidisciplinary approaches such as antibiotic stewardship, hygiene and feeding strategies are necessary to further reduce the burden of sepsis in VLBW infants.

Background : Sepsis neonataroum is an important factor for morbidity and mortality in neonates. The incidence of neonatal bacterial sepsis depends on geographic area and may vary from country to country as well as within the same country.Objective: To identify the percentage of neonatal septicemia confirmed by positive blood cultures among 664 neonates admitted in neonatal care unit, and to identify the bacterial agents causing early and late neonatal sepsis and their antimicrobial susceptibility, and the outcome from neonatal septicemia. Patients and methods: The total number of patients(with clinical signs and symptoms suggesting sepsis) collected from neonatal care unit of ALKadimiya Teaching hospital from the 1st of January to the end of october 2011 were 664 neonates, and only 105 neonates who show signs and symptoms suggestive of septicemia that were confirmed by a positive blood culture were enrolled in this study. Data were collected include :Gestational age, Birth weight , Gender, Onset of sepsis, Place of delivery and also we followed up the subjects and recorded the outcome till discharge.Results: In this prospective study and from 664 neonate were admitted (total number of admission), positive blood cultures were obtained for 105 neonates (15.8%). Gram negative bacteria were the commonest causative agent in both early (66.7%) and late (56.9%) onset sepsis. Among neonates with sepsis, 33 patients (31.4%) had early onset and 72 patient (68.6%) had late-onset neonatal sepsis. The susceptibility of the isolated causative agent to selected antibiotics were the same in early and late onset sepsis. Over 70% of gram negative bacilli were resistant to both ampicillin and cloxacillin but show variable sensitivity to gentamicine and cefotaxime. Most of the isolated gram positive bacteria were sensitive to ampicillin, cloxacillin and cefotaxime but highly resistant to gentamicin. The death rate was 20.9%. Early onset sepsis, male gender, gestational age less than 37 weeks and birth weight less than 2500 gm were found to be significantly associated with death.Conclusions: Gram negative bacteria were the main cause of early and lateonset neonatal sepsis in our center and many of these isolated bacteria were resistant to the used antibiotics. Low birth weight neonates &lt;2500 gm, gestational age &lt; 37weeks, male gender and early onset sepsis were significantly associated with death. The death rate due to neonatal sepsis was higher compared with the other studies.&#x0D; Recommendations: Proper antenatal care and optimal obstetric management in early detection and treatment of mothers at risks together with minimizing invasive procedures of infants as much as possible and ideal nursery setup which includes adequate space for care of infants and aseptic equipments for monitoring.

Background: Incidences and causative organisms of neonatal sepsis in the developing countries are underreported. The aim of the study was to determine the overall incidence of neonatal sepsis in very low birth weight (VLBW) infants born at one of university hospitals in Riyadh, Saudi Arabia for the period 1999 to 2007, and identify the incidences and commonest isolated pathogens in both early and late onset episodes of sepsis in this group of infants. Methods: A retrospective study of all very low birth weight (500grams to 1500 grams) infants born at King Khalid University Hospital (KKUH) in Riyadh over a 9-year period from January 1999 to December 2007 were included. Data were collected from medical records and NICU database after obtaining ethics approval. All cultures were taken (blood and/or CSF) prior to initiation of antibiotics. Only first episodes of sepsis were considered in this study. The main outcomes are total incidences of sepsis, incidence of early and late onset sepsis, and the causative pathogens for each type of sepsis. Results: 48% of included infants (225/468) had positive blood cultures. The incidence of early onset sepsis (EOS) was 10.9% and of late onset sepsis (LOS) was 37.1%. Gram positive pathogens were the commonest causative organisms in both early and late onset sepsis (74.5% and 87.4% respectively). Staphylococcus epidermis was the commonest single pathogen isolated in both groups (45% in EOS, and 63.8% in LOS). Conclusion: The rate of neonatal sepsis in VLBW infants was high (48%) with high rates of EOS as well as LOS which necessitates a high priority to prevent and control sepsis in our unit.

Neonatal Sepsis: A 6-Year Analysis in a Neonatal Care Unit in Taiwan

Clinical features and outcomes of neonatal sepsis caused by resistant Gram-negative bacteria are not well described in Jordan. The aim of the present study was therefore to describe microbiology and clinical features, laboratory findings and outcomes of early- and late-onset Gram-negative neonatal sepsis. All patients with Gram-negative bacteremia between July 2003 and June 2005 were retrospectively included. Resistance profiles, clinical features and outcomes of early and late-onset neonatal sepsis were compared. A total of 79 patients (after excluding all nine cases of Gram-positive bloodstream infection (BSI) were identified as having Gram-negative BSI (25 had early-onset and 54 had late-onset neonatal sepsis). Respiratory distress, metabolic acidosis and requirement of ventilation were found in 74.7%, 40.5%, and 58.2%, respectively. Hypotension was found in 22.9% of patients. Klebsiella pneumoniae was responsible for 43 cases (54.4.2%). Klebsiella pneumoniae resistance rates to ampicillin and ceftazidime were 100% and 50%, respectively. Mortality rate was 30.9%. Forty-eight percent of deaths occurred within 3 days of sepsis. Meningitis was diagnosed in five cases. Elevated C-reactive protein (CRP) and thrombocytopenia were seen in 28% and 24% of infants with early-onset sepsis, respectively, and in 79.6%, 59.3% of infants with late-onset sepsis respectively. Both early- and late-onset neonatal sepsis are caused by highly resistant Gram-negative bacteria. Mortality of sepsis is high. Elevated CRP and thrombocytopenia is seen more commonly in late-onset neonatal sepsis.

Background: Chorioamnionitis (CA) is a major pathological cause of preterm labor and is associated with both short- and long-term adverse outcomes in neonates, including early-onset sepsis (EOS) and late-onset sepsis (LOS). Neonatal sepsis remains a significant contributor to morbidity and mortality in neonatal intensive care units (NICUs). Aim: This study aimed to evaluate the association between maternal chorioamnionitis and the incidence of early-onset and late-onset neonatal sepsis in preterm neonates born at <32 weeks' gestation. Furthermore, the study investigated maternal and neonatal factors affecting the presentation of sepsis. Methods: A retrospective cohort study was conducted on the medical records of preterm neonates born between 2020 and 2022. Inclusion criteria were gestational age < 32 weeks, available microbiological or histological examination for chorioamnionitis, and complete maternal medical records. Infants were categorized into two groups based on the presence (CA group) or absence (non-CA group) of histological and/or microbial chorioamnionitis. Descriptive statistical analyses were performed, including calculation of frequencies and percentages for categorical variables and means with standard deviations and ranges for continuous variables. Results: A total of 189 neonates were included, with a mean birth weight of 1286 ± 405 g and a mean gestational age of 29.2 ± 2.1 weeks. The CA group consisted of 55 neonates (29.1%), while 134 (70.9%) were in the non-CA group. Early-onset sepsis (EOS) occurred in 23 neonates (12.2%), with a significantly higher incidence in the CA group compared to the non-CA group (21% vs. 8%, p = 0.014). Late-onset sepsis (LOS) developed in 66 neonates (34.9%), but no significant difference in incidence was observed between the two groups (p = 0.402). Parsimonious logistic regression analysis identified maternal chorioamnionitis as an independent predictor of EOS (Odds Ratio 2.07, 95% CI 1.85-5.08; p = 0.009). Conclusions: Intrauterine infection and inflammation caused by chorioamnionitis are linked to an increased risk of early-onset sepsis in neonates born before 32 weeks' gestation. However, chorioamnionitis does not appear to significantly influence the incidence of late-onset sepsis, which appears to be more closely associated with postnatal factors.

The spectrum of organisms causing sepsis is different in developing countries. Data on the recent trends of organisms causing sepsis are limited. This study was conducted in a tertiary care neonatal unit in Northern India. All inborn babies with blood-culture-positive sepsis from 1995 to 2006 were divided into two epochs, viz. 1995 to 1998 (epoch I) and 2001 to 2006 (epoch II). Organisms were grouped into early (<72 h) and late onset (> or =72 h) sepsis groups. The overall incidence of sepsis, the incidence of sepsis stratified by weight groups, the organism profile on different days of life, sepsis-related mortality and pathogen-specific case fatality rate were calculated and compared between the two epochs. Out of 34,362 live births during the study period, organisms were isolated in 1,491 neonates. Out of these, 89% had bacterial sepsis. The incidence of neonatal bacterial sepsis increased from epoch I to epoch II (35.8/1,000 versus 40.1/1,000 live births, P<0.05). The incidence of early onset sepsis (EOS) did not change between the epochs, but the incidence of late onset sepsis (LOS) increased from 12 to 16.5 per 1,000 live births (P<0.001). The incidence of bacterial sepsis decreased significantly in the 1,000- to 1,999-g birth weight groups. Klebsiella pneumoniae and Enterobacter aerogenes decreased, whereas Staphylococcus aureus increased in incidence during epoch II. Non-fermenting Gram-negative bacilli emerged as a newly identified pathogen during epoch II. Sepsis-associated mortality decreased from 42 to 20%. The incidence of bacterial sepsis has decreased significantly in 1,000- to 1,999-g infants, with a significant reduction in sepsis-related mortality. New organisms have emerged in recent years. The organism profile in recent years has changed, with a significant overlap of organisms causing EOS and LOS.

Introduction: Neonatal Sepsis (NS) is a major cause of morbidity and mortality worldwide, especially in developing countries like India. The role of antimicrobials is life-saving in NS. To achieve a good prognosis, early diagnosis and appropriate treatment are required. Data related to the irrational use of antimicrobials in neonates are limited. Aim: To evaluate the drug usage pattern and Adverse Drug Reactions (ADRs) of antimicrobials in NS. Materials and Methods: A prospective observational study was conducted among 350 neonates who were admitted and diagnosed with NS from January to December 2021 in the Neonatal Intensive Care Unit (NICU) of PDU Medical College and Civil Hospital, Rajkot, Gujarat, India. Demographic data such as age, sex, birth weight, and clinical data such as type of delivery, type of sepsis, culture-sensitivity status, and antimicrobials used were recorded. Suspected ADRs were reported in the pharmacovigilance database. Categorical data were analysed in percentage, whereas some clinical data were analysed with mean and median using Microsoft Office Excel-2019. Results: In the present study, 172 (49.15%) male and 178 (50.85%) female neonates were almost equally affected. The mean gestational age and birth weight were 35 ± 3.6 weeks and 2 ± 0.7 kg, respectively. Early-Onset Neonatal Sepsis (EONS) cases were more at 273 (78%) compared to Late-Onset Neonatal Sepsis (LONS). Seventeen different antimicrobials were used. The average number of antimicrobials used per case was 2.9. The Piperacillin Tazobactam was the most commonly used antimicrobial in 173 cases (49.43%) in early-onset sepsis, while Meropenem was used in 40 cases (11.43%) in late-onset sepsis. Coagulase-negative Staphylococcus was the most commonly isolated organism in 15 cases (4.2%), followed by Klebsiella Pneumoniae in 13 cases (3.7%). Twelve out of 17 antimicrobials (70.59%) were not included in the first list of essential medicines for children of India in 2011. Six ADRs were reported in the present study. Conclusion: In all admitted cases of sepsis, empirical therapy was given, but variations from standard recommendations were observed in dose and frequency. A periodic survey of antimicrobial use patterns in NS will be useful in the rational selection of empirical therapy.

Introduction: Neonatal sepsis is a major cause of mortality and morbidity in newborn. There are many factors that contribute to neonatal sepsis. The organisms responsible for early onset and late onset sepsis are different. Objective: This study was conducted to analyze the organisms responsible for early onset and late onset neonatal sepsis. Materials and Methods: A prospective hospital based study over the period of one year was conducted at neonatal intermediate care unit of Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal. Results: Organisms were isolated in 6.1% of the collected blood samples. The male female ratio of culture proven sepsis was 1.9:1. Escherichia coli were found to be the most common organism in both early onset and late onset sepsis. Staphylococcus aureus was more common in late onset sepsis than early onset sepsis.Conclusion: Escherichia coli were the most common organism in both early onset and late onset sepsis. Staphylococcal aureus was significantly more common in late onset sepsis than early onset sepsis. Key words: Bacteriological profile; early onset sepsis; late onset sepsis; neonate DOI: 10.3126/jnps.v31i1.4158J Nep Paedtr Soc 2010;31(1):1-5

Objective To analyse the pathway of infection,risk factors,clinical characteristics and pathogenic bacteria distribution of neonatal sepsis.Methods Eighty-eight neonatal with sepsis were enrooled from January 2006 to December 2011 in the First Affiliated Hospital of Lanzhou University.According to disease stage,they were divided into early-onset sepsis group and late-onset sepsis groups.Results Respiratory infections in two groups was the majority (44.7％ vs.46.0％),and there was no significant difference (P =0.906).That premature birth,low birth weight infant,amniotic fluid pollution and asphyxia were risk factors for early-onset sepsis.The most common clinical characteristics in early-onset sepsis were eating less milk(57.9％,22/38) and had fever of the late-onset sepsis(42.0％,21/50).Forty-one cases were with positive blood culture and the rate was 46.6％ (41/88),the blood culture specimens were mainly Gram-positive bacteria in two group (75.0％ (15/20),90.4％ (19/21)).The most common pathogenic bacteria were Staphylococcus aureus and Coagulase-negative staphylococci.Conclusion Premature birth,low birth weight,meconium,asphyxia are risk factors of early onset neonatal sepsis.Early-onset sepsis often shows poor feeding,and late-onset sepsis in children prone to be fever.The common pathogenic germ of early-onset and late-onset sepsis are Grampositivebacteria,Staphylococcus aureus and coagulase-negative staphylococci common.As for neonate with highrisk factors,clinical features of early pathologic examination should be performed in order to further clarify the diagnosis and taking clinical therapy. Key words: Neonatal; Sepsis; Blood culture

Background: Neonatal sepsis is a cause of mortality and long-term morbidity worldwide. Objectives: To describe longitudinal trends in the cumulative incidence of early- and late-onset sepsis (EOS and LOS), mortality, and causative organisms in a Thai Hospital before and after construction of a new neonatal intensive care unit (NICU). Methods: Review of NICU admissions with blood cultures positive for bacteria or fungi for the periods 1995 to 2002 (preconstruction) and 2004 to 2010 (postconstruction). Sepsis was categorized into EOS (within first 3 days of life) and LOS (after first 3 days of life). Results: Of 5,570 admissions, 241 (4.3%) neonates with 276 episodes of sepsis were identified. There was no difference in the rate of sepsis overall (P = 0.90), LOS (P = 0.30), or sepsis-related mortality (P = 0.61) over the two periods, but the rate of EOS increased significantly from 0.34% to 0.81% (P = 0.04). Rates of Klebsiella species and Escherichia coli sepsis increased from 13.6% to 25.6% (P = 0.01) and from 5.3% to 12.2% (P = 0.04), respectively, while rates of Staphylococcus aureus sepsis decreased from 12.9% to 4.3% (P Conclusions: Although direct causality cannot be proven, the rate of EOS and the pattern of causative organisms changed following construction of the new NICU. Building a new unit does not necessarily result in a reduction in the rate of sepsis. This data may provide a baseline for implementing evidence-based infection control strategies to prevent/reduce sepsis and improve neonatal care. Keywords: Early-onset sepsis, infant-newborn, late-onset sepsis, neonatal intensive care unit, sepsis.

Although neonatal sepsis remains a significant cause of morbidity and mortality in preterm infants, few studies in Vietnam have compared the characteristics of early-onset sepsis (EOS) and late-onset sepsis (LOS). To compare the clinical, laboratory, and microbiological characteristics of EOS and LOS in preterm neonates at a tertiary obstetric hospital in Vietnam. This cross-sectional study included 106 preterm infants with culture-confirmed sepsis admitted from August 2022 to May 2024. Clinical data, laboratory results and blood cultures were analyzed. Statistical tests and univariate logistic regression were used to explore differences between EOS and LOS. Of 106 neonates, 24 (22.6%) had EOS, and 82 (77.4%) had LOS. LOS predominated in extremely preterm, very low birth weight infants and was associated with more severe symptoms, including respiratory distress and abnormal heart rate. EOS cases were more likely to have birth weight ≥ 1500 g and maternal conditions such as intrapartum fever, genital infections, contaminated amniotic fluid and prolonged amniotic fluid leakage (> 18 h). Laboratory analysis revealed higher levels of leukopenia, platelet and cerebrospinal fluid protein in EOS, as well as elevated C-reactive protein and blood protein in LOS. Gram-negative bacteria were predominant in both groups. Escherichia coli was most common in EOS (46%), whereas Klebsiella pneumoniae predominated in LOS (38%). EOS and LOS in preterm neonates exhibit distinct patterns in perinatal factors, clinical manifestations, laboratory findings and microbiological profiles. Differentiating these two entities may aid in timely diagnosis and guide empirical treatment in settings with limited resources.

Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units