Neonatal Bloodstream Infections Research Articles

PCR identification of Enterococcus Species as a Primary Pathogen in Neonatal Bloodstream Infections at Damascus University Paediatric Hospital

Bacterial septicaemia is one of the most common causes of death in newborns throughout the globe. Recently, gram positive bacteria have been detected as a main responsible of hospital acquired blood infection in developed country especially Enterococcus sp. and Staphylococcus sp. This preliminary study aimed to identify Enterococcus species and Staphylococcus species isolated form acquired blood infection in the department of premature and neonates at paediatric university hospital in Damascus, based on PCR technology. the antibiotic sensitivity these pathogens was also investigated against common antibiotics usually used to treat septicaemia in this hospital. Bacterial gDNA was extracted directly from blood samples of children with acquired Septicemia. The bacterial infection was confirmed in 50 samples based on the amplification of 16srDNA gene. Genus Enterococcus sp. and Staphylococcus species were identified as source of infection in samples using specific primers via PCR technique. The antibiotic sensitivity of isolated bacterial strains was studied using Kirby-Bauer disc method. Our study showed that 47 of the 50 samples of the infection were bacterial. The rate of blood infection caused by Enterococcus species was 24%, and 4% for Staphylococcus sp. the isolated bacteria showed a high sensitivity to Amikacin, medium sensitivity to Vancomycin, and less sensitivity to Ampicillin and Gentamycin. Enterococcus species Showed good sensitivity to Amikacin and Vancomycin and low sensitivity to Gentamycin, while was resistant to Ampicillin. Furthermore, the two isolated stains Enterococcus sp and Staphylococcus species showed a good sensitivity against chlorhexidine. This study confirmed the importance of molecular technologies in diagnosing the acquired septicaemia and identifying the specific infectious agent. The molecular test showed that Enterococcus sp. was an important cause of acquired blood infection in neonates respect to ampicillin resistant staphylococcus species.

Hospital and Patient Characteristics Associated with Neonatal Blood Stream Infection in Inpatient Care: Insights from the 2019 HCUP KID Database.

This study explores the associations between pediatric adverse events (PAEs) and both hospital and patient characteristics within the inpatient hospital setting, specifically focusing on Neonatal Blood Stream Infection (NBSI) as defined by pediatric quality indicators (PDIs) from the Agency for Healthcare Research and Quality (AHRQ). This research aims to answer questions regarding the relationship between hospital characteristics and patient demographics with the occurrence of NBSI. This study utilized discharge data from the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Databases (KID) for the year 2019. Bivariate and multivariate logistic regression models were employed to analyze patient-level encounters of NBSIs. The analysis examined various factors including hospital size, location, and teaching status, as well as patient-specific variables such as gender, age, race, service lines, payment sources, and major operating room procedures. The results indicate that Public and Private not-for-profit hospitals showed significantly lower odds of experiencing NBSIs when compared to Private investor-owned hospitals, as did smaller, rural, and nonteaching hospitals when compared to large hospitals. Additionally, individual factors such as gender, age, race, service lines, payment sources, and types of major operating room procedures were found to have varying levels of significance in relation to NBSI. This study provides important insights into PAEs within the inpatient hospital setting, particularly focusing on NBSIs within the PDI framework. The findings highlight critical areas for the development of evidence-based interventions and guidelines, which are essential for clinicians and policymakers. Ultimately, this study contributes to the understanding and improvement of pediatric patient safety by emphasizing the necessity for targeted strategies to mitigate the risk of NBSI.

Cost-effectiveness of a new multi-lumen infusion device to reduce central-venous-line-associated bloodstream infections in neonates

A new medical device was developed for multi-infusion in neonatal intensive care units (NICUs) with the aim of addressing issues related to drug incompatibilities and central-line-associated bloodstream infections (CLABSIs). To assess the cost-effectiveness of implementing this new perfusion system in an NICU setting. This single-centre, observational study was conducted in all infants admitted to the NICU within 3 days of birth, and who required a central venous line, to evaluate the cost and effectiveness before (2019) and after (2020) implementation of the new perfusion system. Costs were calculated from the hospital perspective, and the incidence of CLABSIs was examined over a time horizon from NICU admission to discharge. Resource utilization was measured (infusion device, infection-treating drugs and biological analyses), and corresponding costs were valued using tariffs for 2019. The incremental cost-effectiveness ratio (ICER) was calculated, expressed as Euros per CLABSI avoided, and one-way and multi-variate sensitivity analyses were conducted. Among 609 infants selected, clinical characteristics were similar across both periods. The CLABSI rate decreased significantly (rate ratio 0.22, 95% confidence interval 0.07-0.56), and total costs reduced from €65,666 to €63,932 per 1000 catheter-days (P<0.001) after implementation of the new perfusion system, giving an ICER of €251 saved per CLABSI avoided. The majority of sensitivity analyses showed that the new intervention remained economically dominant. This single-centre study showed a significant decrease in the incidence of CLABSIs after implementation of the new perfusion system, without incurring additional costs. Further prospective multi-centre randomized studies are needed to confirm these results in other NICUs.

Antibiogram and ESBL Production Among Neonatal Blood Stream Infections in Intensive Care Units of Selected Hospitals in Delta State, Nigeria

Antibiogram and ESBL Production Among Neonatal Blood Stream Infections in Intensive Care Units of Selected Hospitals in Delta State, Nigeria

Diagnostic value of procalcitonin and hemocyte parameters in neonates with bloodstream infection: Role of activated hemocyte‐related genes

AbstractThis study aimed to evaluate the diagnostic potential of hemocyte parameters and procalcitonin (PCT) in detecting bloodstream infections (BSI) in neonates and explore the contribution of hemocyte activation‐related genes to pediatric sepsis through bioinformatics analysis. A cohort of 419 neonates, categorized as BSI (positive blood culture) and control, underwent comparative analysis of PCT and hemocyte parameters. A predictive model for neonatal BSI was established, demonstrating an impressive area under the receiver ROC curve of 0.968 with remarkable sensitivity (92%) and specificity (87.3%). Hemocyte parameters, including lymphocyte and neutrophil percentages, platelet distribution width (PDW), platelet to lymphocyte ratio (PLR), and PCT, emerged as independent predictors of neonatal BSI. Furthermore, bioinformatics analysis utilizing Gene Expression Omnibus (GEO) datasets yielded significant insights. Differential gene expression (DEGs), gene ontology (GO), pathway enrichment, gene set enrichment analysis (GSEA), and protein–protein interaction (PPI) networks were explored. The differentially expressed genes and hub genes were notably enriched in the activation of neutrophils, lymphocytes, and platelets. Notably, elevated expression levels of SPI1, TYROBP, and FCER1G were observed in pediatric sepsis or septic shock, with positive correlations between SPI1, FCER1G, and TYROBP. In summary, the combination of lymphocyte, PDW, PLR, and PCT effectively diagnosed neonatal BSI. Bioinformatics analysis underscored the pivotal role of activated hemocytes in diagnosing pediatric sepsis, with SPI1, TYROBP, and FCER1G co‐expression influencing the disease's pathophysiology by modulating neutrophil and platelet activity.

The overlap of accessory virulence factors and multidrug resistance among clinical and surveillance Klebsiella pneumoniae isolates from a neonatal intensive care unit in Nepal: a single-centre experience in a resource-limited setting

BackgroundThere is a lack of data on the characteristics of overlap between acquired antimicrobial resistance and virulence factors in Klebsiella pneumoniae in high-risk settings, especially with the inclusion of surveillance isolates along with the clinical. We investigated K. pneumoniae isolates, from a neonatal intensive care unit (NICU) in Nepal, for the presence of both accessory virulence factors and acquired antimicrobial resistance.MethodsThirty-eight clinical and nineteen surveillance K. pneumoniae isolates obtained between January 2017 and August 2022 in the NICU of Siddhi Memorial Hospital, Bhaktapur, Nepal were investigated with antimicrobial susceptibility testing, PCR-based detection of β-lactamases and virulence factors, and genetic similarity by ERIC–PCR.ResultsK. pneumoniae was found positive in 37/85 (43.5%) blood culture-positive neonatal bloodstream infections, 34/954 (3.6%) patient surveillance cultures, and 15/451 (3.3%) environmental surveillance samples. Among 57 isolates analyzed in this study, we detected multidrug resistance in 37/57 (64.9%), which was combined with at least one accessory virulence factor in 21/37 (56.8%). This overlap was mostly among β-lactamase producing isolates with accessory mechanisms of iron acquisition. These isolates displayed heterogenous ERIC–PCR patterns suggesting genetic diversity.ConclusionsThe clinical significance of this overlap between acquired antimicrobial resistance and accessory virulence genes in K. pneumoniae needs further investigation. Better resource allocation is necessary to strengthen infection prevention and control interventions in resource-limited settings.

A decade of neonatal sepsis in Stockholm, Sweden: Gram-positive pathogens were four times as common as Gram-negatives

PurposeTo assess Gram-positive bacterial (GPB) bloodstream infection (BSI) in neonates, covering incidence, morbidity, mortality, antimicrobial resistance patterns and biomarkers in Region Stockholm, Sweden between 2006 and 2016.MethodsA population-based retrospective epidemiological study including infants with GPB-BSI, admitted to the neonatal units at Karolinska University Hospital (KUH). Data were collected from patient records, the Swedish Neonatal Quality Register, the microbiological laboratory at KUH and the Swedish Public Health Agency.ResultsWe identified 357 infants with GPB-BSI, representing an incidence of 1.47/1000 live births (LB). Group B streptococcus (GBS) was the most common pathogen causing BSI in full-term infants and early-onset sepsis (EOS) (0.20/1000 LB), while coagulase-negative staphylococci (CoNS) were predominant in infants born very preterm and in late-onset sepsis (LOS) (0.79/1000 LB). There were no fatal GBS BSI cases, but 10.2% developed meningitis. The GPB case fatality rate was 9.5% and the sepsis fatality rate 2.8%. In GPB-BSI, 1/10 did not have an elevated C-reactive protein level. Staphylococcus aureus (S. aureus) BSI increased during the study period, but no methicillin or vancomycin resistant strains were found. The antimicrobial resistance (AMR) rate was highest in CoNS isolates.ConclusionGPB-BSI was four times more common than Gram-negative BSI in neonates but resulted in lower mortality rate. GBS was the most common pathogen in full-term infants and in EOS. CoNS was the most common pathogen in LOS and infants born very preterm, and the AMR rate was high in these isolates. The increasing trend of S. aureus BSI indicates a need of further investigation.

Analysis and risk factors of deep vein catheterization-related bloodstream infections in neonates.

To investigate the incidence, risk factors, and pathogenic characteristics of catheter-related bloodstream infection caused by peripherally inserted central venous catheter in neonates, and to provide references for reducing the infection rate of peripherally inserted central venous catheter. The clinical data of 680 neonates who underwent peripherally inserted central catheter (PICC) in the neonatal intensive care unit from June 2020 to June 2023 were retrospectively analyzed. The risk factors and independent risk factors of catheter-related bloodstream infection caused by PICC were determined by univariate and multivariate analysis, respectively. Catheter-related bloodstream infection occurred in 38 of 680 neonates who underwent PICC. The infection rate was 4.74%. The proportions of fungi, gram-positive bacteria, and gram-negative bacteria were 42.11%, 36.84%, and 21.05%, respectively. Candida parapsilosis was the main fungus (18.42%), coagulase negative Staphylococcus was the main gram-positive bacteria (23.68%), and Klebsiella pneumoniae and Escherichia coli were the main gram-negative bacteria (7.89%). Univariate analysis showed that gestational age ≤32 weeks, birth weight ≤1500 g, congenital diseases, nutritional support, catheterization time, 5-minute APGAR score ≤7, and neonatal respiratory distress syndrome were associated with catheter-related bloodstream infection caused by PICC. Multivariate analysis showed that premature delivery, low birth weight, parenteral nutrition, long catheterization time, and 5-minute APGAR score ≤7 were associated with catheter-related bloodstream infection caused by PICC. Among the pathogens detected, there were 6 cases of K pneumoniae, 5 cases of coagulase negative staphylococci, and 2 cases of fungi. Low birth weight, premature delivery, off-site nutrition, long catheterization time, and 5-minute APGAR score ≤7 are independent risk factors for catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters. The pathogenic bacteria are fungi and multidrug-resistant bacteria.

Clinical characteristics and risk factors for neonatal bloodstream infection due to carbapenem-resistant Enterobacteriaceae: A single-centre Chinese retrospective study

ObjectivesTo analyse the clinical characteristics and risk factors for bloodstream infections (BSIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) in neonates. MethodsThis single-centre, retrospective study included all patients with BSIs admitted to a neonatal intensive care unit between 1 January 2015 and 30 April 2022. The clinical and microbiological data of patients were collected; predictors of 30-day mortality in patients with CRE BSIs were also identified in this study. ResultsAmong the 224 neonates with Enterobacteriaceae BSIs, 39.29% (88/224) of the patients developed CRE BSIs. The 30-day mortality rate reached up to 21.59% (19/88). The Quick Sequential Organ Failure Assessment score > 2 (odds ratio [OR] and 95% credibility interval [CI]: 3.852 [1.111–13.356], P < 0.05), prior to more than two kinds of antibiotics use (OR and 95% CI: 9.433 [1.562–56.973], P < 0.05), pneumonia (OR and 95% CI: 3.847 [1.133–13.061], P < 0.05), and caesarean section (OR and 95% CI: 2.678 [1.225–5.857], P < 0.05) were independent risk factors associated with CRE BSIs. Moreover, the risk factors for mortality in neonates with CRE BSIs were significantly associated with neonatal Sequential Organ Failure Assessment score > 6 (OR and 95% CI: 16.335 [1.446–184.517], P < 0.05). ConclusionPrior to more than two kinds of antibiotics use, Quick Sequential Organ Failure Assessment score > 2, pneumonia and caesarean section were independent risk factors for CRE BSIs. The Neonatal Sequential Organ Failure Assessment score > 6 was a risk factor for mortality associated with CRE BSIs.

Disparities in Racial, Ethnic, and Payer Groups for Pediatric Safety Events in US Hospitals.

Health care disparities are pervasive, but little is known about disparities in pediatric safety. We analyzed a national sample of hospitalizations to identify disparities in safety events. In this population-based, retrospective cohort study of the 2019 Kids' Inpatient Database, independent variables were race, ethnicity, and payer. Outcomes were Agency for Healthcare Research and Quality pediatric safety indicators (PDIs). Risk-adjusted odds ratios were calculated using white and private payer reference groups. Differences by payer were evaluated by stratifying race and ethnicity. Race and ethnicity of the 5 243 750 discharged patients were white, 46%; Hispanic, 19%; Black, 15%; missing, 8%; other race/multiracial, 7%, Asian American/Pacific Islander, 5%; and Native American, 1%. PDI rates (per 10 000 discharges) were 331.4 for neonatal blood stream infection, 267.5 for postoperative respiratory failure, 114.9 for postoperative sepsis, 29.5 for postoperative hemorrhage/hematoma, 5.6 for central-line blood stream infection, 3.5 for accidental puncture/laceration, and 0.7 for iatrogenic pneumothorax. Compared with white patients, Black and Hispanic patients had significantly greater odds in 5 of 7 PDIs; the largest disparities occurred in postoperative sepsis (adjusted odds ratio, 1.55 [1.38-1.73]) for Black patients and postoperative respiratory failure (adjusted odds ratio, 1.34 [1.21-1.49]) for Hispanic patients. Compared with privately insured patients, Medicaid-covered patients had significantly greater odds in 4 of 7 PDIs; the largest disparity occurred in postoperative sepsis (adjusted odds ratios, 1.45 [1.33-1.59]). Stratified analyses demonstrated persistent disparities by race and ethnicity, even among privately insured children. Disparities in safety events were identified for Black and Hispanic children, indicating a need for targeted interventions to improve patient safety in the hospital.

Neonatal Gut Microbiome Composition and Gut-Derived Bloodstream Infections in a Cohort of Premature Singaporean Infants

Abstract Background Due to their gestational age, low birth weight, and immature gut barriers, premature neonates are at high risk of bloodstream infections (BSI) caused by bacteria that reside in the gastrointestinal tract. Relatively little is known about the effect of alterations to the gut microbiota on the risk of BSI in premature neonates. Methods This prospective cohort study was conducted in the neonatal intensive care unit in the KK Women’s and Children’s Hospital in Singapore between June 1, 2019 and May 31, 2021. Clinical data and twice weekly fecal samples were collected during the first 75 days of life from infants born at or below 30 weeks gestational age. All infants received a Bifidobacterium breve probiotic starting at median (interquartile range [IQR]) day of life (DOL) 2 (1, 3). Fecal samples underwent shotgun metagenomic sequencing, and the resulting reads were aligned to Kraken 2 for taxonomic classification. We utilized permutational multivariate analysis of variance (PERMANOVA) and mixed effects linear regression to evaluate associations between clinical factors and gut microbiota composition. We described gut microbiota alterations among a subset of infants who developed a BSI. Results We collected 581 fecal samples from 75 neonates. Median (IQR) gestational age was 27 (25, 29) weeks and birthweight was 955 (763, 1210) grams. There were 18 BSIs that occurred among these infants and were caused by Streptococcus agalactiae (n=5), Klebsiella pneumoniae (n=3), Escherichia coli (n=2), Staphylococcus aureus (n=2), Staphylococcus epidermidis (n=2), Proteus mirabilis (n=1), Acinetobacter baumannii (n=1), Streptococcus anginosus (n=1), and Streptococcus pasteurianus (n=1). Metagenomic sequencing generated a median (IQR) sequencing depth of 5.9M (4.4M, 34.9M) paired-end reads per sample. The clinical factors that accounted for the most variance in gut microbiota composition were DOL (PERMANOVA; R2=0.022, p=0.001), feeding modality (R2=0.020, p=0.001), and antibiotic exposure (R2=0.018, p=0.001). Probiotic exposure was associated with an increase in the probiotic species, B. breve, and also a decrease in the relative abundances of several Clostridia species. Broad spectrum antibiotic exposures were associated with lower relative abundances of both potential pathogens, e.g., bacteria from the genera Enterobacter, Klebsiella, and Enterococcus, and beneficial bacteria, e.g., Bifidobacteria species, including the probiotic species. Notably, metronidazole and carbapenem exposures were associated with an increase in Staphylococcus species. Of 18 neonates who developed BSI, the causative species was detected in the gut microbiota of 17 infants. The relative abundance of the BSI species was ≥50% immediately prior to or at the time of BSI in 9 (50%) infants (Figure). Interestingly, four (22%) infants had a continued high abundance of the BSI species in the gut microbiota despite definitive antibiotic therapy. Conclusion Several clinical factors contribute to the gut microbiota composition of premature Singaporean neonates, especially postnatal age, feeding modality, and antibiotic exposures. Broad-spectrum antibiotic exposures affected the relative abundance of the probiotic agent and were associated with increases in staphylococcal species known to be potentially pathogenic in neonates. If detected in the gut microbiota, the bacteria that caused the BSI was often present in significant relative abundances both before and after the BSI. Figure. Relative abundances of bacterial species in the gut microbiota before and after bloodstream infections (BSI) in a subset of premature neonates. The relative abundances of the BSI species are plotted in color, whereas relative abundances of other detected species are depicted in gray. Each darkened vertical bar corresponds to a single fecal sample. Shading between each bar is provided to visualize changes in relative abundance between fecal samples. Black vertical lines depict the day of BSI. Specific antibiotic exposures are shown in the colored horizontal bars atop each subject’s time-series plot.

Neonatal Hospital-Acquired Bloodstream Infection in a Single-Centre in Malaysia: Clinical Presentations, Pathogens and Immediate Outcome

Objectives: To determine the epidemiology, clinical characteristics, pathogen, and outcome of hospital-acquired bloodstream infection (HABSI). Methods: This observational, retrospective cohort study of neonates with HABSI between 2013 and 2019 was retrieved from the Infection Surveillance System. The main outcome measure was mortality. Binary logistic regression was used to identify risk factors associated with mortality. Results: There were 278 neonates (27% &lt; 1000gm birth weight and 26% &lt; 29 weeks gestation) with 316 episodes of HABSI documented. The overall incidence of HABSI was 3.79 (95% CI: 3.35 to 4.24) per 1000 admissions and 1.9 per 1000 patients. HABSI was diagnosed at 18.5 days (IQR 11, 36) of hospitalization and 38% presented with severe signs and symptoms of sepsis. The most common pathogens were Klebsiella pneumoniae (29.4%), followed by coagulase-negative staphylococcus (13.9%) and Acinetobacter baumannii (10.1%). Multidrug-resistant (MDR) organisms were noted in 173 (54.7%) with a significant increase over time of extended-spectrum beta-lactamase-producing organisms. Gram-negative resistance to carbapenem was noted in 45% and associated with high mortality. The overall mortality was 25.5% (95% CI:19.6 to 31.5) with no significant changes over time. HABSI due to gram-negative, presented with severe sepsis and prolonged ventilation were associated with poor outcomes. Conclusion: Multidrug resistance is rising and has high mortality in our centre. Factors associated with high mortality were gram-negative organisms, severe sepsis, and prolonged ventilation. Hence, infection and prevention control programs need to be enhanced.

Use of 2% taurolidine lock solution for treatment and prevention of catheter-related bloodstream infections in neonates: a feasibility study

Taurolidine lock, a technique used to prevent or treat catheter-related bloodstream infection (CRBSI), is effective in adult and paediatric patients but has been described rarely in neonates. The aim of this descriptive retrospective study, was to determine the feasibility and direct outcomes of prophylactic and therapeutic taurolidine locks in term and preterm neonates. We implemented the use of therapeutic taurolidine lock in addition to antibiotic treatment with the aim of catheter salvage in critical neonates with difficult vascular access (group 1). In addition, we introduced taurolidine lock as a preventive measure in neonates with a central venous catheter (CVC) at high risk of developing CRBSI (group 2). Every 24h (in the treatment group) a 2% taurolidine solution was injected and the catheter locked for at least 120min, until infection clearance (group 1). In the preventive group, the catheter was locked for 30min every 48h until CVC removal (group 2). Thirty-seven neonates who received taurolidine were included in this study. We did not observe any major adverse events. In group 1 (21 cases), clinical symptom disappearance and bacteraemia clearance were achieved without catheter removal in 18 cases (85.7%); in the other three neonates the catheter was removed shortly after the start of the locks as it was possible to replace the CVC. In group 2 (16 neonates), no CRBSI was observed during the duration of the catheter placement. In this retrospective study, taurolidine was successfully used in neonates both for prevention and treatment of CRBSI, without major undesired effects. A larger cohort and a randomized clinical trial is warranted in order to establish its efficacy and safety in neonates.

Capability and feasibility of the Global Alignment of Immunisation Safety Assessment in pregnancy criteria for the assessment of pregnancy and birth outcomes in Kinshasa, Democratic Republic of the Congo: a prospective cohort study

IntroductionThere is an urgent need to investigate the capabilities of active surveillance in strengthening the development of pharmacovigilance (PV) systems in low-resource settings. Here, we assess the capability and feasibility...

Invasive Malassezia Infections.

The Malassezia species are dimorphic fungi that require lipids such as olive oil for their growth. They are constituents of the normal human skin microbiota and can affix to the host or other surfaces through the establishment of biofilms. Malassezia species are accountable for superficial mycoses like folliculitis. Additionally, they are capable of causing invasive infections, such as of the bloodstream, in neonates and immunocompromised patients, albeit infrequently. Catheter-associated bloodstream infections in neonates are the most commonly reported invasive cases. Remarkably, unlike other invasive fungal infections, neutropenia and the use of broad-spectrum antibiotics do not seem to contribute to the risk of invasive Malassezia infections. Nosocomial outbreaks of Malassezia infections have been reported. While most cases of invasive Malassezia infection are fungemia, they seldom give rise to disseminated lesions in various organs. The diagnosis can be confirmed by the visualization of characteristic yeasts through histologic or cytologic examination of a biopsy or needle aspiration specimen, or via positive culture results from sterile sites. The prognosis for invasive Malassezia infection is generally favorable, with few reports of treatment failure. Nevertheless, due to the limited number of cases, evidence-based treatment recommendations are wanting. Management of invasive Malassezia infections linked to central venous catheters includes removal of the catheter, cessation of intravenous lipid emulsion, and intravenous administration of appropriate antifungal agents.

A new perfusion system to reduce the burden of central-venous-line-associated bloodstream infections in neonates

Central-venous-line-associated bloodstream infection (CLABSI) is a significant cause of morbidity and mortality in preterm infants. As there is large variation in the reported effect of multi-modal preventive strategies, it could be relevant to propose new additional strategies. To assess the impact of a new perfusion system on CLABSI rate. A before-and-after study was performed in infants born at <32 weeks of gestation or with birth weight <1500g who required a multi-perfusion system connected to a central venous line. In the first 12-month period ('before'), the pre-existing perfusion system (multiple stopcocks) was used. An intervention period then occurred with implementation of a new perfusion closed system, without change in 'bundles' related to various aspects of central line care. During the second 12-month period ('after'), the CLABSI rate was assessed and compared with the pre-intervention period. In total, 313 infants were included in this study (before: N=163; after: N=150), and 46% had birth weight <1000g. The change in perfusion system resulted in a significant decrease in CLABSI rate from 11.3 to 2.2 per 1000 catheter-days (P<0.001). The period was independently associated with an 88% reduction in the risk of CLABSI after implementation of the new perfusion system [odds ratio (OR) 0.12, 95% confidence interval (CI) 0.03-0.39; P<0.001]. The duration of central line use was also associated with CLABSIs (for each additional day: OR 1.05, 95% CI 1.02-1.07; P<0.001). Implementation of the new perfusion system was feasible in a large neonatal unit, and reduced the CLABSI rate soon after implementation.

Bloodstream infections in neonates with central venous catheters in three tertiary neonatal intensive care units in Pune, India.

Neonates admitted to the neonatal intensive care unit (NICU) are at risk for healthcare-associated infections, including central line-associated bloodstream infections. We aimed to characterize the epidemiology of bloodstream infections among neonates with central venous catheters admitted to three Indian NICUs. We conducted a prospective cohort study in three tertiary NICUs, from May 1, 2017 until July 31, 2019. All neonates admitted to the NICU were enrolled and followed until discharge, transfer, or death. Cases were defined as positive blood cultures in neonates with a central venous catheter in place for greater than 2 days or within 2 days of catheter removal. During the study period, 140 bloodstream infections were identified in 131 neonates with a central venous catheter. The bloodstream infection rate was 11.9 per 1000 central line-days. Gram-negative organisms predominated, with 38.6% of cases caused by Klebsiella spp. and 14.9% by Acinetobacter spp. Antimicrobial resistance was prevalent among Gram-negative isolates, with 86.9% resistant to third- or fourth-generation cephalosporins, 63.1% to aminoglycosides, 61.9% to fluoroquinolones, and 42.0% to carbapenems. Mortality and length of stay were greater in neonates with bloodstream infection than in neonates without bloodstream infection (unadjusted analysis, p < 0.001). We report a high bloodstream infection rate among neonates with central venous catheters admitted to three tertiary care NICUs in India. Action to improve infection prevention and control practices in the NICU is needed to reduce the morbidity and mortality associated with BSI in this high-risk population.

A rare case of Elizabethkingia meningoseptica infection in a neonate

Background: Elizabethkingia infections were reportedly rare, but if it was found, it had been known to cause neonatal meningitis, bloodstream infections and respiratory infections. Elizabethkingia meningoseptica had a unique antibiotic susceptibility pattern, usually resistant to most antibiotics. Elizabethkingia infections were associated with a high mortality rate because of the lack of effective therapeutic regimens, antibiotic resistance and virulence. Case Presentation: Fourteen days old boy patient came with the chief complaint of seizure, which occurred twice. Before the seizure, the patient had a fever with the highest temperature was 39°C. The patient looked lethargic, tended to sleep more often, cried occasionally and was not as active as previously. Septic marker revealed an Immature to Total neutrophil (IT) ratio of 0.2 and C-Reactive Protein (CRP) 49.30 mg/dL. A blood smear examination showed toxic granules, vacuolization of the leucocyte and reactive thrombocytosis. Cerebrospinal fluid analysis revealed a cell number of 2520 cell/uL, polymorphonuclear (PMN) cell 80%, mononuclear (MN) cell 20%, Nonne and Pandy was positive, protein level at 300 mg/dL and cerebrospinal fluid glucose level below 20 mg/dL. The patient was initially diagnosed with sepsis and meningitis and was given ampicillin and gentamicin. Blood and cerebrospinal fluid culture isolated Elizabethkingia meningoseptica and significantly as the infection-causing agent. The antibiotic sensitivity of the blood culture was ciprofloxacin and levofloxacin. The antibiotic sensitivity of the cerebrospinal fluid culture was levofloxacin. During the treatment, there were several inappropriate results between clinical manifestation and laboratory results; the antibiotic was changed to levofloxacin according to the sensitivity of the blood and cerebrospinal fluid culture. Conclusion: Elizabethkingia meningoseptica was a rare case, and the nature of this bacteria was resistant to multiple antibiotics. Treatment should be considered carefully.

Vaccine safety surveillance in Kenya using GAIA standards: A feasibility assessment of existing national and subnational research and program systems

BackgroundActive surveillance systems for monitoring vaccine safety among pregnant women address some of the limitations of a current passive surveillance approach utilized in low- and middle-income countries (LMIC). However, few active surveillance systems in LMIC exist.Our study assessed the feasibility of utilizing three existing data collection systems in Kenya for active surveillance of maternal immunization and to assess the applicability of Global Alignment of Immunization Safety Assessment in pregnancy (GAIA) case definitions that were initially developed for clinical trials within these systems. MethodsWe assessed applicability of GAIA case definition for maternal Tetanus Toxoid exposure, stillbirth, low birth weight, small for gestational age, Neonatal Invasive Blood Stream Infection (NIBSI), prematurity and neonatal death in two routine web-based health information systems (Kenya EMR and DHIS-2), and a web-based population-based pregnancy research platform (ANCOV11Antenatal, Intrapartum and Postnatal care COVID-19 Surveillance Study (ANCOV).) in Kenya. ResultsAll three HIS were capable of reporting selected outcomes to varying degrees of GAIA certainty. The ANCOV platform was the most robust in collecting and collating clinical data for effective maternal pharmacovigilance. The utilization of facility- and district-aggregated data limits the usefulness of DHIS-2 in pharmacovigilance as currently operationalized. While the Kenya EMR contained individual level data and meets the key considerations for effective pharmacovigilance, it was used primarily for HIV care and treatment records in a small proportion of health facilities and would require additional resources to expand to all antenatal care facilities and to link maternal and infant records. DiscussionPopulation-based research studies may offer a responsive short-term option for implementing maternal vaccine pharmacovigilance in LMICs. However, the foundation exists for long-term capacity building within the national health electronic data systems to provide this critical service as well as ensure participation of the country in international studies on maternal vaccine safety.

Maternal Colonization Versus Nosocomial Transmission as the Source of Drug-Resistant Bloodstream Infection in an Indian Neonatal Intensive Care Unit: A Prospective Cohort Study.

Drug-resistant gram-negative (GN) pathogens are a common cause of neonatal sepsis in low- and middle-income countries. Identifying GN transmission patterns is vital to inform preventive efforts. We conducted a prospective cohort study, 12 October 2018 to 31 October 2019 to describe the association of maternal and environmental GN colonization with bloodstream infection (BSI) among neonates admitted to a neonatal intensive care unit (NICU) in Western India. We assessed rectal and vaginal colonization in pregnant women presenting for delivery and colonization in neonates and the environment using culture-based methods. We also collected data on BSI for all NICU patients, including neonates born to unenrolled mothers. Organism identification, antibiotic susceptibility testing, and next-generation sequencing (NGS) were performed to compare BSI and related colonization isolates. Among 952 enrolled women who delivered, 257 neonates required NICU admission, and 24 (9.3%) developed BSI. Among mothers of neonates with GN BSI (n = 21), 10 (47.7%) had rectal, 5 (23.8%) had vaginal, and 10 (47.7%) had no colonization with resistant GN organisms. No maternal isolates matched the species and resistance pattern of associated neonatal BSI isolates. Thirty GN BSI were observed among neonates born to unenrolled mothers. Among 37 of 51 BSI with available NGS data, 21 (57%) showed a single nucleotide polymorphism distance of ≤5 to another BSI isolate. Prospective assessment of maternal GN colonization did not demonstrate linkage to neonatal BSI. Organism-relatedness among neonates with BSI suggests nosocomial spread, highlighting the importance of NICU infection prevention and control practices to reduce GN BSI.