Cases Of Septicemia Research Articles

Comparative study of hemostatic profile between conventional methods and “Sonoclot Coagulation and Platelet Function Analyzer” in patients with septicemia

Abstract: BACKGROUND: Sonoclot Coagulation and Platelet Functional Analyzer (Sonoclot) operating on the principle of micro-viscometry is known to provide comprehensive information on the entire hemostatic process. We hypothesized that performing global hemostasis assessment in patients with sepsis would identify many more patients with altered hemostasis than the conventional tests. OBJECTIVES: We compared the hemostatic status determined by Sonoclot and that by conventional hemostatic tests. METHODS: It was a prospective analytical study conducted for 18 months in a tertiary care hospital. Sixty-one cases of septicemia admitted in the intensive care units were included in the study. RESULTS: Conventional hemostatic tests (platelet count, prothrombin time [PT], international normalized ratio, and activated partial thromboplastin time [APTT]) were compared with the Sonoclot parameters. Conventional hemostatic parameter PT was prolonged in 60.7% and APTT in 31.1%. Overall, 65.6% of the patients had prolonged coagulation on assessment by conventional hemostatic parameters. Sonoclot-derived parameter-activated clotting time was prolonged in 31.1%, indicating 31.1% of cases to have a hypocoagulable state. The clot rate was increased in 93.4% of subjects, indicating 93.4% to have a hypercoagulable state. Thrombocytopenia was seen in 34.4% and thrombocytosis in 10%. Defective platelet function was observed in 92% of the cases in Sonoclot, and all of them had normal platelet counts. This finding was statistically significant. CONCLUSION: Information about hemostatic status identified by Sonoclot is significantly higher and more complete than that identified by conventional coagulation tests in septicemic patients.

Aerobic Bacteria and Their Antibiotic Resistance Profile in Neonatal Septicaemia: A cross Sectional Study in a Tertiary Care Hospital of Rajshahi, Bangladesh

Objective: Neonatal sepsis is an infection of the bloodstream in infants younger than 28 days old. It continues to be the major cause of morbidity and mortality among newborns, particularly in middle- and low-income nations. The objective of this study was to isolate and identify aerobic bacteria of neonatal sepsis by blood culture using FAN method followed by subculture and relevant biochemical tests. Methods: It was a cross sectional type of descriptive study where the sample size was 95 and data were collected purposively from the clinically suspected neonatal septicaemia cases from inpatient Pediatric department in Rajshahi Medical College Hospital, Rajshahi. Results: Most 34 (35.79%) of the cases were culture positive, whereas 61 (64%) were culture negative. 7 (21%) of the 34 positive cases were Gram-positive, while 27 (79%) were Gram-negative. S. aureus was found in 6 (17.65%) of the culture-positive isolates, followed by CoNS with 1 (02.94%), E. coli with 14 (41.17%), Klebsiella spp. with 6 (17.65%), P. aeruginosa with 6 (17.65%), and Acinetobacter with 1 (02.94%). Gram-positive bacteria were extremely susceptible to Vancomycin (90%), Gentamicin (90%), and Ciprofloxacin (80%) based on antibacterial susceptibility testing. Colistin (100%) and ampicillin (100%) exhibited the greatest resistance. Meropenem (90%), Amikacin (90%), and Colistin (89%) were the most effective antibiotics against Gram-negative bacteria, whereas Ceftazidime (60%) was the least effective. Vancomycin (100%) and ampicillin (100%) exhibited the highest degree of resistance. Conclusion: Both Gram-positive and Gram-negative aerobic bacteria were related with newborn septicaemia, and a significant proportion of them were resistant to multiple medicines. CME J 2024; 3(2); 4-11

The value of IL-6, PCT, qSOFA, NEWS, and SIRS to predict septic shock after Percutaneous nephrolithotomy

BackgroundThere are numerous methods available for predicting sepsis following Percutaneous Nephrolithotomy. This study aims to compare the predictive value of Quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SISR), National Early Warning Score (NEWS), interleukin-6 (IL-6), and procalcitonin (PCT) for septicemia.MethodsPatients who underwent percutaneous nephrolithotomy were included in the study and divided into a control group and a septic shock group. The effectiveness of qSOFA, SIRS, NEWS, Interleukin-6, and Procalcitonin was assessed, with Receiver Operating Characteristic curves and Area Under the Curve used to compare the predictive accuracy of these four indicators.ResultsAmong the 401 patients, 16 cases (3.99%) developed septic shock. Females, elderly individuals, and patients with positive urine culture and positive nitrite in urine were found to be more susceptible to septic shock. PCT, IL-6, SIRS, NEWS, qSOFA, and surgical time were identified as independent risk factors for septic shock. The cutoff values are as follows: qSOFA score > 0.50, SIRS score > 2.50, NEWS score > 2.50, and IL-6 > 264.00 pg/ml. Among the 29 patients identified by IL-6 as having sepsis, 16 were confirmed to have developed sepsis. The qSOFA identified 63 septicemia cases, with 16 confirmed to have developed septicemia; NEWS identified 122 septicemia cases, of which 14 cases actually developed septicemia; SIRS identified 128 septicemia patients, with 16 confirmed to have developed septicemia. In terms of predictive ability, IL-6 (AUC 0.993, 95% CI 0.985 ~ 1) demonstrated a higher predictive accuracy compared to qSOFA (AUC 0.952, 95% CI 0.928 ~ 0.977), NEWS (AUC 0.824, 95% CI 0.720 ~ 0.929) and SIRS (AUC 0.928, 95% CI 0.888 ~ 0.969).ConclusionsIL-6 has higher accuracy in predicting septic shock after PCNL compared to qSOFA, SIRS, and NEWS.

Salmonellosis in Poland in 2021.

The aim of the article is to present and assess the epidemiological situation of salmonellosis in Poland in 2021, in relation to previous years. The assessment of the epidemiological situation of salmonellosis in Poland was made on the basis of individual data on salmonellosis cases, entered by sanitary-epidemiological stations into the EpiBaza System, data on outbreaks caused by Salmonella bacilli from the Registry of Epidemic Outbreaks System (ROE), as well as on the basis of aggregated data published in the annual bulletins "Infectious Diseases and Poisoning in Poland" (NIPH NIH - NRI, GIS, Warsaw), including information sent by laboratories of sanitary-epidemiological stations, data from the article on the epidemiological situation of salmonellosis in Poland in 2020 and data from the Demographic Research Department of the Central Statistical Office. In 2021, in Poland sanitary-epidemiological stations registered 8,294 cases of salmonellosis - 8,014 cases of intestinal salmonellosis and 280 extra-intestinal salmonellosis, including 190 cases of salmonellosis septicemia. The incidence rate for total salmonellosis was 21.7/100,000 population, for intestinal salmonellosis 21.0, for salmonellosis septicemia 0.50, and 0.23 per 100,000 population for other extra-intestinal infections of salmonellosis etiology. The reported 7,988 cases were classified as confirmed and 306 as probable. There were 5,127 hospitalizations due to salmonellosis, mainly children and the elderly. The peak of the incidence was registered in July. The highest incidence rate of salmonellosis in 2021 was recorded in the Podkarpackie voivodeship (39.8/100,000 population), the lowest in the Świętokrzyskie voivodeship (10.7/100,000 population). The highest incidence of intestinal salmonellosis was registered in the age group 0-4 years, accounting for 44.2% of the total number of cases. Among extra-intestinal infections, almost 62% of cases occurred in people aged 60+. In 2021, sanitary-epidemiological stations were detected and reported 229 outbreaks of food poisoning caused by Salmonella bacilli, 75% of them was Enteritidis serotype. In 2021, the most frequently isolated serotypes were S. Enteritidis 72%, S. Typhimurium (2%) and S. Infantis (0.5%). The serotype was not determined in 24.3% of cases. There were 24 imported cases of salmonellosis from different regions of the world. Due to Salmonella infection 11 people died in 2021. Laboratories of sanitary-epidemiological stations performed 438,183 tests for the presence of Salmonella and Shigella bacilli among humans, 92% of these tests concerned people working in contact with food. In 2021, there was an increase in the number of salmonellosis cases in Poland, compared to 2020. It can therefore be concluded that the COVID-19 pandemic did not have a long-term impact on reducing the number of Salmonella infections. At the same time, despite the increase, the situation of salmonellosis in Poland has not fully returned to the state before the COVID-19 pandemic.The area where we observe a significant difference, is the percentage of hospitalizations, which is the lowest in 2021 since 1998. It can be assumed, that one of the reasons for this, could be a stricter qualification of people with milder symptoms for hospital treatment, in favour of outpatient care.

A fatal case of cupriavidus pauculus causing septicemia after duodenal perforation: Case report from university teaching hospital

, a gram-negative bacterium is found ubiquitously in soil and water. It is very rare organism to cause human infection. Here we report a fatal case of septicaemia due to in a young female with duodenal perforation. Blood culture showed isolation of identified by MALDI-TOF-MS. The patient was treated with meropenem and piperacillin and tazobactam, but she died nine days after surgery. To our knowledge, this is the rare case report of causing septicemia after duodenal perforation.

Urosepsis: pathophysiology, diagnosis, and management-an update

Urinary tract infections vary widely in their clinical spectrum, ranging from uncomplicated cystitis to septic shock. Urosepsis accounts for 9-31% of all cases of septicemia and is often associated with nosocomial infections. Amajor risk factor for urosepsis is the presence of obstructive uropathy, caused by conditions such as urolithiasis, tumors, or strictures. The severity and course of urosepsis depend on both the virulence of the pathogen and the patient's specific immune response. Prompt therapy, including antimicrobial treatment and eradication of the infection source, along with supportive measures for circulatory and respiratory stabilization, and adjunctive therapies such as hemodialysis and glucocorticoid therapy, is crucial. Due to demographic changes, an increase in cases of urosepsis is expected-thus, it is of utmost importance for urologists to be familiar with targeted diagnostics and effective treatment.

Bacteriological profile and antibiotic susceptibility pattern of neonatal septicemia in a tertiary care hospital

ABSTRACT Background: Among the various reasons for neonatal mortality, septicemia continues to be a major cause of neonatal morbidity and mortality worldwide. Incidence varies from country to country, but it is much higher in developing countries than in developed countries. In India, the incidence of blood culture-proven sepsis was reported as 8.5 per 1000 live births. The bacteriological profile for causative organisms of neonatal sepsis differs significantly between developed and developing countries. Klebsiella pneumoniae is the most common bacterial agent in developing countries. This study was undertaken to determine the common bacterial agents causing neonatal sepsis from the tertiary care hospital and their antibiotic susceptibility and resistance. Methods: About 150 blood samples of suspected cases of neonatal septicemia admitted in NICU. Bacterial identification and speciation were done by standard laboratory procedures. Isolates and susceptibility were performed on Automation system. Results: Ninety-one babies presented within the first 72 h of life constituting early-onset sepsis, whereas 59 presented as late-onset sepsis. Among the 150 samples, blood culture was positive in 47 samples. Out of 47 culture-positive cases, 27 (58%) were Gram-negative bacilli, 18 (38%) were Gram-positive cocci, and two (4%) were fungal isolate. K. pneumoniae was the most commonly isolated Gram-negative bacilli. Conclusion: Neonatal septicemia is a life-threatening emergency and rapid treatment with antibiotics is mandatory for favorable outcomes. There is also a need for regular periodic surveillance of the causative organisms of neonatal sepsis as well as their antibiotic susceptibility patterns to inform the choice of empirical antibiotic prescription while awaiting blood culture results.

A case of septicemia with meningitis caused by Neisseria weaveri in a 7-year-old child

A case of septicemia with meningitis caused by Neisseria weaveri in a 7-year-old child

Fulminant invasive group A streptococcal infection in children

Group A streptococcal infections dominate among invasive streptococcal infections, with the major causative agent, Streptococcus pyogenes, being quite stable in the environment and bearing a large number of chromosome encoded pathogenicity factors or transmitted by horizontal transfer through bacteriophages. Different genetic variants of S. pyogenes can have a different set of pathogenicity factors able to change during pathogen evolution and determine virulence level for specific isolate. With a short incubation period, the disease can proceed with developing invasive infection and toxic shock syndrome with unfavorable outcome within 7 days from disease onset. The purpose of this article is to increase the doctors’ alertness to early recognition and diagnosis, which directly affects adequate treatment in a timely manner and disease outcome. The data on streptococcal morbidity in Russia and worldwide, review of laboratory diagnostic methods and pathogen genetic typing are presented. The maximum number of cases of streptococcal septicemia in Russia was registered in 2022, which accounted for 69% of all cases during the 2014–2022 observation period. The article also describes two clinical cases of fulminant invasive group A streptococcal infection in children with symptoms of acute respiratory viral infections at the onset of the disease. The results of various laboratory diagnostics methods verifying the diagnosis are presented. The genetic characterization of microbial isolates was performed by deep DNA sequencing. In the biological material from patients (including autopsy in one case), S. pyogenes sequence type ST-28, serotypes emm-1.25 and emm-1.0 were identified. The increasing importance of invasive streptococcal infection for health care in Russia and other countries may be associated with a possible change in dominating S. pyogenes genetic variants. In this regard, the study on circulating S. pyogenes genotypes on an ongoing basis as part of surveillance of streptococcal infection and development of vaccine for specific prevention are required.

Assessment of the prevalence of meningitis in clinically suspected cases of early and late onset neonatal sepsis

Background: Meningitis is more common in the neonatal period than any other time in life and is an important cause of morbidity and mortality globally. In India, rate of neonatal sepsis is reported 0.5 per 1000 live births. The major burden of neonatal sepsis and meningitis occurs in the developing world. According to WHO estimates there are approximately 5 million neonatal deaths in a year. The objective of the study is to assess the prevalence of meningitis in neonates with clinical suspicion of sepsis. Methods: The study was conducted among suspected cases of neonatal septicemia in neonatal intensive care unit (NICU), department of pediatrics, VPIMS, Lucknow. It is a prospective observational study. A total of 180 neonates were included in the study. Results: Out of 180 neonates, CSF examination of 131 (72.78%) neonates was normal, of 37 (20.56%) was suggestive of meningitis. Prevalence of meningitis in neonatal sepsis was 20.0%. It was 18.0% in early neonatal sepsis and 32.6% in late neonatal sepsis cases. Conclusions: The findings of present study suggested that there is a high risk of meningitis among neonatal sepsis cases. Cases with risk factors like twin birth, anemia, low TLC, low platelet count, acid-base imbalance and X-ray findings suggestive of pneumonitis should be kept in a high-risk category.

An Outbreak of Ralstonia mannitolilytica Septicaemia at a Tertiary Care Hospital: An Observational Cross-sectional Study

Introduction: Ralstonia spp. is an emerging non fermenting Gram negative bacillus implicated in cases of bloodstream infections in immunocompromised individuals. It is commonly found as an environmental contaminant in hospital settings. Several sporadic outbreaks have been reported from different parts of the world due to Ralstonia spp. This study reports a similar outbreak at a tertiary care hospital in Northern India. Aim: To determine the source of Ralstonia septicaemia in affected patients at a tertiary care centre. Materials and Methods: The present observational crosssectional study was conducted at the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India from February 2020 until the end of March 2020 (two months). A total of 2,650 blood cultures were received during the study period; of these, 53 (2%) patients were found to have Ralstonia mannitolilytica infection over a two month period. All patients from various wards whose blood cultures showed growth of Ralstonia species were included in this study. The organism was identified using both biochemical tests and Matrix-Assisted Laser Desorption Ionisation-Time of Flight Mass Spectrometry (MALDI-TOF MS). Antibiotic sensitivity testing was conducted using the Kirby-Bauer disk diffusion assay. Environmental surveillance was conducted to detect the source of origin. Patients’ age, sex, duration of hospital stay, co-morbidities, and other clinical parameters were recorded. Statistical analysis was performed using Microsoft Excel. Results: There were 52 cases of septicaemia due to Ralstonia mannitolilytica, and one Ralstonia isolate was obtained from intraoperative pus. Most of the Ralstonia isolates obtained were Multidrug-Resistant (MDR), showing resistance to imipenem, meropenem, amikacin, aztreonam, and sensitivity to first-line drugs such as ceftazidime, piperacillin-tazobactam, cefoperazone-sulbactam, levofloxacin, and trimethoprimsulfamethoxazole, resulting in successful treatment. Out of 53 cases, one patient succumbed to death due to surgical complications. Environmental sampling did not yield any organisms resembling Ralstonia spp. Conclusion: The environmental source of the Ralstonia bacteraemia outbreak could not be identified in this study. All patients except one were successfully treated with antibiotics. Clinicians and microbiologists should remain vigilant in case any such case arises to prevent further outbreaks.

Urinary Tract Infections in Men in Primary Care in Catalonia, Spain.

Antimicrobial resistance is a major global problem that is primarily driven by the excessive and inappropriate utilization of antibiotics. Urinary tract infections (UTIs) are frequent in primary health care (PHC) and are typically treated with antibiotics. There is ample evidence on the management of this condition in women but not in men. The aim of this study was to describe the epidemiology of UTIs in men in Catalonia, Spain. We conducted a population-based observational cohort study that included male patients diagnosed with UTI within our SIDIAP and CMBD database during the period from 2012 to 2021. UTI diagnoses were grouped into five main groups (cystitis, prostatitis, orchitis and epididymitis, urethritis, and pyelonephritis). Of the 316,762 men with at least one recorded UTI episode, the majority were registered with a diagnosis of cystitis in PHC (212,958 patients). Quinolones were the most commonly recorded treatment for UTIs (between 18.3% and 38.6%, depending on the group), except for urethritis in which a combination of antibiotics (36.7%) was most frequently used. The treatment duration period was between 9 days and 18 days, except for the prostatitis group, in which treatment was extended to 21 days. Urine cultures were documented in up to 30% in the cystitis group. Pyelonephritis was the category linked to most septicemia cases (3.0%). Conclusions: This is the first study to assess UTIs in men using a large PHC database in Spain. The sociodemographic characteristics of our sample are similar to other studies in the literature. In our setting, the use of quinolones for the treatment of UTIs is the most registered, and its duration was between 9 days and 18 days, despite the fact that resistance to quinolones exceeds 20% of the strains in our area.

Bacterial Profile and their Antimicrobial Susceptibility Pattern in Pediatric Septicemia patients from Tertiary Care Hospital.

Background:
 Blood stream infection is a life-threatening infection, leading to increased morbidity and mortality in pediatric population. Antimicrobial drug resistance is a major therapeutic challenge and may result in treatment failure. Thus, this study aimed to assess the bacterial profile causing septicemia and their antimicrobial resistance pattern among pediatric population.
 Methods: 
 This reterospective study was conducted in pathology department of Hameed Latif Hospital, Lahore, over a period of two years, from 1st January 2021 to 31 December 2022. Blood samples were aseptically collected and were transferred into Bact/Alert blood culture bottle. After the detection of microbial growth by Bact/Alert 3D system, bacterial isolates were identified by standard microbiological procedures. Antimicrobial sensitivity pattern was determined by Modified Kirby-Bauer disc diffusion method on Mueller Hinton agar. Data was entered and analyzed by using Microsoft Excel 2010.
 Results:
 In our study, out of 1306 blood culture samples, 217(16.6%) were positive for bacterial growth. Among positive cases, Gram negative organisms were predominant isolates 181(83.4%), while Gram positive organisms were isolated in 36(16.6%) samples. Most common bacterial isolates were S. typhi (24%), A.baumanii (19%), P.aeruginosa (9%), while S.aureus and MRSA were 8% each. Highly resistant class of drugs for Gram-positive bacteria were found to be Aminopenicillin (69.1%) and Macrolides (68.6%), while Gram-negative organisms showed maximum resistance against Tetracycline (72.9%), Fluoroquinolones (62.1%) and Cephalosporins (61%).
 Conclusion:
 Bacterial isolates clinically suspected cases of septicemia were high. Majority of bacterial isolates showed maximum drug resistance against different classes of antibiotics. To prevent antibiotic resistance, strict regulation of antibiotic utilization and infection control programs should be implemented.

IDENTIFICATION OF MICRORGANISMS BY USING AUTOMATED MICROBIAL DETECTION SYSTEM IN ADULT PATIENTSSUSPECTED WITH SEPTICAEMIA WITH ITS SUPPLEMENTARY PARAMETERS

Septicaemia is a major cause of mortality in both developed and developing countries. Despite important progress in treatment and prevention of infectious diseases, they are considered as leading cause of death and disability. The purpose of this study was monitoring the spectrum of microorganisms that invade blood stream and to study role of different markers in septicaemia, such data are often used to determine empiric antibiotic therapy, to alert clinicians to emerging pathogens that may pose a threat to community and also help in diagnosing severity of septicaemia. Aims and Objectives: To isolate and study the microorganisms from septicaemiccases, to study antimicrobial susceptibility of microorganisms isolated from septicemic casesandto study role of different markers in septicemic cases. Which help in diagnosing severity of septicaemia. Methodology: The study was conducted from September 2015 to February 2017 in a tertiary care teaching hospital. 1993 samples were collected from patients clinically suspected patients of septicaemia. They were inoculated and then incubated, and gram staining was performed. Antibiotic resistance and susceptibility were measured by the disk diffusion method according to the Clinical and Laboratory standards institute (CSLI) guidelines Result:Out of 1993 patients having, 695(34.87%) were culture positive. Among Gram negative isolates, Klebsiella spp.(14.96%)was commonest followed by Acinetobacter species (13.66%) ,E.coli (7.76%),Pseudomonas aeruginosa (6.76%) and salmonella spp.(1.29%). Among Gram positive organisms in our study CONS was the commonest (14.53%) followed by S. aureus (10.79%) and Enterococcus (6.18%), Streptococcus species (1.72%). It shows that colistin was found to be more sensitive for gram negative organisms followed by aminoglycosides and carbapenem group, while resistance was observed towards fluoroquinolone, 1st and 2nd generation cephalosporine groups. &Vancomycin, Teicoplanin and Linezolide were highly active drugs against Gram positive organisms. Conclusion:Septicaemia is an important cause of morbidity and mortality. The study conducted showed both Gram positive and Gram-negative bacteria were responsible for septicaemia. Most of the strains were multi drug resistant and leaving limited options for treatment. Thus, timely detection and knowledge of most likely pathogens causing septicaemia along with their antibiotic susceptibility pattern will help the clinicians in choosing appropriate antimicrobials for treatment which will reduce the major burden of septicaemia in critically ill patients and will also minimize the further emergence of resistance. Therefore, there should be an intensive surveillance, antibiotic policy formulations and preventive efforts for the effective management and prevention of drug resistance.

Isolation, characterization, and experimental infection of Streptococcus gallolyticus subspecies pasteurianus from commercial turkeys with acute septicemia: a pilot study

Streptococcus gallolyticus (SG) is a Gram-positive cocci found as commensal gut flora in animals and humans. SG has emerged as a cause of disease in young poults between 1 and 3 wk of age. SG is associated with septicemia resulting in acute mortality with no premonitory signs in turkeys. Three SG isolates were obtained from clinical field cases of acute septicemia of commercial turkeys and used in three independent experiments. In Experiment 1, embryos were inoculated 25 d of embryogenesis with varying concentrations of SG1, SG2, or SG3. In Experiment 2, day of hatch, poults were inoculated with varying concentrations using different routes of administration of SG1, SG2, or SG3. In Experiment 3, day of hatch, poults were inoculated with only isolate SG1 using different paths. Poults were randomly selected for necropsy on d 8 and d 15 and sampled to collect spleen, heart, and liver for SG on d 21, the remaining poults were necropsied and cultured. Samples were plated on Columbia nalidixic acid and colistin agar (CNA) (40°C, 18–24 h). Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) confirmed suspect colonies. Data were analyzed using the chi-square test of independence, testing all possible combinations to determine significance (P < 0.05). Weight data were subjected to ANOVA using JMP with significance (P < 0.05). No differences were found in BW or BWG on d 0, 8, 15, or 22. Splenomegaly, focal heart necrosis, and pericarditis were observed in all groups in experiments 1 through 3. In Experiment 3, only airsacculitis was observed in a negative control in separate isolation (P > 0.05). On d 21 of Experiment 3, increased (P < 0.05) recovery of SG from spleens were observed in co-housed negative controls, as well as poults challenged by oral gavage (P > 0.05 for d 7 and d 14). These results confirm numerous previous studies indicating that SG subsp. pasteurianus is a primary infectious microorganism that causes septicemia in young poults.

Association of C-Reactive Protein with Parameters of Early Onset Sepsis and Blood Culture

Background: Blood culture is a gold standard technique to diagnose neonatal sepsis but the C-reactive protein (CRP) is also an important biomarker of acute phase reaction. CRP has a role in humoral immunity against infection, leading to inflammation. Very few of the data is available to conclude the diagnostic accuracy of CRP in association with parameters of early stage neonatal sepsis in pre-term or low birth weight babies. So the aim of current study was to find out the association of C-reactive protein with parameters of early onset sepsis and blood culture in pre-term and low birth weight babies. Methods: A cross-sectional study was conducted at the Pediatric Medicine department of Maternal and Child Health Center (MCH), Shaheed Benazirabad during August 2022 to January 2023. Early onset sepsis was diagnosed on the basis of maternal factors, prenatal history and clinical examination. Blood sample was collected and sent to the pathology laboratory of Peoples University of Medical and Health Sciences for Nawabshah for measurement of C-reactive protein, white blood cell count and culture and sensitivity testing. Data was analyzed by using the Statistical Package for Social Science (SPSS) version-20. p-value less than 0.05 was considered as significant. Results: A total of 120 patients of neonatal sepsis were enrolled in the study out of them 52 were positive for C-reactive protein. The mean age of the study participants was 1.6 ±0.69 days. Male participants were predominant (63.5%) over their female counterpart. Majority cases of septicemia (57.7%) were having birth weight less than 2.5kg. Odd ratio of C-reactive protein was estimated at 95% confidence interval and the results found that age had significant association with positive C-reactive protein. Birth weight less than 2.5kg also showed significant negative association with C-reactive protein but the term of birth found no any significant association. Patients having positive blood culture and those who had WBC count more than 25000/mm3 reported strongly significant association with C-reactive protein. Conclusion: It can be concluded that the C-reactive protein is significantly associated with parameters like age, WBC count more than 25000/mm3 and blood culture but no association has been found with maturity of neonate i.e. term or pre-term babies. The birth weight less than 2.5kg is negatively associated with the C-reactive protein. Keywords: Neonatal sepsis, C-reactive protein, Pre-term

A Network-DEA model to evaluate the impact of quality and access on hospital performance.

The relationship between efficiency, quality, and access in healthcare is far from being well defined. In particular, there is no consensus on whether there is a trade-off between hospital performance and its social dimensions, such as the care appropriateness, safety, and access to proper health care. This study proposes a new approach based on the Network Data Envelopment Analysis (NDEA) to evaluate the existence of potential trade-offs between efficiency, quality, and access. The aim is to contribute for the heated debate around this topic with a novel approach. The suggested methodology combines a NDEA model with the weak disposability of outputs to handle with undesirable outputs related to the poor quality of care or the lack of access to appropriate and safe care. This combination results in a more realistic approach that has not yet been used to investigate this topic. We utilised data of the Portuguese National Health Service from 2016 to 2019, with four models and nineteen variables selected to quantify the efficiency, quality, and access to public hospital care in Portugal. A baseline efficiency score was calculated and compared with the performance scores obtained under two hypothetical scenarios to quantify the impact of each quality/access-related dimension on efficiency. The first scenario considers that each variable, individually, is at its best situation (for example, absence of septicaemia cases), and the second one, at its worst (e.g., all seen inpatients had a septicaemia case). The findings suggest that there might exist meaningful trade-offs between efficiency, quality, and access. Most variables exhibited a considerable and negative impact on the overall hospital efficiency. That is, we may expect a trade-off between efficiency and quality/access.

Bacteriological Profile of Neonatal Septicaemia and Antibiotic Susceptibility Pattern of the Isolates Admitted in SCANU of a Tertiary Levels Hospital of North Bengal, Bangladesh

Introduction: Neonatal septicemia is one of the most common causes of infection and mortality in neonates, due to which 30–50% of neonates die each year in developing nations. Various studies have suggested that bacteremia occurs in 20% of neonates, and approximately 1% die due to neonatal sepsis. It affects newborns below 1 month of age and encompasses systemic infections including meningitis, pneumonia, arthritis, osteomyelitis and urinary tract infections. Objective: To assess the Bacteriological profile of neonatal septicaemia and antibiotic susceptibility pattern of the isolates admitted in SCANU of a tertiary levels hospital of North Bengal, Bangladesh. Methods: A prospective study was conducted including 50 suspected cases of septicemia admitted to the Special Care Neonatal Unit (SCANU) of the selected Department of Paediatrics, TMSS Medical College, Bogura Bangladesh July to December 2022. Demographic data included birth weight, gestational age, postnatal age, and treatment as well as survival outcome. Clinical and laboratory data included the number of days between birth and admission to the SCANU, admitting and discharge diagnoses, and pharmacological treatment. Data was analysed by percentages of each antibiotic used. And which organism was responsible for neonatal sepsis. Results: Total 50 cases clinically suspected neonatal sepsis were included in the study. The mean age was 8.33±7.36 days, mean birth weight was 2816.25±288.6gm, male were predominant which was 70%. Among gestational age of the Neonates having septicemia Preterm (&lt;37) 66% and Term (37 up to 42) 36%. Out of the 50 proven sepsis cases, 36 cases (72%) were early onset and 14 cases (28%) were late onset. In this study out of 50 cases 16 cases were culture positive septicemia which was 32%. Gram negative organism were predominant with 10 isolates (62.5%) in comparison to gram-positive 6 (37.5%) isolates was the most common S. aureus (25.0%) and E. coli (12.5%) among the organism isolated. Other organisms isolated were Staphylococcus Pneumoniae (6.3%), Staphylococcus epidermidis (18.7%), Proteus (18.7%), Listeria species (6.3%), Pseudomonas (6.3%), and Enterococci (6.3%). In this study, Staphylococcus aureus was the commonest organism isolated from both EOS (20%) and LOS (33.3%) followed by Staphylococcus epidermidis (10% &amp; 33.3%). Amoxiclave is highly sensitive to S. aureus &amp; E. coli. In this study, vancomycin showed 25.0% sensitivity to S. aureus but for Nitrofurantoin it was only 33.3%. The Listeria species isolates here were 100% sensitive to meropenum. In our study, ciprofloxacin showed 33.3% to 100% sensitivity to different isolates. Conclusion: In the present study, high bacterial resistance among the pathogens suspected to cause neonatal septicemia is demonstrated which can be controlled by prudent use of available antibiotics. This study suggests regular monitoring of the antimicrobial sensitivity of the causative organisms in a particular setting is very important.

Haematological Scoring System: An Early Predictor of Newborn Sepsis as Compared to Blood Culture at tertiary care centre

Background: Newborn sepsis is a clinical syndrome characterised by infection-related signs and symptoms in the first month of life, with or without bacteraemia. Sepsis is defined by the Brazilian Health Surveillance Agency (ANVISA) as a systemic reaction with at least two or more of the following signs and symptoms: thermal instability, bradycardia, apnea, intolerance, worsening of respiratory discomfort, hypoactivity and lethargy. Materials and Methods: This cross-sectional study was conducted in the Bal Chikitsalaya, M. B. Government Hospital, Udaipur (Rajasthan). A total of 100 sample sizes were included in between 6-month periods from March 2019 to August 2019. Blood culture reports were compared to haematological scoring parameters, C-reactive protein (CRP) levels, and other factors. Results: 27% of the 100 cases under investigation had positive blood cultures. There were 65% male. 35% of neonates had very low birth weights and 60% were premature. 74% of cases of septicemia had an early onset, compared to 26% of cases with a late onset. In 37.1% of cases, klebsiella was the most frequent organism identified, followed by E. coli and Coagulase Positive Staphylococcus. It has a higher sensitivity and a lesser specificity. The PPV range of the haematological grading criteria was 47% to 65%. C-reactive protein has extremely high sensitivity (81.5%) and extremely low specificity (9.6%), respectively. Conclusion: The early diagnosis of newborn sepsis can be made with the help of the Haematological Scoring System (HSS), which is a rapid, easy-to-use, readily accessible, bedside, cost-effective diagnostic. As opposed to blood cultures, haematological scoring factors are effective early diagnostic and treatment tools. Since the indicators have excellent sensitivity and specificity, antibiotics can be administered to asymptomatic patients with negative culture results. The accuracy of the sepsis diagnosis is improved.

Streptococcus suis outbreak caused by an emerging zoonotic strain with acquired multi-drug resistance in Thailand.

Streptococcus suis is an emerging zoonotic swine pathogen which can cause severe infections in humans. In March 2021, an outbreak of S. suis infections with 19 confirmed cases of septicemia and meningitis leading to two deaths, occurred in Nakhon Ratchasima province, Thailand. We characterized the outbreak through an epidemiological investigation combined with Illumina and Nanopore whole genome sequencing (WGS). The source of the outbreak was traced back to a raw pork dish prepared from a single pig during a Buddhist ceremony attended by 241 people. WGS analysis revealed that a single S. suis serotype 2 strain belonging to a novel sequence type (ST) of the emergent Thai zoonotic clade CC233/379, was responsible for the infections. The outbreak clone grouped together with other Thai zoonotic strains from CC233/379 and CC104 in a global S. suis phylogeny and capsule switching events between serotype 2 zoonotic strains and serotype 7 porcine strains were identified. The outbreak strain showed reduced susceptibility to penicillin corresponding with mutations in key residues in the penicillin binding proteins (PBPs). Furthermore, the outbreak strain was resistant to tetracycline, erythromycin, clindamycin, linezolid and chloramphenicol, having acquired an integrative and conjugative element (ICE) carrying resistance genes tetO and ermB, as well as a transposon from the IS1216 family carrying optrA and ermA. This investigation demonstrates that multi-drug resistant zoonotic lineages of S. suis which pose a threat to human health continue to emerge.