Cases Of Septicemia Research Articles

Microbial Profile of Neonatal septicaemia in a tertiary care hospital of Bhopal

Aims :To determine the microbial profile of neonatal septicaemia cases and antibiotic sensitivity pattern of aerobic isolates at a tertiary care hospital of Bhopal. Material and methods : In this retrospective study the laboratory data of blood culture reports of 256 neonates admitted to NICU,Peoples Hospital,Bhopal with clinical suspicion of septicaemia from July 2012 to December 2013 was analyzed. Results : Total 256 samples were received during the study period of which 174 (68%) were found to be positive of which 118(67.8%), 50(28.7%) and 5(2.87%) had Gram positive, Gram negative and Candidal infection respectively. Staphylococcus aureus and Klebsiella pneumoniae were the commonest isolates. Gram positive organisms were found to be most sensitive to Linezolid, Pristinomycin, Cefoxitin and Vancomycin. Imipenem, Levofloxacin and 3 rd generation Cephalosporins were found to be most effective against Enterobacteriaceae group. Pseudomonas and Acinetobacter sp. were found to be most susceptible to Imipenem, Aztreonam and Piperacillin tazobactam. Conclusion : This study emphasizes the need for longitudinal surveillance to be carried at regular intervals to describe the varied pathogens causing neonatal sepsis as well as their changing antibiotic susceptibility pattern which will provide a useful information base to guide practise and policies on rational use of antibiotics.

PO-0520 Neonatal Meningitis Due To Moraxella Osloensis; Case Report And Review Of The Literature: Abstract PO-0520 Table 1

Introduction Neonatal meningitis causes substantial morbidity and mortality and is commonly caused by GBS. Moraxella osloensis is an aerobic, gram-negative coccobacillus infrequently isolated from CSF. There is little published related to risk factors of M. osloensis infections in the paediatric population. We report a case of Moraxella meningitis a neonate and review of cases in children. Case report A 2 day old neonate was referred for jaundice and bilirubin check. He was noted to be jaundiced and lethargic. He was born at term complicated with maternal pyrexia and raised maternal inflammatory markers. He was discharged on day1 following 12 h of satisfactory observation. A full septic screen was performed on the baby in-view of risk factor for sepsis. The biochemical work-up was suggestive of meningitis. The blood and CSF culture were negative; however the CSF PCR was positive for Moraxella Oslonesis. He was treated with 3 week course of IV cefotaxime and discharged without any acute complications. Discussion A PubMed search yielded 4 published cases of M. osloensis meningitis but none of them presented in the neonatal period. There was 1 published case of neonatal septicemia without meningitis, however there was no specific risk factor identified in any of these patients. In conclusion, although M. osloensis meningitis is rare it may cause severe CNS infection in children we were able to definitely identify the species of the isolates only by using 16S rRNA gene sequencing and extended PCR must be performed on all babies presenting with possible meningitis.

A Case of Polymicrobial Septicemia Unraveling to Be Due to Colovesical Fistula

Introduction: Fistula is a rare outcome of complicated diverticular disease (2%). We present a case of septicemia with known diverticular disease and recurrent urinary tract infections (UTIs) that turned out to be due to colovesical fistula. Case Report: A 57-year-old white male with history of liver cirrhosis, alcoholism, benign prostatic hypertrophy, and recurrent UTIs for 1 year presented with altered mental status. He denied history of pneumaturia and fecaluria. Vital signs: temperature 104° F, heart rate 118 bpm, respirations 26 breaths/min, and blood pressure 120/54 mmHg. No abdominal tenderness, mass, or ascites noted. Admission labs revealed white cell count 1.9 x 103 cm, platelets 85 x 103/μL, total bilirubin 5.2 mg/dL, INR 1.8, creatinine 1.09 mg/dL, lactate 3.4 mg/dL, and bicarbonate 16 mEq/L. Urine was cloudy and positive for blood, leukocytes, and bacteria. Vancomycin and cefepime were initiated after obtaining blood and urine cultures. Blood cultures grew pan-sensitive Escherichia coli and streptococcal infantarius, while urine culture was positive for pan-senstive Klebsiella pneumonie. After acute management of sepsis, further work-up was initiated to investigate the source of infection in light of polymicrobial septicemia in setting of recurrent UTIs. CT abdomen with PO and IV contrast showed air fluid level in the bladder that was suggestive of thickened bladder and a possible fistulous tract between sigmoid colon and bladder. Previous CT scan showed severe diverticular disease with no prior history of diverticulitis. Urology was consulted and poppy seed test was performed. He was given 1.25 ounce of poppy seeds mixed with a 6-ounce serving of yogurt orally. Poppy seeds were seen in urine in next 24 hours. This confirmed the abnormal fistulous tract between colon and bladder. No surgical intervention was done due to sepsis. The patient continued on broad spectrum antibiotics with no significant improvement. The patient later developed acute respiratory distress syndrome and opted for comfort measures. Unfortunately, other causes of colovesical fistula, such as malignancy, could not be ruled out. Discussion: Colovesical fistula is a rare complication and should be considered in differential diagnosis in patient with history of diverticular disease, recurrent UTIs, and poly-microbial sepsis. CT abdomen with contrast and poppy seed test are preferred diagnostic tools. Poppy seed test is highly sensitive and cost-effective. Early fistulectomy with open or laparoscopic approach is the treatment of choice. Early correction of fistula may improve mortality and morbidity in patients not responding to broad spectrum antibiotics.

A case of multiple splenic abscesses due to Enterococcus hirae

Introduction: Enterococci are prevalent human pathogens that display increasing resistance to antimicrobial agents. Twelve species pathogenic for humans have been described to date, including the most common human isolates, Enterococcus faecalis and Enterococcus faecium. Enterococcus hirae is a known member of the intestinal flora of several domestic animal species but rarely encountered in humans. Case presentation: We report a case of multiple splenic abscesses caused by E. hirae in an adult patient diagnosed with type 2 diabetes mellitus. The patient responded to combined therapy with antibiotics plus splenectomy. Conclusion: Only 9 human infections due to E. hirae have been reported in the literature. To our knowledge, this is the first reported case of splenic abscess and septicemia caused by E. hirae.

Monte Carlo analysis of the product handling and high-pressure treatment effects on the Vibrio vulnificus risk to raw oysters consumers

A Monte Carlo procedure considering the variability in oyster handling from harvest to raw consumption estimated reductions in the number of Vibrio vulnificus induced septicemia cases achieved by high-pressure processing (HPP). The calculations yielded pathogen load distributions in raw oysters from harvest to consumption. In the warm season, 2–6min treatments at 250MPa and 1°C would lower the predicted number of septicemia cases associated with raw oyster consumption from 4932 to less than four per 100 million consumption events (95% confidence). This study highlighted that HPP conditions should be selected according to the seasonal pathogen load and environment temperature. Finally, the procedure emphasized that the variability in the V. vulnificus population at harvest, before and after HPP treatments, reflecting in part the microbiological quantification methods used, significantly affected the estimated number of septicemia cases. Therefore, improving microbiological quantification should provide better predictions of the number of septicemia cases.

Costs of surviving meningococcal disease in Spain: Evaluation for two cases of severe meningitis and septicaemia

ObjectivesThe aim of this study was to count the lifelong rehabilitation costs associated with surviving meningococcal disease with major sequelae from the perspective of the Spanish National Healthcare System (NHS) and the national government. MethodsTwo severe scenarios describing meningococcal disease were developed, one case that represented meningococcal septicaemia and another case for meningococcal meningitis. The scenarios were developed based on a literature review on severe sequelae of meningococcal disease, and discussions with paediatricians who have been responsible for the treatment of children with this disease in Spain. Second, a detailed list of all health, educational and social care resources used by survivors during their acute illness and during the rest of their lives and by family members was obtained by interviewing survivors and their families. Professionals in health and social care were also interviewed to complete the list of resources and ensure the scenario's were accurate. The costs attributed to these resources were obtained from tariff lists, catalogues and published information by the national authorities. All costs were based on a life expectancy of a survivor of 70 years and expressed in EUR 2012. ResultsIn this study it was estimated that the lifelong discounted rehabilitation costs associated with the treatment of long-term sequelae due to meningococcal disease are approximately €1180,000–€1400,000. Medical care and social care were the main cost drivers for both septicaemia and meningitis. Annual costs showed to be the largest in the first year after diagnosis of the disease for both cases, due to high hospital admission and medical care costs during this period and decreased significantly over the years. ConclusionThis study shows that the lifelong rehabilitation costs associated with the survival of meningococcal disease with severe sequelae place an important burden on the NHS budget and governmental resources in Spain.

Successful treatment of two cases of Elizabethkingia meningoseptica septicemia and a review of the literature

Elizabethkingia meningoseptica is emerging as a cause of hospital acquired infection particularly in immunocompromised adults. The treatment of this bacterium is difficult since it is intrinsically resistant to a number of antibiotics. Here we report two cases of septicemia in patients who were critically ill and were successfully treated with appropriate antibiotics. Cotrimoxazole, quinolones, and rifampicin seem to be drugs effective against E. meningoseptica. Antibiotic susceptibility results are ineffective in guiding treatment. The bacterium particularly colonizes water pipelines and tap faucets and occurrence of infection by this bacterium should direct attention towards eradicating the source of this bacterium.

A retrospective study of equine actinobacillosis cases: 1999-2011.

Several Actinobacillus spp. are common commensal bacteria of the oral cavity, gastrointestinal tract, and reproductive tract of horses and can cause disease in both foals and adults. The current retrospective study was designed to review Actinobacillus spp. isolated from clinical samples or necropsies of 99 horses during 1999-2011. The cases consisted of 43 foals (<6 months of age), 4 young adults (6 months-2 years), 39 adults (>2 years of age), 2 aborted fetuses, and 11 with unspecified ages. Clinical history, signs, bacterial species isolated, and associated lesions were documented. Actinobacillus spp. were isolated 111 times. The most common isolates were Actinobacillus equuli subsp. equuli (38.7%) and hemolytic Actinobacillus spp. (24.3%). Other isolates were Actinobacillus lignieresii (5.4%), Actinobacillus pleuropneumoniae (1.8%), and unclassified Actinobacillus spp. (28.8%). Actinobacillus equuli subsp. equuli was most commonly isolated from clinical and necropsy cases of septicemia and respiratory disease in both foals and adults. Embolic nephritis, the classical septicemic lesion of equine neonatal actinobacillosis, was also present in several adult septicemic actinobacillosis cases. Predisposing factors such as failure of passive transfer of colostral antibodies as well as concurrent pathogenic bacterial or viral infections were present in numerous actinobacillosis cases. There were many cases, however, for which a predisposing factor or concurrent infection was not documented or apparent, suggesting that Actinobacillus spp. can be primary pathogens under the right circumstances and in the right location.

Rate of co-colonization with serotypes of strep pneumonia isolated from nasopharyngeal swab

Background: Extended Spectrum Beta Lactamases (ESBLs) that mediate resistance to 3rd generation cephalosporins are now observed worldwide. Numerous types of ESBLs exist and can be found in nosocomial infections with Klebsiella pneumoniae strains in hospitals in Nigeria. However, there is no information available on the detection and prevalence of beta-lactamases of Klebsiella pneumoniae in clinical samples in Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. Methods & Materials: In this analytical cross sectional study, between January2012and January2013,600 isolateswere received from different clinical samples. Susceptibility of the isolates to different antibiotics was determined by disk diffusion method using NCCLS guidelines. The MICs of ceftazidime was determined using broth dilution assay. Isolates showing MICs≥ 4 g/ml for ceftazidime were phenotypically confirmed for ESBL production using double disc synergy method. The positive ESBL isolates were subjected to Polymerase Chain Reaction (PCR) to study the target genes. Demographic datawere assessed and all datawere analyzed accordingly. Results: Patient’s mean age was 65±26.36 year. Three hundred and twenty six (54.3%) cases were females and Two hundred and eighty two (45.6%) cases were males. Clinical presentation of infection were 189 cases of respiratory infection (31.5%), 129 cases of septicaemia (21.5%), 117 cases of wound infection (19.5%), 96 cases of UTI, (16%), 36 cases of STI (6%) and 33 cases of meningitis (5.5%). All the isolates were sensitive to imipenem. Resistance to ceftazidime and cefotaxime were 43.5% and 46.2% respectively. Frequency of 375 (62.5%) cases of positive ESBL was recorded. The prevalence of SHV, CTX-M and TEM genes among these isolates were 32% (n=120), 36% (n=135) and 32% (n=120) respectively. There was no significant correlation between ESBL positivity, age, ward and clinical presentation. Conclusion: The incidence of ESBL producing isolates of Klebsiella pneumonia is high in OAUTHC, Ile–Ife, Nigeria. These are associated with multiple drug resistance and pose a special therapeutic challenge. Routine evaluation of ESBL producing pathogens in the hospital can help clinicians in empirical treatment of high risks patients with serious nosocomial infection.

Acid stress management by Cronobacter sakazakii

Cronobacter sakazakii is a foodborne pathogenic microorganism associated with sporadic cases of neonatal meningitis, necrotising enterocolitis, septicaemia, bloody diarrhoea and brain abscesses acquired through the consumption of contaminated powdered infant formula (PIF). This study aimed to investigate the growth of C. sakazakii DPC6529, a particularly stress tolerant clinical isolate, in acidified laboratory media and PIF. The possibility of a stationary-phase acid tolerance response (ATR) was also investigated. C. sakazakii DPC6529 grew in LB broth acidified to pH4.2 with hydrochloric acid (HCl) and was capable of relatively fast growth in PIF acidified to pH5.0 with HCl, representing the stomach pH reported for newborns and infants. Moreover, bacterial growth in LB broth supplemented with 1% (w/v) glucose gave rise to a stationary-phase ATR which resulted in enhanced survival against a subsequent acid challenge at pH3.0. A transposon mutagenesis approach was used to shed light on some of the molecular mechanisms involved in the response C. sakazakii DPC6529 to normally lethal acid exposures. The data suggests that repairing damage in proteins and nucleic acids, posttranscriptional modification of tRNA molecules and maintenance of the integrity of the cellular envelope are key processes in the defence against acid stress. Clones carrying transposon insertions in genes encoding the envelope stress response regulators CpxR and OmpR were identified as acid-sensitive mutants. Further analyses of the ompR defective mutant and its complemented counterpart evidenced that OmpR is a key player in the response of C. sakazakii to acid stress, although it was not essential to mount an active stationary-phase ATR, at least under the tested conditions. The ability of C. sakazakii DPC6529 to grow in acid environments and to develop an adaptive stationary-phase ATR may allow for its survival or even proliferation within the infant gastrointestinal tract after consumption of contaminated milk formulae.

Serratia marcescens: an outbreak experience

Serratia marcescens: an outbreak experience

Antimicrobial susceptibility patterns of the gram-negative bacteria isolated from septicemia in Children's Medical Center, Tehran, Iran.

The choice of antimicrobial treatment for septicemia is often empirical and based on the knowledge of local anti-microbial activity patterns of the most common bacteria causing such bloodstream infections. The current study aimed to study the prevalence of bacterial pathogens causing septicemia and their antimicrobial resistant profiles in hospital admitted patients. This cross sectional study done at Children's Medical Center, Tehran, Iran. We examined 168 bacterial strains isolated from 186 clinically diagnosed septicemia cases refereed at Children's Medical Center, Tehran, Iran. Over a period of twelve months from July 2010 to 2011 July. 11446 blood samples from patients of clinically suggestive septicemia were evaluated. Bacterial strains were isolated from 910 (7.95%) of blood cultures. Gram-negative bacteria identified were Pseudomonas species (20.5%), Pseudomonas aeruginosa (1.86%), Salmonella spp (1.09%), Acinetobacter naumannii (8.13%), Escherichia coli (4.06%), Klebsiella spp (5.16%). Gram-negative pathogens were more than gram positive in bloodstream infections. Antimicrobial susceptibility testing was done according to Clinical and Laboratory Standards Institute (CLSI, USA) guidelines against: amikacin ampicillin, amoxicillin, amoxiclav, cefuroxime, cefotaxime, ceftazidime, cefoperazone tetracycline, chloramphenicol, ciprofloxacin, gentamicin. Resistanc to different antibiotics in the most important isolated bacteria were: 32.1%, 10.8%, 87.8%, 96%, 39.1%, 35.2, 49.4%, 69%, 80.02%, 22%, 59%, 30.1% respectively, for Pseudomonas spp, 32%, 3.7%, 84.2%, 83.2%, 80.1%, 75.4%, 44.8%, 45.2%, 33.3%, 19%, 34.1, 11.5% respectively for Acinetobacter species. Resistant to majority of the antimicrobial agents for several pathogens implicated in bloodstream infections, particularly in Gram-negative bacteria, can make complication in treatment of infection cause by them.

Should prophylactic thrombolysis be routine in clinical practice? Evidence from an autopsy case of septicemia

BackgroundCentral venous catheters provide easy access for intravenous infusion and nutrition, but they can bring about complications such as catheter-related infections. Infected central venous catheters often cause nosocomial bloodstream infections with high morbidity and mortality. However, most of the morphological data that have been published are derived from in vitro and in vivo studies and few reports of direct evidence obtained from patient-derived samples have been described. Here we present visual evidence of catheter-related candidemia. To our knowledge, this is the first reported conventional histopathological evidence of a Candida-infected intraluminal thrombus in a patient’s central venous catheter.Case presentationA 62-year-old Japanese female with obstructive jaundice, gastrointestinal bleeding, and liver metastasis from pancreatic head cancer was given an implantable subcutaneous central venous port for nutrition and chemotherapy administration. High fever ensued on day 16 after the central venous port insertion and blood cultures revealed Candida albicans. Although the patient was given 300 mg/day of fosfluconazole according to the suggestion of the infection control team, she died from respiratory failure. Postmortem computed tomography revealed findings consistent with acute respiratory distress syndrome, suggesting that the patient’s course was complicated by catheter-related sepsis. Autopsy revealed a subcutaneous abscess around the port, from which C. albicans was cultured. However, no catheter-adherent thrombus, thrombosis of the great central veins, or endocardial vegetations were detected in the patient. Histological analysis revealed scattered abscesses in several organs including lungs and kidneys. Hyaline membrane formation and Candida colonies were found in the lungs. The central venous port tube, together with the part of the subclavian vein into which it had been inserted, was involved in an intraluminal fibrin thrombus containing neutrophils and macrophages, indicating that the thrombus existed while the patient was alive. Histopathological examination following use of the periodic acid-Schiff reagent and the Grocott stain revealed scattered Candida in the thrombus.ConclusionsProphylactic thrombolysis should be encouraged to prevent central venous catheter-related candidiasis in clinical practice.

Identification of 'Candidatus Neoehrlichia mikurensis' and Anaplasma species in wildlife from Croatia

Vector borne diseases are classical emerging infectious diseases in human and animal populations. Ticks represent perfect vectors for number of bacteria, parasites and viruses. The genera Anaplasma, Ehrlichia and recently specified cluster ‘Candidatus Neoehrlichia’ comprise all bacteria from family Anaplasmataceae, transmitted by ixodid ticks to mammalian hosts causing infection in humans and animals. ‘Candidatus Neoehrlichia mikurensis’ is one of emrgening vector borne zoonosis recently recognized as human pathogen. First case of human infection was reported from Sweden in 2010 and up to now six human infections were described in Czech Republic, Germany and Switzerland. In 2011 first case of septicaemia in two dogs was reported indicating ability of Neoehrlichia to infect various mammalian species, while different rodent species may act as reservoir host. The aim of this study was to identify species from family Anaplasmataceae from different species of wild animals (851). The presence of selected pathogens from wild cervids, wild boars, small rodents, muflons, chamois, martens, bears, badgers, wolves, jackals and foxes were determined by performing PCR on spleen samples and subsequent sequencing of fragment of 16S rRNA gene. Sequence analysis revealed presence of N. mikurensis, two strains of Anaplasma phagocytophilum, Anaplasma centrale, A. bovis and Ehrlichia sp. Small rodents were infected mainly with N. mikurensis together with A. phagocytophilum. Neoehrlichia mikurensis was single species detected in wild boars, bears and badgers, which represent first finding in these mammalian species. In chamois all species have been found except A. bovis. Wild cervids were harbouring both strains of A. phagocytophilum, while muflons were infected with A. centrale, A. phagocytophilum, A. bovis and N. mikurensis. Martens and jackals were free from pathogens while sequencing failed in wolf samples. Foxes were infected with both strains of A. phagocytophilum and interestingly in single animal A. bovis was confirmed. Two isolates Ehrlichia sp. from roe deer and chamois were identical to Ehrlichia sp. from Sika deer from Japan. Data obtained from this study clearly present presence of two zoonotic pathogens: A. phagocytophilum, causative agent of human granulocytic anaplasmosis (HGA) and newly recognized pathogen N. mikurensis in various species. These results also imply importance of wildlife as potential reservoir for ticks and potential transmission to humans.

Neonatal Septicaemia Caused by Vancomycin Resistant Enterococcus Faecium -A Case Report

Neonatal bacterial sepsis is one of the major causes of morbidity and mortality in neonates. 10% cases of neonatal bacteraemia and septicaemia are caused by Enterococci. The increasing incidence of Vancomycin resistant enterococci (VRE) is of particular concern because of limited treatment options and increased mortality. We report here a case of neonatal sepsis in a premature baby caused by vancomycin resistant Enterococcus faecium Van A phenotype from a tertiary care Hospital in South India. A preterm baby boy with low birth weight was admitted to the NICU with Respiratory distress and meconium aspiration. On 5(th) day the baby succumbed to death and a final diagnosis of respiratory distress and meconium aspiration with sepsis was made. Blood cultures sent yielded vancomycin resistant Enterococcus faecium (minimum inhibitory concentration ≥ 256 μg/ml). It was confirmed as Enterococcus feacium Van A phenotype by Automated Vitek system.

A case of community-acquired pleuropulmonary infection and fatal septicemia caused by anaerobic bacteria

A case of community-acquired pleuropulmonary infection and fatal septicemia caused by anaerobic bacteria

Comparison of Susceptibility of Various Candida Species Isolated From Neonatal Septicaemia to Voriconazole and Fluconazole

Background: Candida species are known to be the most common fungal pathogens isolated from blood cultures of neonates. Recent reports from our country indicates trend towards an increasing prevalence of non-albicans candidemia. Candida species possess a number of virulence factors which enable them to cause hematogenously disseminated infections in susceptible hosts with increased morbidity and mortality. Objectives:To know the prevalence of candidemia in neonates and their antifungal susceptibility pattern. Materials and Methods: Blood samples from suspected cases of neonatal septicemia were subjected to culture, incubated for 7 days and subcultures performed. Culture yielding pure growth of Candida were included for the study and identified by standard methodology. Antifungal susceptibility was performed towards fluconazole and voriconazole by disc diffusion method on Muller-Hinton agar with 2% glucose and methylene blue. Result: Among 1583 blood cultures 80(5%) candida isolates were obtained. The various species isolated were C.pseudotropicalis 34(42.5%), C.tropicalis 22(27.5%), C.albicans 12 (15%) C.guillermondii 6(7.5%), C.parapsilosis 4(5%) and C.krusei 2(2.5%). Fluconazole susceptibility was observed in 56(70%) sensitive, 18 (22.5%) Susceptible-Dose Dependent (SDD) and 6(7.5%) resistant and all were sensitive to voriconazole. Conclusion: In this study non albicans candida was the common isolate & they showed decreased resistance to Fluconazole. In neonatal septicemia speciation & antifungal susceptibility may help in management.

Chryseobacterium indologenes Septicemia in an Infant.

Chryseobacterium indologenes is a rare cause of infection in children. The organism causes infections mostly in hospitalised patients with severe underlying diseases. The choice of an effective drug for the treatment of infections due to C. indologenes is difficult as the organism has a limited spectrum of antimicrobial sensitivity. We present a case of nosocomial septicemia caused by C. indologenes in an infant with congenital heart disease who was successfully treated with trimethoprim sulfamethoxazole and also reviewed fourteen additional cases of C. indologenes infections reported in the English literature in this report.

Extended Spectrum β Lactamase Producing Klebsiella pneumoniae and Escherichia coli in Neonatal Intensive Care Unit

Introduction: Neonatal Septicemia is an important cause of morbidity and mortality. As infections due to ESBL producing K. pneumoniae & E. coli are on the rise, the present study was carried out in the NICU of KIMS, Narketpally, with an aim to identify any environmental sources & the mode of transmission over a period of 3 years from August 2006 to July 2009. Materials and Methods: A total of 264 neonates admitted with clinical features suggestive of septicemia in the NICU were studied by blood culture and CRP estimation. Antibiotic susceptibility pattern was determined. ESBL detection was done by double disc synergy test. Environmental samples from various sites (Incubators, phototherapy units, suction apparatus, trolley, door, floor, work surfaces) were collected using sterile swabs every month and processed simultaneously. Results: Of the 264 blood cultures, 197 (75%) showed bacterial growth. K. pneumoniae, 64 (32.7%) was the commonest organism followed by E. coli 55 (28%), S. aureus 31 (16%), Pseudomonas aeruginosa 28 (14%), Acinetobacter 13 (7%), and Coagulase negative Staphylococci 6 (2.8%) respectively. K. pneumoniae & E. coli were isolated from various environmental sites at least on one occasion and consistently from phototherapy units, door & floor of the NICU. The similarity between antibiograms of ESBL producing strains of K. pneumoniae & E. coli isolates from neonates and environment of NICU were statistically significant (P < 0.05). Conclusion: Wide spread use of third generation cephalosporins as a preemptive antibiotic for suspected cases of septicemia have contributed to the emergence of ESBL producing K. pneumoniae & E. coli in addition to other risk factors, both of which have extensively colonized the environment of the NICU. Repeated isolation of these two organisms from the NICU environment proves that some of the neonatal infections may be from the environment itself. Transmission can be stopped by maintaining the sterility of the NICU & hand hygiene among the mothers and health care workers.

The changing trends in antibiotic resistance pattern in septicemia.

Septicemia is one of the important causes of morbidity and mortality. Emergence of multidrug resistant bacteria is a major problem in the management of septicemia. Present study was undertaken to isolate the common bacterial pathogens associated with septicemia and determine their antibiotic resistance. Blood cultures from 100 suspected cases of septicemia were examined. The growths from the subcultures were identified by conventional biochemical tests. Antibiotic susceptibility testing done by Kirby-Bauer disk diffusion method and antibiotic resistant strains in the primary screening were further processed for MRSA, ESBL and MBL production. Out of 100 suspected cases, 28 (28%) were cultures positive. Of which 15 (53.57%) were Gram positive cocci and 13 (46.42%) were Gram negative bacilli. The prevalence of MR CONS was found to be high 78% when compared to MRSA 67%. The overall prevalence of ESBL producers among Gram negative bacilli was found to be 46% and MBL among Pseudomonas aeruginosa was 33%.Thus, the study highlights the rising level of antibiotic resistance amongst the bacterial isolates from blood and, hence, the need to continuously monitor the locally emerging antibiotic resistance patterns, and updates the existing antibiotic policies.