Culture-positive Sepsis Research Articles

Meningitis Among Neonates with Suspected Sepsis Presenting to Pediatric Emergency.

We aimed to assess the risk factors, clinical features and microbial profiles of meningitis in neonates with suspected sepsis referred to a pediatric emergency. Over 13 months, 191 neonates were enrolled, of whom 64 (33.5%) had meningitis. There were no significant differences in risk factors or clinical features between infants with and without meningitis. Ninety-three neonates (49%) had culture-positive sepsis (109 isolates). Candida spp. (n = 29), coagulase-negative staphylococci (n = 28) and Klebsiella pneumoniae (n = 23) were the most common pathogens. Forty-one (53%) bacteria were multidrug resistant.

Acute kidney injury and early fluid load in a retrospective cohort of neonatal sepsis.

Sepsis and acute kidney injury (AKI) are associated with mortality in the newborn intensive care unit (NICU). There is a paucity of studies that describe AKI and fluid overload in neonatal sepsis and their association with mortality. Retrospective study of neonates with culture positive sepsis admitted to the NICU between June 2020 and June 2021 was conducted. Primary outcome was in-hospital mortality according to AKI as defined by the neonatal modified Kidney Diseases Improving Outcomes criteria. Secondary outcomes were early fluid overload and vasopressor use. Thirty-three percent of neonates had AKI with sepsis, and 57% of cases were severe AKI. AKI was associated with mortality after adjusting for variables that were different between survivors and non-survivors (aOR 5.7 [95% CI 1.1-36], p = 0.04). Early fluid overload occurred in 27% of neonates who were at higher risk of having AKI with sepsis (OR 7.4 [95% CI 1.6-26.0], p = 0.01) and higher risk of mortality (aOR 17.8 [95% CI 2-7545], p = 0.02). AKI and early fluid overload are associated with mortality in sepsis in our retrospective cohort. Mitigating AKI and early fluid overload in sepsis might be a fruitful strategy in reducing mortality with sepsis. A higher resolution version of the Graphical abstract is available as Supplementary information.

1242: PEDIATRIC SEPSIS HAS HIGH MORTALITY REGARDLESS OF PATHOGEN IDENTIFICATION

Introduction: Sepsis remains a major cause of morbidity and mortality in critically ill children worldwide. Culture-negative sepsis (CNS) is diagnosed when a patient meets the criteria for sepsis with no causative pathogen identified. The etiology of CNS may be an uncultivable pathogen, treatment with antimicrobials before a culture was drawn, or a non-infectious cause. For adults, CNS is estimated to comprise up to 50% of all ICU admissions for sepsis, but the characteristics of the pediatric population with CNS are poorly understood. Methods: This is a retrospective cohort study of 3 pediatric ICUs within an urban, tertiary children’s hospital. All patients who received piperacillin-tazobactam, the institution’s standard initial broad-spectrum agent, were screened for study inclusion. Patients ≤18 years old who were hospitalized between March 2020 and February 2021 and met the criteria for sepsis defined in the 2020 Pediatric Surviving Sepsis Guidelines were included in the study. Results: Of the 302 patients screened, 61 met the criteria for sepsis. Thirty-two patients (52.5%) had culture-positive sepsis (CPS) and 29 patients (47.5%) had CNS. The median age for CPS was 5 years (interquartile range [IQR] 1-15y) and 3 years (IQR 0.5-15y) for CNS. Both groups had similar numbers of medically complex patients with >3 comorbidities (68.8% for CPS vs 70% for CNS, p=0.98). There was no statistically significant difference in mortality (28.1% CPS vs 17.2% CNS, p=0.32), need for mechanical ventilation (62.5% vs 58.6%, p=0.19), need for vasoactive medication (62.5% vs 55.2%, p=0.41), or median ICU and hospital length of stay (47 vs 27d, p=0.11; 53 vs. 27d, p=0.07) between groups. CPS patients were treated with longer courses of antibiotics (median 10 vs 7d for CNS p=0.03). Conclusions: When compared to CPS, outcomes for patients with CNS were similar though overall rates of mortality in both groups were high compared to previous reports (4-15%). Patients with CNS comprised a considerable proportion of the total number of patients with sepsis. A median ICU length of stay of 27 days for CNS patients represents significant resource utilization for these individual children. Given these findings, further studies are warranted to better understand this population and determine optimal treatment strategies.

Association between timing and adequacy of antibiotics and adverse outcomes in patients with sepsis and septic shock: A multicentre retrospective cohort study.

To investigate the association between the timing and adequacy of antibiotics administered to patients presenting with culture-positive sepsis and septic shock to the ED and in-hospital mortality and/or intensive care unit (ICU) admission. Multicentre retrospective cohort study of ED presentations at four metropolitan hospitals in Sydney, Australia between January 2017 and November 2019. Encounters for patients aged ≥16 years meeting specified criteria for sepsis or septic shock with antibiotic administration within the first 6 h of presentation were included. Of 7611 encounters included in the study, 2328 (31%) were culture positive, and 2228 (29%) met the criteria for septic shock. In culture-positive sepsis encounters, partial or inadequate antibiotic coverage was associated with higher risk of death or ICU admission (adjusted odds ratio [AOR] 1.50, 95% confidence interval [CI] 1.04-2.06 and 1.95, 95% CI 1.28-2.99, respectively). This effect was not significant in septic shock encounters (AOR 1.10, 95% CI 0.64-1.88) with partial coverage and (AOR 1.63, 95% CI 0.81-3.3) inadequate coverage. Time to antibiotics was not significantly associated with the risk of mortality/ICU admission. This inference remained the same when analysis was restricted to cases with adequate antibiotic coverage. In a large multicentre sample of patients with culture-positive sepsis, inadequacy of antibiotics was associated with higher risk of in-hospital mortality or ICU admission.

Covid-period-associated changes in organism profile of neonatal sepsis in a tertiary center from East India.

Neonatal sepsis is a major cause of morbidity and mortality with a higher burden from the low- and middle-income countries. The coronavirus disease 2019 (Covid 19) pandemic has impacted healthcare in various ways including healthcare-associated infections (HAI). The objective of the present study was to determine changes in organism profile and incidence rates of HAI in neonates admitted to the index hospital during the pandemic and compared it with the data from the pre-pandemic period. The study design was a retrospective, observational analysis of data from neonates with culture-positive sepsis, in a tertiary care children's hospital, between January 2018 and December 2021. Pre-Covid (January 2018 to December 2019) and Covid period data (January 2020 to December 2021) were analyzed for the significance of change. The prevalence of culture-positive sepsis, in pre-Covid and Covid periods, was 19.55% [95% confidence interval (95% CI) 17.13-21.52)] and 18.36% (CI 16.05-20.74), respectively. HAI rates/1000 patient days increased slightly during the Covid pandemic [7.2% (95% CI 6.98-10.08) to 9.8% (95% CI 9.78-13.67)] mainly due to an increase in fungal HAI (26% pre- vs. 41.5% Covid period). However, the proportion of Gram-negative (GN) infections fell significantly (70.5% vs. 48.6%) during the same period. In the pre-Covid period, Klebsiella followed by Burkholderia cepacia, Acinetobacter spp and Pseudomonas, were the major HAI isolates. During the Covid period, there was a decline in these isolates and Burkholderia spp was not detected. All fungal isolates were Candida species. The case fatality ratio (CFR) from HAI decreased significantly from 38% to 15.45%, mainly due to a decrease in GN HAI. During Covid pandemic, there was a significant decline in GN HAI and CFR from HAI, due to improved compliance with infection control measures in the neonatal intensive care unit (NICU). At the same time, there was a rise in the fungal HAI, possibly because of a higher proportion of premature, and sick neonates with longer hospital stay and more invasive procedures. Consolidations of gains in infection control and restriction of invasive procedures could help to minimize HAI in NICUs.

Reducing catheter related bloodstream infection risk of infant with a prophylactic antibiotic therapy before removing peripherally inserted central catheter: A retrospective study.

This study examined the efficacy of prescribing antibiotics, specifically a single dose of vancomycin, in reducing the incidence of culture-positive and culture-negative sepsis prior to the removal of peripherally inserted central catheters (PICCs). We retrospectively reviewed charts of infants who had PICCs in a tertiary level hospital during the period from 2010 to 2019. The incidence of post-catheter removal clinical sepsis between the groups with or without antibiotics was compared. The antibiotic group was defined by receiving a single dose of vancomycin or any other antibiotic prior to line removal. We enrolled 585 PICC removal episodes in 546 infants for analysis. Antibiotics were given prior to removal in 257 cases (43.9%) and not given prior to removal in 328 cases (56.1%). There were 13 episodes of post-catheter removal clinical sepsis detected within 72h (2.2%), 2 of which were culture-positive (0.3%). A 9.3-fold decrease in the odds for clinical sepsis was observed in the antibiotic group (p=0.01). The incidence of post-catheter removal sepsis was decreased by a single prophylactic dose of vancomycin (p=0.02), whereas the use of other antibiotics showed no effect (p=0.35). Logistic regression analysis demonstrated that comorbidities with gastrointestinal diseases (p=0.01), PICC insertion sites in the scalp and neck (p=0.04), and no vancomycin administration prior to line removal (p=0.02) were independent risk factors for subsequent clinical sepsis. A single prophylactic dose of vancomycin prior to PICC line removal might reduce clinical sepsis events in infants.

Impact of Donor Human Milk in an Urban NICU Population.

The American Academy of Pediatrics recommends the use of donor human milk in infants when mother's own milk is not available. Our objective was to analyze whether the use of donor human milk in preterm, very-low-birth-weight (VLBW, <1500 g) infants affected the rates of necrotizing enterocolitis, duration of parenteral nutrition (PN), growth, culture-positive sepsis, length of hospital stay, and mortality in an urban NICU population with low exclusive breast-feeding rates. A retrospective cohort study was conducted comparing two 2-year epochs of VLBW neonates before and after the introduction of donor breast milk in our neonatal intensive care unit (NICU). With the introduction of donor human milk, there was a significant reduction in the rate of necrotizing enterocolitis (NEC) (5% vs. 13%; p = 0.04) and less severe NEC as defined by Stage III based on the Modified Bell Staging Criteria (10% to 3%; p = 0.04). In the donor milk era, there was earlier initiation of enteral feeding (2.69 days vs. 3.84; p = 0.006) and a more rapid return to birthweight (9.5 days. 10.9 days; p = 0.006). In this study, a change in practice to the use of donor breast milk in a population with low rates of human milk provision was associated with earlier initiation of enteral feeding, faster return to birth weight, and a reduced incidence of NEC.

In vitro antibiotic susceptibility of bacterial pathogens and risk factors associated with culture positive neonatal sepsis in two hospitals, Katsina metropolis, Nigeria

In vitro antibiotic susceptibility of bacterial pathogens and risk factors associated with culture positive neonatal sepsis in two hospitals, Katsina metropolis, Nigeria

A Neonatologist-Driven Antimicrobial Stewardship Program in a Neonatal Tertiary Care Center in Oman.

The overuse of antimicrobials in neonates is not uncommon and has resulted in a global health crisis of antibiotic resistance. This study aimed to evaluate changes associated with a neonatologist-driven antimicrobial stewardship program (ASP) in antibiotic usage. We conducted a pre-post retrospective cohort study in a tertiary care hospital in Oman. Neonates admitted in 2014 to 2015 were considered as the pre-ASP cohort. In 2016, a neonatologist-driven ASP was launched in the unit. The program included the optimization and standardization of antibiotic use for early- and late-onset sepsis using the Centers for Disease Control and Prevention's "broad principles," an advanced antimicrobial decision-support system to resolve contentious issues, and placed greater emphasis on education and behavior modification. Data from the years 2016 to 2019 were compared with previous data. The outcome of interest included days of therapy (DOT) for antimicrobials. Baseline characteristics and outcomes were compared using standard statistical measures. The study included 2,098 neonates in the pre-ASP period and 5,464 neonates in the post-ASP period. There was no difference in baseline characteristics. The antibiotic use decreased from 752 DOT per 1,000 patient-days (PD) in the pre-ASP period to 264 DOT in the post-ASP period (64.8% reduction, p < 0.001). The proportion of neonates who received any antibiotics declined by 46% (pre-ASP = 1,161/2,098, post-ASP = 1,676/5,464). The most statistically significant reduction in DOT per 1,000 PD was observed in the use of cefotaxime (82%), meropenem (74%), and piperacillin-tazobactam (74%). There was no change in mortality, culture-positive microbial profile, or multidrug-resistant organism incidence in the post-ASP period. Empowering frontline neonatologists to drive ASPs was associated with a sustained reduction in antibiotic utilization. · Overuse of antimicrobials is not uncommon in neonatal intensive care units.. · ASPs and infection control and prevention measures may help in decreasing antibiotic consumption and culture-positive sepsis.. · Empowering frontline neonatologists resulted in a sustained decrease in antimicrobial use without extra resources or financial burden..

Clinical importance and characteristics of secondary culture-negative sepsis after surgery for abdominal infection: A retrospective study

PurposeHerein, we identified whether the clinical outcomes differ according to secondary culture results in postoperative sepsis patients and determined the predictors of culture-negative sepsis after abdominal surgery based on the secondary culture results. MethodsPatients who admitted to the intensive care unit(ICU) after surgery due to abdominal infection and diagnosed with postoperative sepsis were included. Culture tests were obtained from body fluids and drains. Primary culture test was performed immediately after surgery, and secondary culture test was performed within 48 h to 7days after surgery. The participants were divided into the culture-positive sepsis(CPSS) and the culture-negative sepsis group(CNSS) according to culture positivity, and the clinical outcomes were compared. The predisposing factors of secondary CNSS were determined using multiple logistic regression analysis. ResultsAmong 83 participants, 51 patients (61.4%) showed secondary culture-positivity(2′CPSS) and 32 patients (38.6%) showed secondary culture-negativity(2′CNSS). ICU mortality and in-hospital mortality were not different between two groups, but the length of ICU and hospital stay were significantly longer in 2′CPSS. In multivariate analysis, non-bowel surgery [odds ratio(OR) = 6.934, 95% confidence interval(CI):1.609–29.884, p=0.009], no diabetes (OR = 4.027,95%CI:1.161–13.973, p=0.028), and the prolonged administration of preoperative antibiotics (OR = 1.187,95%CI:1.023–1.377, p=0.024) were revealed as significant predisposing factors of 2′CNSS. ConclusionMortality showed no difference according to secondary culture positivity in postoperative sepsis patients after abdominal surgery. If a patient underwent non-bowel surgery or had no diabetes or administered preoperative antibiotics for more than 3 days, the physician should pay more attention to clinical deterioration, even if the seconday culture results are negative.

Short-term outcome and complications of therapeutic hypothermia in neonates with moderate-to-severe hypoxic ischaemic encephalopathy: a single-centre retrospective observational study in a hospital in Mumbai, India

ABSTRACT Background Although shown to reduce death or disability in moderate-to-severe hypoxic ischaemic encephalopathy (HIE), therapeutic hypothermia (TH) has recently been associated with an increase in adverse events in low- and middle-income countries (LMIC). Aim To determine the clinical characteristics, complications and short-term outcome in neonates receiving TH in King Edward Memorial Hospital, Mumbai, India. Methods A retrospective single-centre study of neonates with moderate-to-severe HIE who received TH from 1 January 2018 to 31 December 2021 was undertaken. TH was provided as per the unit’s protocol using either a servo-controlled device or a phase-changing material (PCM). Results One hundred and fifty-five neonates were included with 94.2% intramural births. Mean gestation and birthweight were 38.6 (1.5) weeks and 2776.7 (431) g, respectively. HIE staging was moderate in 87.1% and severe in 12.9%, with a mean cord pH of 6.93 (0.14) and seizures in 38.7%. Adverse events included shock (50.3%), clinically significant bleeding (16%), acute kidney injury (6.7%), culture-positive sepsis (11.6%), persistent pulmonary hypertension (9%), bradycardia (9%), food intolerance (14.9%) and premature termination (7.1%). A servo-controlled device (15.5%) or PCM (84.5%) was used, with comparable adverse events. 84.5% of the neonates were discharged, 7.1% discharged against medical advice and 8.4% died. Detailed neurological assessment at discharge/discharge against medical advice suggested neurological impairment in 128 (87.1%) neonates. Conclusion Adverse events during TH range from asymptomatic laboratory abnormalities to life-threatening complications, which are manageable in well equipped units. Neurological impairment at discharge in neonates who received cooling mandates strict neurological follow-up. Abbreviations: aEEG: amplitude-integrated EEG; AKI: acute kidney injury; BW: birthweight; EEG: electro-encephalogram; GA: gestational age; HELIX: hypothermia for encephalopathy in low- and middle-income countries; HIE: hypoxic ischaemic encephalopathy; IVH: intraventricular haemorrhage; LMIC: low- and middle-income countries; NICHD: National Institute of Child Health and Human Development; NICU: neonatal intensive care unit; PPHN: persistent pulmonary hypertension of newborn; PCM: phase-changing material; SGA: small-for-gestational age; TH: therapeutic hypothermia.

Sepsis among Neonates in a Ghanaian Tertiary Military Hospital: Culture Results and Turnaround Times.

In this study, we described the bacterial profile, antibiotic resistance pattern, and laboratory result turnaround time (TAT) in neonates with suspected sepsis from a tertiary-level, military hospital in Accra, Ghana (2017–2020). This was a cross-sectional study using secondary data from electronic medical records. Of 471 neonates clinically diagnosed with suspected sepsis in whom blood samples were collected, the median TAT from culture request to report was three days for neonates who were culture-positive and five days for neonates who were culture-negative. There were 241 (51%) neonates discharged before the receipt of culture reports, and of them, 37 (15%) were culture-positive. Of 471 neonates, twenty-nine percent (n = 139) were bacteriologically confirmed, of whom 61% (n = 85) had late-onset sepsis. Gram-positive bacterial infection (89%, n = 124) was the most common cause of culture-positive neonatal sepsis. The most frequent Gram-positive pathogen was coagulase-negative Staphylococcus (55%, n = 68) followed by Staphylococcus aureus (36%, n = 45), of which one in two were multidrug resistant. The reasons for large numbers being discharged before the receipt of culture reports need to be further explored. There is a need for improved infection prevention and control, along with ongoing local antimicrobial resistance surveillance and antibiotic stewardship to guide future empirical treatment.

NEONATAL SEPSIS AND PROLONGED RUPTURE OF M EMBRANES

Background: Prolonged rupture of membranes (PROM) is considered when the duration of rupture of amniotic membranes is more than 18 hours prior to delivery. PROM is one of the common risk factors for early-onset neonatal sepsis. Timely identication of sepsis is important.The aim of the study was to determine the outcome and requirement of prophylactic use of antibiotics in newborns born to PROM. Materials &amp; methods: A retrospective study on neonates born to mothers with PROM was conducted from December 2019 to December 2020. Total of 54 neonates fullling the inclusion criteria were included and their case records were evaluated for clinical and laboratory records as well as diagnosis and outcomes. Results: Out of 54 neonates, 30(55%) were males and 24(45%) females. 28 (51%) were full term and 26(49%) were pre term. Mode of delivery was vaginal in 32 (59%), and LSCS in 22 (41%). Clinical features suggestive of sepsis were present in Twenty-eight neonates (52%). Fever was the most common symptom seen in 13(46%) neonates followed by poor feeding in 9 neonates and tachypnoea in two neonates. C- reactive protein was positive in 20 (37%) neonates with a mean CRP value being 30 mg/dl. from which 14 (70%) had clinical signs. Twelve (22%) neonates required NICU admission and culturepositive sepsis was seen in ve (9%) neonates. E. coli was isolated in three neonates while Acinetobacter baumanii in two. Only one neonate succumbed. Conclusion: Conrmed sepsis was seen in a very low proportion of neonates born to mothers with prolonged rupture of membranes. Hence early sepsis screening and follow-up of neonates with clinical features suggestive of sepsis might decrease the use of prophylactic antibiotics.

Incidence of Sepsis and Its Determinants among Neonates Admitted in Level III Neonatal Unit - A Prospective Observational Study.

Introduction: Neonates are prone for sepsis due to their immature immune system. Sepsis is preventable if we aware of the maternal and neonatal risk factors. This study aimed to identify the incidence of sepsis and its risk factors. Methods: A prospective observational study was carried out among 288 neonates in level III Neonatal unit. Convenience sampling technique was used to enroll the neonates who met the inclusion criteria. Data pertaining to neonatal and maternal demographic and clinical characteristics, incidence of sepsis, risk factors of sepsis were collected by direct observation and from medical record. Data regarding number of skin pricks for blood sample and intravenous cannulation and number of handling of the baby were collected from Tally counters. Data were analysed using chi square test, t-test and logistic regression with SPSS software version 25. Results: The incidence of sepsis was 34.7% in level III neonatal unit. Culture positive sepsis constituted 7.3%, urinary tract infection 0.3%, meningitis 7 % and probable sepsis 26.4%. Neonatal factors like extreme preterm, extreme low birth weight, gestational age, birth weight, duration of stay in level III neonatal unit, number of handling, number of skin pricks, duration of intravenous line, duration of tube feeds, mechanical ventilation and maternal premature rupture of membrane were associated with neonatal sepsis significantly. Conclusion: Incidence of neonatal sepsis can be minimized by concentrating on modifiable risk factors and implementing the protocol of minimum handling and minimal skin pricks for the neonates.

Culture-negative sepsis after pediatric cardiac surgery: Incidence and outcomes.

Significant proportion of congenital heart surgery (CHS) children exhibit sepsis, but have negative blood culture and defined "culture negative sepsis (CNS)." Retrospective analysis of CNS patients undergoing CHS. 437 consecutive CHS children grouped as controls (antibiotic prophylaxis), CNS, and culture positive sepsis (CPS). Incidences of CNS and CPS were 16% and 7%. Median mechanical ventilation (MV) in hours among CPS, CNS, and control was 116 (45-271), 63 (23-112), and 18 (6-28) (P < 0.001), respectively. Multivariable linear regression identified CPS (median ratio: 3.1 [2.3-4.1], P < 0.001), CNS (median ratio: 5.6 [3.7-8.4], P < 0.001), and weight (kg) (median ratio: 0.98 [0.96-0.99], P = 0.009) as associations of MV. Intensive care unit (ICU) stay (hours) was 192 (120-288) in CNS, 288 (156-444) in CPS, and 72 (48-120) in controls (P < 0.0001). Multivariable linear regression showed CNS (median ratio: 2.4 [2.0-2.9], P< 0.001) CPS (median ratio: 3.3 [2.5-4.4], P < 0.001), and weight (median ratio: 0.98 [0.97-0.99], P ≤ 0.001) prolonging ICU stay. Mortality was 10.7%, 2.9% and 1.2% in CPS, CNS, and control (P = 0.03). Multivariable regression identified CPS an independent predictor of mortality with odds ratio 8.6 (1.7-44.9; P = 0.010). 11.26% patients in CNS and 79.3% in CPS received antibiotics for more than 10 days. Incidence of CNS was 16%; duration of MV and ICU stay and mortality was significantly less in CNS than CPS patients.

THROMBOCYTOPENIA AMONG NEONATES HAVING CULTUREPROVEN SEPSIS AT A TERTIARY CARE HOSPITAL IN PAKISTAN

Objectives: To determine the frequency of thrombocytopenia in culture-positive neonatal sepsis. Methodology: This hospital-based cross-sectional study was conducted at a tertiary care hospital of Pakistan be­tween July to December 2021 at the Department of Pediatrics, National Institue of Child Health Karachi - Pakistan. All the neonates admitted to NICU with signs and symptoms of sepsis and positive blood culture were enrolled for this study. Complete blood count, C - reactive protein (CRP) and blood culture were sent. All the data regarding age, gender, birth weight, platelet count, and the organism isolated on blood culture was recorded in a proforma. Data was analyzed statistically and p=0.05 was considered to be statistically significant. Results: Two hundred forty-six babies were included in the study. The mean gestational age was 37±0.56 weeks and birth weight was 3.4±0.67 kg. Male to female ratio was 1.2:1 and the mean age of admission was 6.37+5.99 days. Thrombocytopenia was found in 192 (78.4%) of neonates. There was a significant association of Burkrolderia cepacia (p=0.002), Klebsiella pneumonia (p=0.032), and Serratia marcescens (p=0.027) with thrombocytopenia. Conclusions: Thrombocytopenia is strongly associated with gram-negative bacteria and the most prevalent or­ganism found in thrombocytopenic neonates was Burkrolderia cepacia.

Susceptibility Pattern of Blood Stream Infections in Neonatal Sepsis: Striking Alarm in Era of Antibiotic Resistance

Neonatal blood stream infections are significantly associated with increased morbidity and mortality in the recent years. In this study, we aim to determine the bacteriological profile and antibiotic susceptibility pattern of culture positive neonatal sepsis in the NICU of a tertiary teaching hospital in Kolkata. This retrospective study was conducted in the Department of Microbiology of a tertiary care teaching hospital in Kolkata between August, 2020 to July, 2021. All the neonates [both inborn / out born] admitted to NICU with the clinical diagnosis of sepsis during the specified period were screened for BSI. The blood was cultured in BACTAlert and analysed by VITEK 2. Out of 200 neonates with sepsis, 30 had culture positive sepsis of which 60% were Gram positive, rest were Gram negative. Staphylococcus aureus and Coagulase negative Staphylococcus (CoNS) were predominant (35.2%), Klebsiella was the predominant Gram negative organisms. Babies with birth weight ≤ 2 kg and gestational age 33 to 37 weeks were affected. Mortality was seen in 36.3% babies. Significant proportion of multidrug resistant isolates posed a great threat to neonatal survival. Hence modification of therapy based on anti-microbial surveillance pattern of the Institution with implementation of proper escalation and de-escalation of therapy is warranted. Keywords: antibiotic resistance, blood stream infections, culture positive sepsis

Restrictive prescription of antibiotics in preterm infants with premature rupture of membranes

BackgroundIn preterm infants with premature rupture of membranes, antibiotic treatment is frequently started but rates of early onset sepsis are lower. In line with national guidelines, a stratified approach in the decision to start antibiotic treatment using maternal history, clinical impression and biomarkers has been implemented in our level III neonatal center and its results are evaluated.MethodsRetrospective cohort study of all preterm newborns with rupture of membranes at least 1 h prior to delivery admitted to our tertiary neonatal intensive care unit. Data on antibiotic exposure, mortality and major neonatal complications were extracted from the electronic patient charts to evaluate the effects and safety of our stratified approach.ResultsFour hundred fifty-six infants met the inclusion criteria. 120 (26%) received primary antibiotics whereas 336 (74%) did not. Of those receiving primary antibiotics, 13 (11%) had a blood culture positive sepsis, 46 (38%) met the criteria of clinical sepsis and in 61 (51%) sepsis was ruled out and antibiotics were stopped after 48-96 h. All infants with blood culture positive sepsis were identified and treated within the first 24 h of life using this approach. None of the 336 infants who were not started on antibiotics primarily needed antibiotic therapy within the first 5 days of life. There were no deaths or major neonatal complications in the group that did not receive empiric antibiotics.ConclusionsOur stratified approach for preterm infants with premature rupture of membranes allows a safe reduction of antibiotic exposure even in this high risk population. As a result, only 25% of high risk preterm newborns are treated with antibiotics of which more than half receive less than 5 days of treatment. To treat one infant with blood culture positive sepsis, only 9 infants receive empiric antibiotics.

Identification of potential risk factors for the poor prognosis of neonatal sepsis.

Background and aimRisk factor-based approach is one of the best approaches employed by middle income countries which are not well facility driven for any disease management. Thus, through this approach, we aim to identify the potential risk factors responsible for the poor outcome in neonatal sepsis.MethodsA case control was conducted retrospectively with neonates admitted to Neonatal Intensive Care Unit during January 2012 to December 2016. Cases were identified using ICD-10 Code from inpatient medical records and demographic, maternal and neonatal details were collected from the medical files. Logistic regression was performed to identify the risk factors associated with mortality in neonatal sepsis.ResultsA total of 613 neonates were found to have culture positive sepsis from the 4690 neonates admitted in the Neonatal Intensive Care Unit (NICU). There was a total of 831 episodes in the 613 neonates. The mortality rate in neonates with sepsis was found to be 25.4%. Extremely low birth weight (OR 6.171, CI 3.475–10.957), extreme preterm (OR 5.761, CI 2.612–12.708), very preterm (OR 2.548, CI 1.607–4.042), preeclampsia (OR 1.671, CI 1.091–2.562), acute renal failure (OR 4.939, CI-2.588–9.426), coagulopathy (OR 2.211, CI-1.486–3.289), septic shock (OR 173.522, CI-23.642–1273.59), thrombocytopenia (OR 5.231, CI-3.310–8.268), leukopenia (OR 2.422, CI- 1.473–3.984), CRP > 24 (OR 2.099, CI-1.263–3.487) and abnormal absolute neutrophil count (OR 2.108, CI-1.451–3.062) were some of the significant predictors, identified through risk-based approach, in assessing mortality in neonatal sepsis.ConclusionRisk-based approach applied was successful in determining plausible important predictors such like extreme low birth weight, extreme preterm, resistance against gram negative infections, preeclampsia, septic shock, hypotension, leukopenia, neutropenia, thrombocytopenia in predicting mortality in neonatal sepsis. These potential risk factors, identified through risk- based approach, can play a pivotal role in assisting clinician to make appropriate and judicious decision.

Aetiology, antimicrobial susceptibility and outcome of children with sepsis, admitted at Muhimbili National Hospital, Dar es Salaam.

Introductionsepsis is defined as a systemic inflammatory host response syndrome (SIRS) to infection, commonly bacterial. The global prevalence of sepsis is 8.2% with a mortality rate of 25%, whilst in Tanzania the prevalence is 6.6%. Treatment of sepsis involves early initiation of antibiotics based on local sensitivity patterns. However, there is an increase in antimicrobial resistance to commonly used antibiotics. Hence to promote rational use of antibiotics, we aimed at establishing the etiology, local susceptibility patterns and outcome of children with sepsis aged 2 months to 15 years, admitted at Muhimbili National Hospital (MNH), Dar es Salaam.Methodsa hospital based prospective cross sectional study was conducted among 245 participants who were consecutively recruited. A standardized structured questionnaire was used to collect information. Blood cultures and complete blood counts were done. Antimicrobial susceptibility was also done on positive cultures using disc diffusion method. Data were analyzed using SPSS version 20. Frequencies and proportions were used to summarize categorical data, whilst median and interquartile range was used to summarize continuous data. Student T test was used to compare means of data which were normally distributed and the differences in proportions were tested using Chi square test or Fisher’s exact test. A p value of = 0.05 was considered to be statistically significant.Resultsthere was predominance of male participants (67.5%) with a median age was 2 years and an interquartile range (IQR) 10 months to 4 years. Culture positive sepsis was detected among 29.8% of the participants, and the common Gram-positive bacterial isolates were S. aureus (39.7%) Coagulase Negative Staphylococcus (CoNS) (35.6%) and Gram-negative isolates were E. coli (12.3%), Klebsiella spp (6.8%) and Pseudomonas aeruginosa (5.5%). All bacteria showed a high resistance to ampicillin (80%- 100%) followed by ceftriaxone (40 - 70%). All Pseudomonas aeruginosawere 100% resistant to ampicillin, gentamycin and ceftriaxone but were sensitive to amikacin. There was less than 40% resistance to co-amoxiclav, meropenem, ciprofloxacin, amikacin, and clindamycin. The overall case mortality rate from sepsis was 9.4%. Among children discharged 59.3% had prolonged hospital stay of more than 7 days. Age group 1 to 5 years, prior use of antibiotics, tachycardia, and leukocytosis were significantly associated with high mortality.Conclusionbacterial sepsis is prevalent at Muhimbili National Hospital contributing to 9.4% of mortality and a prolonged hospital stay of more than 7 days among 59.3% of the participants. Gram-positive bacteria were found to be predominant cause of sepsis, whereas both Gram-positive and Gram-negative bacteria had a high resistance to first and second line antimicrobials including: ampicillin, gentamycin, and ceftriaxone.