Culture-proven Sepsis Research Articles

Markedly raised levels of C-reactive protein are associated with culture-proven sepsis or necrotising enterocolitis in extremely preterm neonates.

目的 C反应蛋白( C－reactive protein，CRP)明显升高提示严重的炎症反应过程，研究新生儿CRP>100 mg/L时病因和结果的关系。 方法 回顾性分析一个三级新生儿病房2007年1月至2011年12月277例CRP超过100 mg/L的患儿。 结果 研究期间6 025例住院新生儿，258例CRP至少一次>100 mg/L。总体病死率是44/258(17%)；在7 d内死亡的36例患儿CPR>100 mg/L，其中34例是极早产儿。106例患儿在生后3 d之内CRP超过100 mg/L －足月74例，早产25例，极早产7例，81%没有确切感染。相比之下，生后4天之后的171例患儿中87%存在感染－极早产129例，早产23例和足月19例－主要是凝固酶阴性葡萄球菌脓毒症和坏死性小肠结肠炎。 结论 生后3 d之内CRP显著升高主要在没有感染(81%)的足月儿中(74/106)，生后4 d之后CRP >100 mg/L的主要为极早产儿(129/171)，多数(87%)为感染性原因。

Glucosuria as an early marker of late-onset sepsis in preterms: a prospective cohort study.

BackgroundEarly and accurate diagnosis of late-onset sepsis (LONS) in preterm infants is difficult since presenting signs are subtle and non-specific. Because neonatal sepsis may be accompanied by glucose intolerance and glucosuria, we hypothesized that glucosuria may be associated with LONS in preterms, in an early stage. We aim to evaluate the association of glucosuria and late-onset neonatal sepsis (LONS) in preterm infants, in an attempt to improve early and accurate diagnosis of LONS.MethodsWe performed a prospective observational cohort study in 316 preterms (<34 weeks). We daily measured glucosuria and followed patients for occurrence of LONS, defined as clinical and blood culture-proven sepsis occurring after 72 h. Attending physicians were blinded to glucosuria results. We assessed the diagnostic value of glucosuria for clinical and blood culture-proven LONS using logistic regression analysis.ResultsGlucosuria was found in 65.8 % of 316 preterm patients, and sepsis was suspected 157 times in 123 patients. LONS was found in 47.1 % of 157 suspected episodes. The presence of glucosuria was associated with LONS (OR 2.59, 95 % CI 1.24–5.43, p = 0.012) with sensitivity 69.0 % and specificity 53.8 % (Likelihoodratio 1.49). After adjustment for gestational age, birth weight, and postnatal age, this association weakened and was no longer significant (adjusted OR 2.16; 95 % CI 0.99–1.85, p = 0.055). An increase in glucosuria 48–24 h before onset of symptoms was not associated with LONS.ConclusionIn preterms glucosuria is associated with LONS within 24 h, however this association is too weak to be of diagnostic value.

Relationship between Self-Reported Maternal Substance Abuse and Adverse Outcomes in the Premature Newborn.

This study aims to compare neonatal and long-term outcomes among preterm newborns from women with reported versus those who did not report substance abuse. Secondary analysis of a trial of magnesium sulfate for cerebral palsy prevention. Cases were pregnant women who reported substance abuse, controls were those who denied it. Study outcomes included (1) composite neonatal morbidity, defined as any of the following: Apgar score ≤ 3 at 5 minutes, seizures, culture-proven sepsis, necrotizing enterocolitis grades 2 or 3, intraventricular hemorrhage grades 3 or 4, and/or death before discharge; (2) infant and childhood morbidity, defined as stillbirth or death by 1 year, or moderate/severe cerebral palsy by age of 2. Among 1,972 women meeting the inclusion criteria, 197 (10%) reported substance abuse. Composite neonatal, infant, and childhood morbidity rates were similar between cases and controls. However, women reporting substance abuse who delivered between 32(0/7) and 36(6/7) weeks had a higher frequency of composite infant and childhood morbidity (6.5 vs. 1.0%; adjusted odds ratio, 6.5; 95% confidence interval, 1.14-36.99). Preterm birth was associated with similar composite neonatal morbidity between cases and controls. After 32 weeks, self-reported substance abuse was associated with a sevenfold increase in the rates of stillbirth and long-term infant morbidity.

Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein (≦10 mg/L).

BackgroundElevated C-reactive protein (CRP) level is widely used in clinical practice as a marker to distinguish between neonates with or without sepsis. However, some neonates with bacteremia have a CRP level within the normal range and they are not well characterized.MethodsAll episodes of neonatal culture-proven bloodstream infections (BSIs) between July 2004 and June 2012 were enrolled. Patients characteristics were compared for three CRP groups (low, ≤ 10 mg/L; intermediate, 11–100 mg/L; and high, > 100 mg/L) using the Chi-square test and one-way ANOVA. The sepsis-attributable mortality rates were compared using logistic regression analyses.ResultsOf 986 episodes of neonatal BSI, 247 (25.1 %) had CRP ≤10 mg/L at the onset of clinical sepsis. In the low CRP group, patients had lower gestational age and birth weight, and an earlier occurrence of BSI. Patients with underlying gastrointestinal pathology, renal disorders, cholestasis, and pulmonary hypertension had a non-significant elevated CRP level at the onset of sepsis. In the blood culture of the low CRP group, coagulase-negative staphylococci (CoNS) were relatively more common (55.9 %, p < 0.001) than the other two groups, although one-fourth were infected with gram-negative bacilli (19.0 %), fungi (2.8 %), or polymicrobial pathogens (3.6 %). Of the BSIs with initial low CRP, 29.1 % were treated with inadequate antibiotics, 13.0 % progressed to septic shock, and 5.3 % had infectious complications. The sepsis-attributable mortality rate was lower in the low CRP group (4.9 %) than in the high CRP group (13.6 %).ConclusionsA considerable proportion of neonatal BSIs had a normal or low initial CRP level (≤10 mg/L), which was more likely to occur in low birth weight or extremely preterm infants, those with earlier onset of sepsis, and those infected with CoNS. Plasma CRP level should not be used to rule out severe culture-proven sepsis or guide the empirical choice of antibiotics.

Efficacy of Bovine Lactoferrin Supplementation in Preventing Late-onset Sepsis in low Birth Weight Neonates: A Randomized Placebo-Controlled Clinical Trial.

To evaluate the efficacy of bovine lactoferrin (BLF) in preventing first episode of late-onset sepsis (LOS) in low birth weight (LBW) neonates. In this study conducted from May 2012 to July 2013 in the neonatal intensive care unit (NICU) of a tertiary care hospital, inborn asymptomatic neonates, <2000 g, admitted to NICU in first 12 h of birth with no maternal risk factors for sepsis were randomized to receive BLF or placebo from 1st to 28th day of life. The incidence of culture-proven sepsis and sepsis-attributable mortality after 72 h of life was recorded. Increasing doses of BLF were used with higher birth weights. Incidence of first episode of culture-proven LOS was significantly lower in the BLF group vs. placebo [2/63 (3.2%) vs. 9/67(13.4%); risk ratio, 0.211; 95% CI, 0.044-1.019; p = 0.036]. Statistically significant reduction in the sepsis-attributable mortality was also seen after use of prophylactic BLF [0/63 (0%) vs. 5/67 (7.5%); p = 0.027]. BLF supplementation in LBW neonates reduced the incidence of first episode of LOS.

Neonatal sepsis in a rapidly growing, tertiary neonatal intensive care unit: Trends over 18 years

We investigated changes in the admission patterns of neonatal intensive care units and the epidemiology of neonatal sepsis following the rapid expansion and improvements in neonatal intensive care. Data on the admission of neonates with culture-proven sepsis between 1996 and 2013 (period I, 1996-2005; period II, 2006-2013) were collected retrospectively. The admission of extremely low-birthweight (ELBW) infants increased between periods I and II (11.1 vs 28.7 infants per 1000 live births, P < 0.001). The survival rate of the ELBW infants improved (57.5 vs 80.1%, P < 0.001), and duration of hospital stay increased (median, 64 vs 80 days, P = 0.001). The incidence of sepsis among all infants and ELBW infants increased (all infants, 5.9 vs 12.7 cases per 1000 live births; ELBW infants, 189.5 vs 290.1 cases per 1000 live births). In ELBW infants, the incidence of sepsis caused by coagulase-negative Staphylococcus (CONS), significantly increased during period II (8.8 vs 25.4%, P = 0.039). On multivariate analysis, central vascular catheters and prolonged hospitalization were independently associated with increased sepsis rate, particularly CONS in ELBW infants. The inborn admission rate for ELBW infants has increased significantly and is accompanied by improved survival and longer hospital stay. The incidence of neonatal sepsis, particularly in ELBW infants, has also increased, and CONS has emerged as a major pathogen. Central vascular catheters and prolonged hospitalization could be independent risk factors for the increased sepsis rate, particularly sepsis due to CONS.

Outcome of neonates with severe hyperbilirubinemia in a tertiary level neonatal unit of North India

ObjectivesThe primary objective was to determine the outcome, in terms of mortality and development of bilirubin encephalopathy, of neonates with severe hyperbilirubinemia. The secondary objective was to determine the possible risk factors for development of acute bilirubin encephalopathy (ABE). MethodsConsecutive neonates of >35 weeks gestation admitted to Neonatal Intensive Care Unit (NICU) with a serum bilirubin >20mg% in first 72h of life or >25mg% later were enrolled in the study. The clinical and demographic characteristics of the neonates were recorded. Neonates were treated with phototherapy and exchange transfusion as required.Outcome in terms of mortality and development of bilirubin encephalopathy was noted. Discharged neonates were followed at 1, 3, and 6 months for chronic bilirubin encephalopathy (CBE). ResultsOut of 64 neonates enrolled, 28 (44%) were admitted with ABE. Four with ABE left against medical advice. Out of 60 neonates studied, 5 (8.3%) expired. A total of 17 (89.5%) neonates of ABE group and 25% of all neonates developed CBE on follow-up. A lower weight on admission (2254.68+417g vs 2481.75+369g; p=0.0195), ABO/Rh incompatibility (odds ratio 4.00; 95% CI: 1.13–14, p=0.030), a positive Coomb's test (odds ratio 5.7; 95% CI: 1.53–21.4, p=0.0096), culture-proven sepsis (odds ratio 16; 95% CI: 0.82–312, p=0.067), and normal vaginal delivery (odds ratio 5.5; 95% CI: 1.1–27.4, p=0.037) were found to be significant risk factors for development of ABE. ConclusionNearly half of the neonates admitted in a tertiary care NICU with severe hyperbilirubinemia had features of ABE on admission. The risk was more if they were born vaginally, had a lower weight on admission, had blood group incompatibility with positive Coomb's test, and had sepsis.

Randomized controlled trial of lactoferrin for prevention of sepsis in peruvian neonates less than 2500 g.

Lactoferrin (LF) is a broad-spectrum antimicrobial and immunomodulatory milk glycoprotein. To determine the effect of bovine LF on the prevention of the first episode of late-onset sepsis in Peruvian infants. We conducted a pilot randomized placebo-controlled double blind study in infants with a birth weight (BW) less than 2500g in 3 Neonatal Units in Lima. Patients were randomized to receive bovine LF 200mg/kg/d or placebo for 4 weeks. One hundred and ninety neonates with a BW of 1591 ± 408 g and a gestational age of 32.1 ± 2.6 weeks were enrolled. Overall, 33 clinically defined first late-onset sepsis events occurred. The cumulative sepsis incidence in the LF group was 12/95 (12.6%) versus 21/95 (22.1%) in the placebo group, and 20% (8/40) versus 37.5% (15/40) for infants less than or equal to 1500 g. The hazard ratio of LF, after adjustment by BW, was 0.507 (95% CI: 0.249-1.034). There were 4 episodes of culture-proven sepsis in the LF group versus 4 in the placebo group. Considering that children did not received the intervention until the start of oral or tube feeding, we ran a secondary exploratory analysis using time since the start of the treatment; in this model, LF achieved significance. There were no serious adverse events attributable to the intervention. Overall sepsis occurred less frequently in the LF group than in the control group. Although the primary outcome did not reach statistical significance, the confidence interval is suggestive of an effect that justifies a larger trial.

Antimicrobial therapy in neonatal intensive care unit.

Severe infections represent the main cause of neonatal mortality accounting for more than one million neonatal deaths worldwide every year. Antibiotics are the most commonly prescribed medications in neonatal intensive care units (NICUs) and in industrialized countries about 1% of neonates are exposed to antibiotic therapy. Sepsis has often nonspecific signs and symptoms and empiric antimicrobial therapy is promptly initiated in high risk of sepsis or symptomatic infants. However continued use of empiric broad-spectrum antibiotic treatment in the setting of negative cultures especially in preterm infants may not be harmless.The benefits of antibiotic therapy when indicated are clearly enormous, but the continued use of antibiotics without any microbiological justification is dangerous and only leads to adverse events. The purpose of this review is to highlight the inappropriate use of antibiotics in the NICUs, to exam the impact of antibiotic treatment in preterm infants with negative cultures and to summarize existing knowledge regarding the appropriate choice of antimicrobial agents and optimal duration of therapy in neonates with suspected or culture-proven sepsis in order to prevent serious consequences.

Markedly raised levels of C-reactive protein are associated with culture-proven sepsis or necrotising enterocolitis in extremely preterm neonates.

A serious inflammatory process is suspected when C-reactive protein (CRP) is very high, and we established the causes and outcomes when CRP was >100 mg/L in neonates. We retrospectively reviewed all 277 episodes where CRP exceeded 100 mg/L between January 2007 and December 2011 at a tertiary neonatal unit. Of the 6025 neonates admitted during the study period, 258 had CRP >100 mg/L at least once. The overall mortality rate was 44/258 (17%); 36 died within 7 days of CRP >100 mg/L, and 34 were extremely preterm infants. CRP exceeded 100 mg/L in 106 infants within the first 3 days of life - 74 term, 25 preterm and seven extremely preterm - with no infection identified in 81%. In contrast, infections were found in 87% of the 171 episodes from day four of life - 129 extremely preterm, 23 preterm and 19 term - predominantly coagulase-negative staphylococcus sepsis and necrotising enterocolitis. Markedly elevated CRP in the first 3 days of life was most likely to affect term neonates (74/106) with no infectious cause (81%). However, CRP >100 mg/L from the fourth day of life was most likely to affect extremely preterm neonates (129/171) and have an infectious cause (87%).

Prospective surveillance of antibiotic use in the neonatal intensive care unit: results from the SCOUT study.

Prolonged or unnecessary antibiotic use is associated with adverse outcomes in neonates. Our objectives were to quantify all antibiotic use in a Level-III neonatal intensive care unit and to identify scenarios where their use could be reduced. Surveillance and evaluation of all antibiotic use provided to every infant admitted to a Level-III neonatal intensive care unit from 10/3/11 to 11/30/12 was performed. Types of antibiotics, reasons for their initiation, discontinuation and duration, as well as clinical, laboratory and outcome data were recorded. Antibiotic use was quantified by days of therapy (DOT) per 1000 patient-days (PD). A total of 1607 infants were included. The total antibiotic use was 9165 DOT (343.2 DOT/1000 PD; 5.7 DOT/infant). Seventy-two percent of infants received 1 (43%) or more (29%) courses of antibiotics. Gentamicin (46%), ampicillin (39%) and oxacillin (8%) were the most frequently used agents. Ninety-four percent of antibiotic use (323 DOT/1000 PD) was empiric therapy for suspected infection. Sixty-three percent (216.2 DOT/1000 PD) was discontinued at approximately 48 hours when cultures were sterile (68%>48 hours, 32%≤48 hours). Twenty-six percent of all antibiotic use (89.4 DOT/1000 PD) was therapy for ≥5 days despite sterile cultures; pneumonia (16%) and "culture-negative" sepsis (8%) were the major contributors. Five percent (17.4 DOT/1000 PD) of antibiotic use was for culture-proven sepsis, 5% (16.6 DOT/1000 PD) was penicillin prophylaxis for group B Streptococcus and 1% (3.5 DOT/1000 PD) was preprocedural prophylaxis. Narrow-spectrum therapy accounted for >92% of antibiotic use and would not be monitored by most stewardship programs. Only 5% of antibiotic usage was due to culture-proven infection. Pneumonia and "culture-negative" sepsis were frequent reasons for prolonged therapy; further study of these conditions may allow reduction in treatment duration.

Clinico-bacteriological profile of neonatal septicemia in a tertiary care hospital

Introduction: Neonatal septicemia is a major cause of mortality and morbidity. Surviving neonates can have significant neurologic sequelae, septic shock or hypoxemia. The spectrum of bacteria that cause neonatal septicemia varies in different parts of the world. The management of these infections is being complicated by the emergence of antibiotic resistance. The aim of this study was to determine the etiology, clinical characteristics and outcome of neonatal septicemia cases. Materials and Methods: During a 1-year study, 257 clinically suspected cases of neonatal sepsis were enrolled and classified as early onset septicemia (EOS) and late onset septicemia (LOS) based on appearance of signs and symptoms, i.e. within or after 72 h, respectively. Blood culture was performed using BACTEC 9240, isolates were identified by standard techniques and antibiotic susceptibility was performed as per the CLSI guidelines. Risk factors associated with neonatal sepsis were recorded and analyzed with respect to culture-proven sepsis. Results: In both suspected and culture-proven sepsis cases, majority of the neonates were male, pre-term and low birth weight babies. The prevalence of EOS and LOS was 82.4% and 17.5%, respectively. Culture positivity was seen in 7.8% of the cases. In culture-proven septicemia, 55% neonates presented with EOS and 45% presented with LOS. Gram positive isolates were more as compared with Gram negative isolates. The most common isolates were S. aureus, S. epidermidis and E. coli. All Gram positive isolates were sensitive to vancomycin and linezolid, while carbapenems and polymyxin B were the most effective drugs in the Gram negative isolates. Mortality was higher in LOS as compared with EOS cases, and the difference was statistically significant. Conclusion: Gram positive pathogens were predominant in septicemia. Vancomycin and linezolid were the most effective antibiotics for Gram positive isolates and carbapenems for most effective Gram negative organisms.

Antibiotic administration for prevention or treatment of meconium aspiration syndrome in neonates: A systematic review

Objectives: To conduct a systematic review of the clinical trials evaluating the role of antibiotics for prevention or treatment of meconium aspiration syndrome (MAS). Methods: We searched several electronic databases including MEDLINE, EMBASE, CINAHL, SCOPUS (until September 2013), and CENTRAL (until August 2013). Additional citations were retrieved from the bibliographies of the selected articles. Studies were included if they were: Randomized or quasi-randomized trials, compared use of antibiotics with no antibiotics for treatment or prevention of MAS, and reported on clinical outcomes in the neonatal period. Results: Four randomized controlled trials (RCTs) were identified; three studies enrolled subjects for treatment of MAS and one study evaluated the prophylactic use of antibiotics in infants exposed to meconium stained amniotic fluid (MSAF). These trials enrolled 695 infants, with the duration of antibiotics between 3 and 7 days. All studies excluded subjects considered to be at higher risk for neonatal sepsis at onset. There were no differences noted for the outcomes of infection rates (relative risk [RR] [95% confidence interval: 0.85 [0.42, 1.73] for clinical sepsis, and 0.93 [0.36, 2.40] for culture-proven sepsis), need for mechanical ventilation (RR: 1.39 [0.68, 2.82]), air leaks syndrome (RR: 1.65 [0.68, 3.99]), hospital stay (mean difference − 0.34 days [−1.13, 0.45]), or mortality (RR: 1.25 [0.36, 4.39]) between the intervention and control groups. Conclusions: In neonates at low-risk for sepsis, insufficient evidence exists to support the routine use of antibiotics following exposure to MSAF or for the treatment of for suspected MAS. We discuss the implications and limitations of review findings for clinical practice.

Clinical, Bacteriological Profile &amp; Outcome of Neonatal Sepsis in a Tertiary Care Hospital

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

Chlorhexidine – a novel intervention to decrease the nursery stay and antibiotic exposure duration – randomized trial

Objective: To study the effect of chlorhexidine (CHD) application on umbilical cord and evaluate its impact on duration of NICU stay and antibiotic exposure days.Method: We enrolled 140 newborns in our study (70 in intervention group and 70 in control group), and their data were collected. Newborns in control group were given routine umbilical cord care, and intervention group received CHD spray on umbilical cord three times a day and for the next three days of cord fall. In this study, swabs were sent from umbilical cord at the age of three and seven days of life for culture. Data regarding culture-proven sepsis, duration of NICU stay and antibiotic days were recorded in the proforma for data collection.Results: This is a secondary analysis of the data of the randomized control trial. A significant reduction in duration of nursery stay was seen in CHD group in comparison with control group (12.4 ± 5.38 d versus 14.7 ± 6.62 d, p = 0.04, significant). Significant reduction was also seen in days of antibiotic exposure in the intervention group (9.74 ± 6.88 d versus 12.1 ± 7.78 d, p = 0.04, significant).Conclusion: Application of CHD to umbilical cord shortens duration of nursery stay and antibiotic days during nursery admission. This simple intervention may be used as mode in places where nursery facilities are limited, as aid in early discharge and shortening the exposure to antibiotic, which may help in reducing the prevalence of multidrug-resistance microbes. This cheap intervention may also be effective in reducing the economical burden on the health infrastructure of the country and parents.

486: Temporizing management versus termination of pregnancy in women with severe preeclampsia at 28-34 weeks (TOTEM-Trial)

To investigate the hypothesis that temporising treatment of women with early-onset, severe preeclampsia does not improve infant outcome as compared to immediate delivery after corticosteroid treatment. In this multicenter randomized clinical trial (TOTEM NTR 2986), we included women between 28+0 and 34+0 weeks of gestation after admission for severe preeclampsia with or without HELLP syndrome. Participants were randomly allocated for delivery 48 hours after admission or for expectant management. The primary outcome was adverse perinatal outcome, defined as perinatal death, severe respiratory distress syndrome, bronchopulmonary dysplasia, culture proven sepsis, intraventricular hemorrhage, periventricular leukomalacia, and necrotising enterocolitis. Major maternal complications was a secondary outcome. Power analysis estimated 1130 women needed to rule out an increase in adverse perinatal outcome with at most 5%. Analysis by intention to treat. The trial was closed after 24 months because of low recruitment. Fifty-six women from nine hospitals were randomised, 30 allocated to temporizing management and 26 to immediate delivery. Gestational age at randomisation was 30 weeks in both groups. Adverse perinatal outcome rate was 55% versus 50% in the immediate delivery vs. expectant group, RR 1.1 (95% CI 0.68-1.8). Median prolongation of pregnancy was 1 day (IQR 0-1 days) in the immediate delivery group and 3 days (IQR 2-5 days) in the expectant group (p<0.01). Reason for delivery in the expectant group was 19/30 (63%) maternal and 11/30 (37%) fetal. In both groups 1 baby died. Mean birth weight was 1417 g after immediate delivery versus 1289 g after expectant management (p=0.10). There were no maternal deaths. There was one women who suffered pulmonary edema and one women who had an abruption, both in the expectant group. This trial showed that in women with early-onset, severe preeclampsia, the possibility to postponed delivery is limited.

A Randomized Case-Controlled Study of Recombinant Human Granulocyte Colony Stimulating Factor for the Treatment of Sepsis in Preterm Neutropenic Infants

To investigate the efficacy and safety of recombinant human granulocyte colony-stimulating factor, recombinant human granulocyte-macrophage colony-stimulating factor (rhG-CSF) to treat sepsis in neutropenic preterm infants. Fifty-six neutropenic preterm infants with suspected or culture-proven sepsis hospitalized in Zeynep Kamil Maternity and Children's Educational and Training Hospital, Kozyatağı/Istanbul, Turkey between January 2008 and January 2010 were enrolled. Patients were randomized either to receive rhG-CSF plus empirical antibiotics (Group I) or empirical antibiotics alone (Group II). Clinical features were recorded. Daily complete blood count was performed until neutropenia subsided. Data were analyzed using SPSS version 11.5. Thirty-three infants received rhG-CSF plus antibiotic treatment and 23 infants received antibiotic treatment. No drug-related adverse event was recorded. Absolute neutrophil count values were significantly higher on the 2(nd) study day and 3(rd) study day in Group I. Short-term mortality did not differ between the groups. Treatment with rhG-CSF resulted in a more rapid recovery of ANC in neutropenic preterm infants. However, no reduction in short-term mortality was documented.

Is bacteremic sepsis associated with higher mortality in transplant recipients than in nontransplant patients? A matched case-control propensity-adjusted study.

Sepsis is a serious complication of solid organ transplant (SOT). Evidence on survival differences between SOT recipients and non-SOT patients with sepsis is lacking. This was a matched, case-control propensity-adjusted study. Conditional logistic regression was performed for risk factor analysis, and Cox proportional hazards regression for survival analysis. Three hundred sixty-nine patients (123 cases; 246 controls) diagnosed with blood culture-proven sepsis were matched 1:2 by age, sex, and hospital location. The distribution of allografts was 36.6% kidney, 34.1% liver, 13% kidney-pancreas, 7.3% small bowel/liver, 5.7% heart/lung, and 3.3% multivisceral. The conditional logistic regression showed that the following factors were significantly more frequently associated with SOT compared to non-SOT: higher number of comorbidities (odds ratio [OR] = 8.2 [95% confidence interval {CI}, 1.48-45.44], P = .016); higher Sepsis-related Organ Failure Assessment score (OR = 1.2 [95% CI, 1.07-1.32], P = .001); presence of nosocomial infection (OR = 36.3 [95% CI, 9.71-135.96], P < .0001); appropriate initial antibiotics (OR = 0.04 [95% CI, .006-.23], P < .0001); and lower white blood cell count (OR = 0.93 [95% CI, .89-.97], P < .0001). Cox proportional hazards regression showed that after all adjustments for clinical presentation, severity of illness, and types of infection, SOT recipients with sepsis had a significantly lower risk of death at 28 days (hazard ratio [HR] = 0.22 [95% CI, .09-.54], P = .001) and at 90 days (HR = 0.43 [95% CI, .20-.89], P = .025). The 28-day and 90-day mortality were significantly decreased for transplant recipients compared with nontransplant patients. These findings suggest that the immunosuppression associated with transplantation may provide a survival advantage to transplant recipients with sepsis through modulation of the inflammatory response.

PO-0518 The Incidence And The Microbial Pattern Of Neonatal Sepsis In Jordan

Introduction Neonatal sepsis is a common and potentially serious neonatal disease especially in preterm babies and more complicated in developing countries. Objectives To study the incidence and the microbial pattern of neonatal sepsis in our unit in Amman/Jordan. Method A retrospective study of all newborn cases admitted to our NICU as suspected sepsis over a 4-year period, 2001–2004 analysing the results of blood cultures. Results The total number of newborns delivered in our NICU over a 4-year period was 25715. - 819 (3.2%) babies were admitted as suspected sepsis. *616(75%) were full term babies. *203 (25%) were preterm babies (28 to 36 weeks) - The total culture- proven cases (positive blood cultures) were 51 (6.2%).out of which 21(40%) cases were preterm babies. So culture-proven sepsis was found in about 10% of preterm babies and in about 5% of full term babies who were admitted as suspected sepsis. - The overall incidence of sepsis was 2 per 1000. - Gram negative organisms recovered in 32 cases (63%),mainly Klebsiella species in 21 cases (40%), E.coli in 7(14%)and Pseudomonas in 4 cases (8%). - Gram positive cases were 19(37%) : Staphylococci aureus in 7 cases, Staph. Epidermidis in 4, GBS in 5 and Strept.viridans in 3 cases. The mortality among all culture-proven cases was 2 cases (4%). Conclusion - A bout 3.2% of all newborns were admitted as suspected sepsis. - Only 6% of suspected cases of sepsis were proven culture positive-The overall incidence of neonatal sepsis in our unit is 2/1000. - Klebsiella species is the commonest pathogen isolated in our NICU.

PS-212 Epidemiology Of Neonatal Sepsis In Switzerland – Results From The Swiss Paediatric Sepsis Study

Background and aims Neonatal infection is a major cause of morbidity and mortality. The ongoing Swiss Paediatric Sepsis Study prospectively evaluates the epidemiology of blood culture-proven sepsis in newborns and children in Switzerland. Methods Newborn infants admitted to nine Swiss neonatal intensive care units (NICUs) and presenting with culture-proven sepsis between 9.2011–2.2014 were prospectively enrolled. Early-onset sepsis (EOS) was defined as infection occurring. Results We identified 189 episodes of blood culture-proven sepsis in 186 patients. Thirty seven episodes were classified as EOS and 152 episodes were classified as LOS. Median gestational age at birth was 34 weeks for EOS, and 28 weeks for LOS. Mortality was 14% in EOS and 9% in LOS. Forty six percent of patients required mechanical ventilation during the sepsis episode, and 4% required catecholamine treatment for arterial hypotension. Group B Streptococcus (GBS) and Escherichia coli were the most frequently isolated pathogens in EOS, accounting for 35% and 16% of episodes. Coagulase-negative staphylococci were the leading pathogens in LOS (36%), followed by Staphylococcus aureus (18%), Escherichia coli (16%), and GBS (11%). The proportion of hospital-acquired LOS due to Coagulase-negative staphylococci, Staphylococcus aureus and Escherichia coli varied between 10–68%, 0–45% and 0–30% in different NICUs. Conclusions This national study confirms that neonatal sepsis continues to cause high morbidity and significant mortality. GBS is the most common cause of EOS. There are important differences in the aetiology of LOS in different institutions.