Fungal Sepsis Research Articles

Clinical spectrum and outcomes of fungal sepsis in neonates in the two neonatal intensive care unit of Bangladesh: a prospective observational study

Clinical spectrum and outcomes of fungal sepsis in neonates in the two neonatal intensive care unit of Bangladesh: a prospective observational study

A Chart Review for Epidemiology and Outcome of Fungal Bloodstream Infections Among Neonates in a Tertiary Care Hospital at North India

Background and Aims The risk of fungal bloodstream infection (BSI) and accompanying mortality in neonates varies widely in between centres depending on the region, the population characteristics and the risk factors. Methods This chart review of neonatal cases with fungal BSI admitted in a tertiary care teaching hospital in North India aimed to comprehensively investigate the epidemiology, profile of fungal species (and their susceptibility to various antifungal agents), risk factors, clinical profile and outcomes in these neonates. The study spanned over a one-year period, from September 2022 to August 2023, included all symptomatic neonates with positive blood cultures for fungal pathogen. Results Over one year, 24 out of 1,174 neonates at risk were diagnosed with fungal BSI, with a cumulative risk of 2.0 per 100 neonates. A peak in cases occurred in February. Candida pelliculosa was the predominant species (75% of isolates), while Candida albicans constituted 4.2%. Most isolates were sensitive to fluconazole, except for some fluconazole-resistant Candida pelliculosa (5.5%) and Candida tropicalis (25.0%), which remained susceptible to amphotericin-B and voriconazole. Around 60% of neonates were preterm, 40% had very low birth weight and 37% were small for gestational age. Nearly all had received prior broad-spectrum antibiotics, with 92% receiving prolonged courses over five days. Respiratory support, including intubation and mechanical ventilation, was used in 83% before onset of fungal sepsis. Intriguingly, all neonates had some invasive device in place for more than seven days. Mortality rate of 25% was observed, with preterm birth and gastrointestinal anomalies contributing to adverse outcomes. Conclusions This study confirms the ongoing shift in trend from albicans to non-albicans Candida infections in our region as well. A seasonal peak of fungal sepsis noted in the month of February hinted at potential seasonal variation or lapses in infection control practices during colder months. The analysis of trends in fungal BSI might hold a significance within neonatal intensive care units (NICUs) for the prompt detection of outbreaks. Simultaneously, understanding and analysing risk factors associated with fungal BSI are essential for targeted prevention.

Rice bran oil supports robust growth of the commensal fungus Malassezia

Malassezia are lipophilic budding yeasts that thrive on natural lipid sources. They are found on the skin, scalp, and upper back of humans and other warm-blooded animals, due to the high sebaceous gland activity in these regions that support their growth. They generally thrive as commensals and, upon certain not-so-well-defined conditions, transform into pathogenic states, giving rise to dermatological diseases and, at times, systemic infections. The studies for identifying the role of Malassezia in causing disease are severely hampered due to the lack of suitable growth media. Because of the challenges associated with isolation, there have been cases reported of undetectable fungal sepsis and often misdiagnosis for the same reason. The media routinely used for culturing yeast is supplemented with lipids. This study aimed to show that an inexpensive oil supplement like rice bran can support the growth of Malassezia, and SDA media supplemented with rice bran oil gave commendable growth of the budding yeast, better than the traditionally used olive oil-supplemented media. Therefore, rice bran oil can be used as a lipid supplement in the culture medium for the isolation, and maintenance of lipophilic yeasts. Our study again signifies the importance of media in microbiological research and stresses the need to develop better growth substrates for difficult-to-culture organisms like Malassezia and this will aid in molecular taxonomy, species characterization and phylogenetic studies.

Changing Patterns of Organisms Causing Neonatal Sepsis and Their Antimicrobial Sensitivity Profile in a Tertiary Center - A Prospective Study.

To identify the profile of organisms causing neonatal sepsis and their antibiotic susceptibility pattern in recent years. In this prospective study, authors included neonates with blood culture proven sepsis. Antibiotic resistance patterns that were identified were extended spectrum β-lactamase, AmpC β-lactamase and possible carbapenamase producer. Xpert CARBA-R test was performed to identify genes causing carbapenem resistance. There were 210 neonates with 216 episodes of blood culture proven sepsis. Klebsiella pneumoniae (n = 85) and Escherichia coli (n = 19) were the most common gram-negative organisms. Coagulase negative Staphylococcus (n = 11) and Staphylococcus aureus (n = 7) were the mostcommon gram positive organisms. There were 17 episodes of fungal sepsis with Candida albicans (n = 6) being the most common. Sixty-five out of 216 (30%) organisms were multidrug resistant. Among the Klebsiella isolates, 32/85 (37.6%) were possible carbapenamase producers. Xpert CARBA-R performed for 13 infants showed that all were positive for New Delhi metallo-β-lactamase. Among the 19 Escherichia coli, 10/19 (37.6%) were multidrug resistant and 1/19 (5.3%) was a possible carbapenamase producer. The authors found a significant increase in New Delhi metallo-β-lactamase positive Klebsiella pneumoniae causing neonatal sepsis in last three years. Regular monitoring of resistance patterns and prudent use of antimicrobials are imperative in regulating the shadow pandemic of multi-drug resistant neonatal sepsis.

Infective Endocarditis due to Unusual Pathogens Complicated with Pulmonary Thromboembolism: A Rare Occurrence in a Premature Infant

Background: Survival of low birth weight preterm neonates has increased with the availability of better neonatal care, however, the use of central lines for longer duration increases the risk of bacterial and fungal sepsis. Neonatal infective endocarditis (IE) is a rare presentation of neonatal sepsis and is often associated with complications and high mortality. Clinical Description: A 36 weeker, premature baby, hospitalized for early onset sepsis, was transferred to our hospital on day 15 of life, with an umbilical catheter in situ, with fever, respiratory distress, and persistent thrombocytopenia. Clinical examination revealed decreased oxygen saturation, crepitations in the right lung field, systolic murmur, and hepatomegaly. Management and Outcome: Baseline investigations revealed positive septic screen with thrombocytopenia with meningitis, neonatal cholestasis, and right sided consolidation on chest X ray. A two dimensional echocardiography (ECHO) revealed vegetation on the tricuspid valve, and blood culture from two sites revealed growth of Candida tropicalis and Serratia marcescens. Colistin, tigecycline, and amphotericin B therapy were initiated as per sensitivity along with low molecular weight heparin for prevention of embolization. The baby developed acute worsening in respiratory distress after 4 weeks of therapy. Repeat ECHO revealed increased size of cardiac vegetation and computed tomography of thorax with pulmonary angiography revealed pulmonary thromboembolism. Unfortunately, the baby succumbed to complications of IE. Conclusion: Invasive instrumentations such as umbilical catheterization and prolonged hospitalizations of premature newborns predispose them to develop IE, especially with unusual organisms. Such infections have a complicated course and may be fatal.

Diagnostic Values of Blood Indices for Neonatal Sepsis

Background: Sepsis is the leading cause of death in newborns, particularly in underdeveloped countries. Early diagnosis and appropriate treatment are critical in reducing neonatal mortality. Since blood culture results are often unavailable for 48 - 72 hours, other hematologic findings may provide useful information for early diagnosis. Objectives: We examined the relationship between neonatal sepsis and blood indices in order to achieve early diagnosis. Methods: In this hospital-based retrospective multiple-event case-control study, we allocated the neonates into three groups: Culture-positive sepsis, culture-negative sepsis, and neonates without sepsis. We compared the lab data within these three groups. Results: The study included 319 neonates: 209 cases of culture-positive sepsis, 65 cases of culture-negative sepsis, and 45 cases without neonatal sepsis. Pearson's test demonstrated a significant correlation between thrombocytopenia, positive C-reactive protein (CRP), and high cell distribution width with culture-positive sepsis (P = 0.000), indicating a statistical difference between the three groups. The mean CRP and eosinophil levels were higher in the culture-positive group with fungal sepsis. Conclusions: In septic neonates with high CRP levels, particularly in conjunction with eosinophilia, fungal coverage should be considered.

Vitamin C: Rationale for Its Use in Sepsis-Induced Acute Respiratory Distress Syndrome (ARDS).

Acute respiratory distress syndrome (ARDS) is a life-threatening event that occurs in patients suffering from bacterial, fungal, or viral sepsis. Research performed over the last five decades showed that ARDS is a consequence of severe unrestrained systemic inflammation, which leads to injury of the lung's microvasculature and alveolar epithelium. ARDS leads to acute hypoxic/hypercapnic respiratory failure and death in a significant number of patients hospitalized in intensive care units worldwide. Basic and clinical research performed during the time since ARDS was first described has been unable to construct a pharmacological agent that will combat the inflammatory fire leading to ARDS. In-depth studies of the molecular pharmacology of vitamin C indicate that it can serve as a potent anti-inflammatory agent capable of attenuating the pathobiological events that lead to acute injury of the lungs and other body organs. This analysis of vitamin C's role in the treatment of ARDS includes a focused systematic review of the literature relevant to the molecular physiology of vitamin C and to the past performance of clinical trials using the agent.

Pathogen-wise Clinical Profile, Outcome and Antibiotic Sensitivity Profile of Septic Newborns in Level III Neonatal Intensive Care Unit of a Tertiary Teaching Hospital: A Retrospective Study

Introduction: Culture positive sepsis remains to be a leading cause of death in Neonatal Intensive Care Unit (NICU) mainly among preterm and low birth weight newborns. The objective was to analyze the initial signs of sepsis, antibiotic sensitivity, and outcome of septic newborns in NICU. Methods: The demographic data, initial clinical features at suspicion of sepsis, diagnosis, laboratory abnormalities, pathogen isolated and antibiotic sensitivity patterns of the septic neonates, and their outcome were documented from their case records. Results: A total of 161 culture positive septic newborns, 76.4% were preterm and 54 died of sepsis (33.54%). Early and late onset sepsis was seen in 56 and 109 neonates, respectively. The initial clinical findings at suspicion of sepsis which had a statistical significance were tachycardia in Escherichia coli and Pseudomonas sepsis, hyperglycemia in Burkholderia, fever in Candida, sclerema in Klebsiella pneumoniae (KP), and seizures in E. coli sepsis. The cerebrospinal fluid culture positive newborns commonly presented with apnea, poor perfusion, and lethargy. Raised C reactive protein was seen in a higher proportion of newborns with Candida (60%) sepsis and E. coli (50%) sepsis. Severe thrombocytopenia was seen in 53%–62% newborns with gram-negative and fungal sepsis. Metabolic acidosis was seen in all gram-negative sepsis neonates, particularly in >80% cases of Klebsiella and Candida sepsis. Mortality was highest and statistically significant in KP (55.4%) and Citrobacter koseri (55.6%) sepsis ( p = .004). The statistically significant risk factors for mortality included neonates with raised C Reactive Protein (CRP). Most of the gram-negative pathogens were sensitive to colistin and aminoglycosides and resistant to carbapenems. Conclusion: Observing the initial clinical features at suspicion of sepsis may help predicting the likely pathogen awaiting the final blood/CSF culture report and knowing the antibiotic sensitivity profile of commonly isolated organisms in our NICU helps in the selection of a rational empirical antibiotic.

Tumor necrosis factor-α inhibitor for successful treatment of toxic epidermal necrolysis with severe infection: a case series.

Toxic epidermal necrolysis (TEN) is a rare severe cutaneous adverse reaction that involves more than 30% of the body surface area. TEN can be accompanied by a series of systemic symptoms and has a high risk of death. Tumor necrosis factor (TNF)-α inhibitors such as adalimumab and etanercept have been shown to be safe and effective for the treatment of TEN in some cases. However, clinical data on the use of TNF-α inhibitors to treat TEN with severe systemic infection are scarce. In the present study, three adult patients who developed TEN with serious active infection were successfully treated with etanercept. One of the three patients had active open pulmonary tuberculosis, and the other two had septicemia and/or fungal sepsis. All patients' skin lesions significantly improved after several days, and none of the patients developed emerging or re-emerging infectious diseases, adverse reactions, or a similar rash during follow-up. TNF-α inhibitors may be an effective treatment choice for TEN with severe systemic infection. However, further studies with large samples are still required for validation because clinical experience is limited.

Parasitic and Fungal Triggers of Cytokine Storm Syndrome.

Infections caused by parasites and fungi can trigger the cytokine storm syndrome (CSS). These infections causing CSS can occur together with acquired immunodeficiencies, lymphomas, the use of immunosuppressive medications, transplant recipients, cancer, autoinflammatory, and autoimmune diseases or less frequently in healthy individuals. Histoplasma, Leishmania, Plasmodium, and Toxoplasma are the most frequent organisms associated with a CSS. It is very important to determine a previous travel history when evaluating a patient with a CSS triggered by these organisms as this may be the clue to the causal agent. Even though CSS is treated with specific therapies, an effort to find the causal organism should be carried out since the treatment of the infectious organism may stop the CSS. Diagnosing a CSS in the presence of parasitic or fungal sepsis should also lead to the study of an altered cytotoxic or hemophagocytic response in the susceptible host.

Successful Liver Retransplantation in a Patient With Disseminated Aspergillosis and Nocardiosis: A Case Report

Clinical guidelines list active fungal infection and sepsis as contraindications to liver transplantation due to the risk of worsening infection with immunosuppression postoperatively. Mortality from systemic opportunistic infections in transplant recipients is high, approaching 100% for disseminated aspergillosis. However, the optimal duration of treatment required before transplant is unclear. Additionally, delaying surgery while the infection is treated risks death from hepatic decompensation and physical deconditioning, preventing progression to transplantation. Here, we present a patient who underwent successful repeat liver transplantation for recurrent autoimmune hepatitis and graft rejection while undergoing treatment for disseminated aspergillosis and nocardiosis. He had pulmonary, hepatic, and central nervous system involvement. He had received 2 months of antimicrobials but had ongoing radiologic evidence of infection when listed for retransplantation. He remains well and infection-free 1 year postoperatively. Few cases of successful liver transplantation in the setting of disseminated aspergillosis have been reported previously. To our knowledge, this is the first successful liver transplant in a patient with disseminated nocardial infection.

No Critical Ultrasound, No Life: The Value of Point-of Care Critical Ultrasound in the Rescue of Critically Ill Infants.

Point-of-care critical ultrasound (POC-CUS) screening plays an increasingly important role in the treatment of critically ill infants. Without POC-CUS, the lives of many infants would not be saved in time and correctly. A premature infant with systemic multiple organ system dysfunction caused by fungal sepsis was treated and nursed under the guidance of POC-CUS monitoring, and the infant was ultimately cured. This premature infant had systemic multiple organ system dysfunction and disseminated intravascular coagulation (DIC) caused by fungal sepsis. In the hypercoagulable state of early-stage DIC, cardiac thrombosis could be found using ultrasound screening. For this case, right renal artery thrombosis was found via renal artery Doppler ultrasound examination. Due to the severity of this disease, ultrasound-guided peripherally inserted central catheter (PICC) insertion and ultrasound checks of the PICC tip's position were performed, which ensured the success of this one-time catheterization and shortened the catheterization time. Lung ultrasound is used for the diagnosis and differential diagnosis of pulmonary diseases, and to guide the application of mechanical ventilation. Because the abdominal circumference of the patient's markedly enlarged abdominal circumference, bloody stool, and absence of bowel sounds, abdominal ultrasonography was performed, which revealed a markedly enlarged liver, significant peritoneal effusion, and necrotizing enterocolitis. Guided by POC-CUS monitoring, we had the opportunity to implement timely and effective treatment that ultimately saved this critically ill patient's life. The successful treatment of this newborn infant fully reflects the importance of carrying out POC-CUS screening.

Factors associated with the response to postnatal dexamethasone use in very low birthweight infants: a nationwide cohort study

BackgroundDexamethasone is widely used as a systemic corticosteroid to treat and prevent bronchopulmonary dysplasia (BPD) in preterm infants. We evaluated the current epidemiology of dexamethasone use to prevent BPD and...

Outcomes of Neutropenic Patients with Severe Infections Treated with Granulocyte Transfusions: The USC Experience

Introduction Despite major progress in antimicrobial and supportive measures, prolonged disease-associated or treatment-related neutropenia is a leading cause of mortality and morbidity in patients after stem cell transplantation or with hematologic malignancies or bone marrow failure. Intuitively, a granulocyte transfusion should be as effective as a platelet or red cell transfusion. However, efforts to prove the effectiveness of granulocyte transfusions have been disappointing. Due to the lack of adequately powered randomized controlled trials, it is difficult to prove or refute the effectiveness of granulocyte transfusions in neutropenic patients. Therefore, they are likely underutilized or used inappropriately as a last resort. To better understand the utility of this treatment modality, we reviewed the outcomes of patients with hematologic conditions who received granulocyte transfusions at our institutions during the treatment of neutropenic sepsis. Methods We identified 20 patients with severe neutropenia who received a granulocyte transfusion at Norris Comprehensive Cancer Center or Keck Hospital of USC in Los Angeles, California between 2014-2022. 19 of these patients received a total of 166 transfusions for treatment of suspected or confirmed sepsis. One patient received a prophylactic dose of granulocytes and was excluded from this study. Granulocyte donors were mobilized with 480 mcg G-CSF and a minimum yield of 4 x 10 10 granulocytes was obtained. The primary outcome was attainment of “clinical improvement” defined as either safe discharge from the hospital or resolution of symptoms. Descriptive statistics were presented as counts and percentages for categorical variables and as means with standard deviations for continuous variables. Categorical variables were accessed by Chi-square test or Fischer's exact test when appropriate. For continuous variables, Kruskal-Wallis test was used. P-values of ±0.05 were regarded as significant and all tests were two-tailed and analyzed with SAS (9.4). Results In our cohort, 47.4% were male, ages ranged from 20-70, and 57.9% identified as Hispanic. The most common diagnosis was acute myeloid leukemia (AML) (n=13), followed by aplastic anemia (n=3), myelodysplastic syndrome (MDS) (n=2), and acute lymphoblastic leukemia (ALL) (n=1). The most common infections were fungal or presumed fungal (n=9) and mixed fungal and bacterial (n=7). Prior to the start of granulocyte transfusions, 63.2% of patients were neutropenic (ANC <500) for at least 30 days and 84.2% had an absolute neutrophil count (ANC) <100. In surviving patients, the average number of days from the first transfusion to clinical improvement was 17.5 days. 47.4% of patients had a reported reaction to the granulocytes, with the most common being fever and tachycardia. Of the 19 patients treated, seven (37%) died from infection. Of those who died, two (29%) died from E. coli bacteremia and five (71%) from mixed bacterial and fungal sepsis. All nine patients with acute fungal infections without concomitant bacterial infections survived. Conclusion In this cohort, granulocyte transfusions appear to have had a positive effect with 63% of critically ill patients attaining clinical improvement from infection. All patients who had a purely fungal infection achieved clinical improvement and all patients who died had bacterial or mixed infection. Time to transfusion from initial infection, number of transfusions, and demographic variables did not appear to impact overall survival. Granulocyte transfusion could be an effective therapeutic modality in the treatment of infection in patients with prolonged severe neutropenia, especially those with fungal infections. Adequately powered randomized controlled trials are the next step in determining the effectiveness of this treatment.

Abstract 17064: Reversible Myocardial Depression and Dilatation in COVID-19 Shock Patients

Introduction: A characteristic pattern of bacterial and fungal septic shock is decreased left ventricular ejection fraction (LVEF) and modest dilatation of the left ventricle. In survivors, the myocardial depression and dilatation are reversible within several days. Using echocardiography, we have previously reported a cohort of COVID-19 shock patients with reduced LVEF. We now report serial studies of COVID-19 shock patients. Hypothesis: Myocardial dysfunction and dilatation associated with COVID-19 are reversible. Methods: In COVID-19 patients with shock requiring vasopressors who underwent echocardiography, left ventricular ejection fraction (LVEF) by Simpson’s rule and stroke volume by doppler were analyzed. Based on the LVEF and CI, patients were categorized into groups with low or normal values using EF 45% and CI 2.2 liters/minute/meter as the respective thresholds. A subset of 18 patients underwent serial echocardiography which were performed at a median of 13(9,39) days after the initial. The LVEF and LV volumes recorded during initial and follow-up echo were analyzed retrospectively using paired t-testing. Results: Comparing initial with follow-up values, the mean LVEF was 34.7(2.0) vs 43.8(3.47), p=0.01, indexed stroke volume 29.6(1.9) ml vs 31.7(2.3) ml, p=0.52, LV end-diastolic volume 182(14.1) ml vs 152.1(12.9) ml, p=0.03 and LV end-systolic volume 120.2(13.1) ml vs 90.1(12.1) ml, p=0.03 respectively (see Figure). Conclusions: Serial echocardiographic studies of COVID-19 shock patients with reduced LVEF and ventricular dilatation demonstrate reversibility of myocardial depression and dilation with no change in stroke volume, a finding strikingly similar to that seen in bacterial and fungal induced septic shock. Thus, COVID-19 (viral) induced septic shock may have a similar pathogenetic mechanism of myocardial dysfunction to that seen with bacterial or fungal sepsis.

Клінічний випадок успішного лікування пацієнта з перфорацією дивертикула сигмовидної кишки, ускладненого сепсисом на тлі COVID-19

описано випадок успішного лікування пацієнта, у якого після перенесеного COVID-19виникла перфорація дивертикула сигмовидної кишки, що ускладнилась перитонітом та сепсисом,спочатку бактеріальним, потім грибковим. На фоні проведеної консервативної терапії в перед іпісляопераційному періоді та частого застосування нестероїдних протизапальних препаратів,зокрема метамізолу натрію у хворого розвинулась важка лейкопенія та тромбоцитопенія, щобули частково рефрактерними до глюкокортикоїдів. Через відсутності можливості призначеннярекомбінантних факторів росту у даного пацієнта був застосований нестандартний підхід якийполягав у призначенні ціанокобаламіну в комбінації з фолієвою кислотою, що в комплексі з іншимизаходами дозволили нормалізувати рівень лейкоцитів та тромбоцитів.

Profile of neonatal candidiasis in tertiary neonatal intensive care unit: A report from a developing country.

Systemic candidiasis is an important nosocomial infection in neonatal intensive care units. The objective of this study was to identify the change in the profile of neonatal candidiasis in a tertiary neonatal intensive care unit (NICU) in eastern India in recent times. It was a retrospective review of case records from 2014 to 2019 from a tertiary NICU of eastern India. Data of the fungal sepsis, demographic details, risk factors of fungal sepsis and mortality were collected from 103 neonates. One hundred and three neonates had blood culture positive for fungal species of which 91 (88.3%) infants weighed ≥1500 g and 66 (64%) infants were term. There was significant higher incidence of candidiasis among outborn (Relative risk of outborn 18.84, 95% CI 10.74-33.05). Prolonged antibiotic usage (>14 days), meropenem usage (>5 days), central catheterization (>5 days), invasive mechanical ventilation (>5 days), surgical intervention were found in 64 (62.1%), 46 (44.6%), 31(30.0%), 40 (38.8%) and 39 (37.8%) infants. Non albicans candida (NAC) was isolated as the predominant species (82/103, 79.6%). Resistance to both of fluconazole and amphotericin B were found in 19 (18.4%) babies. Presence of NAC infection and resistance to both amphotericin B and fluconazole were independent predictors of candida associated mortality in NICU. Neonatal candidiasis is found among outborn infants with higher birth weight and gestational age. NAC species are predominant organisms with resistance to common antifungal drugs.

Antimicrobial Resistance Pattern and Empirical Antibiotic Treatments in Neonatal Sepsis: A Retrospective, Single-Center, 12-Year Study.

Neonatal sepsis is an important cause of morbidity and mortality in neonatal intensive care units (NICUs). Continuous evaluation of antimicrobial resistance (AMR) profiles is advised to implement antimicrobial stewardship (AMS) programs and establish effective empiric antibiotic protocols. AMS may reduce AMR in NICUs and improve sepsis outcomes. In this retrospective observational study, we report data on culture-positive neonatal sepsis, assessing differences after the implementation of an AMS program (2011-2016 vs. 2017-2022). A total of 215 positive bacterial cultures from 169 infants were retrieved, with 79 early-onset (36.7%) and 136 late-onset (63.3%) sepsis episodes. Frequent causative agents for early-onset sepsis were S. agalactiae and E. coli, all susceptible to empiric treatment. Late-onset sepsis was mainly caused by Enterobacterales and S. aureus. Aminoglycosides, cefotaxime, and piperacillin-tazobactam resistance among Enterobacterales was substantially low; S. aureus was mostly susceptible to oxacillin and vancomycin. There were no differences in mortality and multidrug-resistant pathogens rates between the two study periods. There were five episodes of fungal late-onset sepsis, mostly due to C. albicans, of which one was fatal. The microbial distribution pattern and AMR profiles overlapped with other European studies. Because susceptibility patterns are rapidly changing worldwide, with the emerging threat of Methicillin-resistant S. aureus and extended-spectrum beta-lactamases producers, infection prevention and control practices and AMS strategies require continuous optimization to limit selection pressure and AMR escalation.

Evaluation of the relationship between procalcitonin level and the causative pathogen in intensive care patients with sepsis.

Aim: This study was designed to investigate how procalcitonin (PCT) levels are affected by different pathogens in patients with sepsis. Materials & methods: A total of110 Gram-positive sepsis, 62Gram-negative sepsis and 27 fungal sepsis patients were included in the study. Kaplan-Meier and ROC curve analysis was performed to assess PCT levels. Results: PCT levels were 2.36ng/ml in Gram-negative patients, 0.79ng/ml in Gram-positive patients and 0.89ng/ml in fungal patients. The area under the curve for PCT was 0.608, the cutoff value was 1.34, sensitivity was 56.50%the specificity was 56.50%. Conclusion: PCT survival levels of 7.71ng/ml in Gram-negative patients, 2.65ng/ml in Gram-positive patients and 1.16ng/ml in fungal patients can be evaluated to predict survival.

Antimicrobial Resistance Patterns Among Neonates Referred to Pediatric Emergency in North India: A Prospective Cohort Study.

Sepsis is a leading cause of neonatal mortality worldwide, with a disproportionately high burden in low-income and middle-income countries. There is limited prospective data on microorganism profiles and antimicrobial resistance (AMR) in outborn newborns referred to pediatric emergency in developing countries. We aimed to assess the pathogen profile and AMR patterns in outborn neonates referred to the pediatric emergency at a tertiary care center. In this prospective cohort study, we enrolled neonates with suspected sepsis and sent blood or cerebrospinal fluid cultures. Neonates were followed up daily until discharge or death. The isolated organisms were identified and tested for antimicrobial susceptibility. Standard definitions were used to define multidrug resistance. Between January 1, 2020, and December 31, 2020, 1072 outborn neonates with suspected sepsis were enrolled. The rate of proven sepsis was 223.6 (95% CI:198.7-248.4) per 1000 infants. Gram-negative sepsis was the most common (n = 107,10%), followed by gram-positive sepsis (n = 81,7.6%) and fungal sepsis (n = 67,6.3%). Coagulase-negative staphylococci (n = 69), Candida spp. (n = 68), Klebsiella spp. (n = 55), Acinetobacter spp . (n = 31) and Escherichia coli (n = 9) were the most common pathogens. Over two-thirds (68.6%) of pathogens were multidrug resistance, with an alarming prevalence in Klebsiella spp. (33/53, 62%), Acinetobacter spp. (25/30, 83%) and coagulase-negative staphylococci (54/66, 82%). In total, 124 (11.6%) neonates died in the hospital (13.3% of proven cases and 11.1% of culture-negative sepsis cases). High sepsis burden and alarming AMR among neonates referred to tertiary care centers warrant urgent attention toward coordinated implementation of rigorous sepsis prevention measures and antimicrobial stewardship across all healthcare levels.