Outcome Of Neonatal Sepsis Research Articles

Racial and Ethnic Disparities in Neonatal Sepsis.

Sepsis is a significant health burden in the neonatal population. Although disparities in neonatal care have been reported, there are no data on racial/ethnic disparities in the context of sepsis. Therefore, we aimed to assess racial/ethnic disparities in the prevalence and outcomes of neonatal sepsis. The national inpatient Kids' Inpatient Database produced by the Healthcare Cost and Utilization Project was used for the year 2019. The International Classification of Diseases, 10th revision codes were used to identify the primary outcome of the neonates diagnosed with sepsis. The χ2 and Fisher tests were used to calculate odds ratios for categorical variables, and logistic regression was performed to calculate adjusted odds ratio (aOR) to account for confounders in neonatal sepsis. Of the total 3,512,817 patients, 202,103 patients with neonatal sepsis were identified across all racial and ethnic groups. Overall prevalence was statistically significant in Black [aOR, 1.13 (95% confidence interval [CI], 1.10-1.17)], Hispanic [aOR, 1.19 (95% CI, 1.15-1.22)], Asian/Pacific Islander [aOR, 1.10 (95% CI, 1.05-1.16)] and Native Americans [aOR, 1.17 (95% CI, 1.04-1.31)] compared with Whites. In Black infants, the OR for the overall mortality was 1.35 (95% CI, 1.28-1.42), and sepsis-related mortality was 1.20 (95% CI, 1.06-1.35) compared to Whites. Although the prevalence of sepsis is marginally higher in Hispanic infants compared with Whites, the overall and sepsis-related mortalities are the highest in Black infants compared with all races and ethnic groups.

Epidemiology and Outcomes of Neonatal Sepsis: Experience from a Tertiary Australian NICU

Introduction: Neonatal sepsis is associated with significant mortality and morbidity. Low-middle-income countries are disproportionately affected, but late-onset sepsis (LOS) still occurs in up to 20% of infants <28 weeks in high-income countries. Understanding site-specific data is vital to guide management. Methods: A retrospective cohort study was conducted at King Edward Memorial Hospital (KEMH), Perth. Infants admitted between January 2012 and June 2022 were included. Data were extracted from routine electronic databases. Incidence and aetiology of sepsis were determined and the association of sepsis with neonatal outcomes analysed. Results: During the study period, 23,395 newborns were admitted with a median gestation of 37 weeks and birth weight of 2,800 g. There were 370 sepsis episodes in 350 infants; 102 were early-onset sepsis (EOS) (1.6 per 1,000 live births), predominantly Streptococcus agalactiae (35, 34.3%) and Escherichia coli (27, 26.5%); 268 were LOS (0.9 per 1,000 inpatient days), predominantly coagulase-negative staphylococci (CONS) (156, 57.6%) and E. coli (30, 11.1%). The incidence of LOS declined from 2012 to 2022 (p = 0.002). Infants with EOS had increased brain injury (25.7% vs. 4.1%; p = 0.002) and mortality (18.8% vs. 1.6%; p < 0.001). Those with LOS had increased hospital stay (median 95 vs. 15 days; p < 0.001), mortality (15.3% vs. 1.6%; p = 0.018), necrotising enterocolitis (NEC) (7.4% vs. 0.5%; p < 0.001), and chronic lung disease (CLD) (58.1% vs. 5.9%; p = 0.005). Infants <28 weeks with sepsis were at increased risk of neurodevelopmental impairment compared to those without infection (43.2% vs. 30.9%, p = 0.027). Conclusions: While we observed a reduction in LOS incidence, sepsis remains associated with higher mortality, and in survivors with longer hospital stay and increased risk of brain injury, NEC, CLD, and neurodevelopmental impairment.

Bacterial pathogens and treatment outcomes in neonatal sepsis: A comparative observational study across various hospital settings

Bacterial pathogens and treatment outcomes in neonatal sepsis: A comparative observational study across various hospital settings

A practical predictive model to predict 30-day mortality in neonatal sepsis.

Neonatal sepsis is a serious disease that needs timely and immediate medical attention. So far, there is no specific prognostic biomarkers or model for dependable predict outcomes in neonatal sepsis. The aim of this study was to establish a predictive model based on readily available laboratory data to assess 30-day mortality in neonatal sepsis. Neonates with sepsis were recruited between January 2019 and December 2022. The admission information was obtained from the medical record retrospectively. Univariate or multivariate analysis was utilized to identify independent risk factors. The receiver operating characteristic curve was drawn to check the performance of the predictive model. A total of 195 patients were recruited. There was a big difference between the two groups in the levels of hemoglobin and prothrombin time. Multivariate analysis confirmed that hemoglobin>133 g/L (hazard ratio: 0.351, p=0.042) and prothrombin time >16.6 s (hazard ratio: 4.140, p=0.005) were independent risk markers of 30-day mortality. Based on these results, a predictive model with the highest area under the curve (0.756) was built. We established a predictive model that can objectively and accurately predict individualized risk of 30-day mortality. The predictive model should help clinicians to improve individual treatment, make clinical decisions, and guide follow-up management strategies.

Clinical, Bacteriological Profile and Outcome of Neonatal Sepsis.

Sepsis is a major cause of morbidity and mortality among neonates in Nepal. This study was conducted to determine the clinical-bacteriological profile, their antibiotic susceptibility patterns, and clinical outcome of culture-positive neonatal sepsis. This was a prospective study conducted at B.P Koirala Institute of Health Sciences from July 2018 to June 2019. Neonates with clinically diagnosed sepsis having blood culture positive were included in the study. Blood samples culture and antimicrobial susceptibility testing were performed with the standard microbiological method. Demographic, clinical information, and clinical outcomes were documented. The incidence of culture-positive sepsis was 10.3% (183/1773) of neonatal admissions. Poor feeding 85(46%) and fever 68(37%) were the common clinical features at presentation. The incidence of early-onset sepsis and late-onset sepsis were found to be 116 (63%) and 67(37%) respectively. Staphylococcus aureus was the common pathogen in both early-onset 61(49%) and late-onset 34(41%) sepsis. The incidence of multidrug-resistant cases was 41% (75/183) with 20% (15/75) extensively drug-resistant gram-negative bacilli, 36% (20/75) multidrug-resistant gram-negative bacilli, and 44% (33/75) Methicillin-resistant Staphylococcus aureus cases. In-hospital mortality rate was 12 (7%) with a higher frequency in multidrug-resistant sepsis 92% (11/12) than non- multidrug-resistant 8% (1/12). The median hospital days were longer in multidrug-resistant cases than non- multidrug-resistant [11(9-13) verses 3(2-5)]. The incidence of multidrug-resistant pathogens causing neonatal sepsis is high at our hospital and are associated with more in-hospital mortality and longer hospital stay. Implementation of effective preventive strategies to combat the emergence of antimicrobial resistance is immediately needed.

Frequency, Bacteriological Profile, and Outcome of Neonatal Sepsis with Carbapenem-Resistant Gram-Negative Bacteria at the Tertiary Neonatal Intensive Care Unit, Ahvaz, Iran

Background: One of the leading causes of neonatal mortality in low- and middle-income countries (LMICs) is neonatal sepsis caused by carbapenem-resistant gram-negative bacteria. Objectives: This study aimed to determine the frequency, bacterial profile, and outcome of carbapenem-resistant Gram-negative neonatal sepsis in southwest Iran. Methods: This 15-month retrospective cross-sectional descriptive study was conducted at a level 3 referral training hospital. The study included all neonates hospitalized from birth who had positive blood cultures for Gram-negative bacteria. Patients were divided into carbapenem-resistant and carbapenem-sensitive groups. Results: During the study, Gram-negative bacteria were isolated from the blood cultures of 113 neonates. Positive Gram-negative bacteria blood cultures and carbapenem-resistant cases were 2.38% and 1.52%, respectively. In these cases, 66 (58.4%) of the infants were males, 100 (88.4%) were preterm, and 74 (65.4%) required mechanical ventilation within the first three days of life. The study found 45 (39.8%) infants with early-onset sepsis. Acinetobacter was the most common isolated organism, while Enterobacter had the lowest isolation rate. Carbapenem resistance was discovered in 72 (63.7%) positive blood cultures. Acinetobacter had the highest prevalence of carbapenem resistance, while Pseudomonas had the lowest. Mortality rates in infants infected with carbapenem resistance bacteria (CRB) were 89.3% compared to 10.7% in those infected with carbapenem-sensitive bacteria (CSB). Conclusions: The frequency of carbapenem-resistant Gram-negative sepsis in our ward was 1.52 percent of all admissions, and Acinetobacter bacteria was the most common cause of this type of neonatal sepsis. Infants infected with CRB had a higher mortality rate than those infected with CSB, 89.3% versus 10.7%.

Frequency of Thrombocytopenia and Associated Mortality in Neonates with Neonatal Sepsis

Aim: To assess the frequency of thrombocytopenia and associated mortality in neonates with neonatal sepsis. Methodology: This descriptive study was designed to identify the frequency of thrombocytopenia in neonates and conducted at Nazir Hussain Medical Complex KKF Hospital Hyderabad from 1st September 2022 to 28th February 2023 after ethical clearance through the institutional review committee. This study enrolled 190 neonates which were admitted in NICU with the diagnosis of neonatal sepsis. All those neonates under 28 days of age and having a positive blood culture reports were included. A 3cc whole blood was drawn from each neonate by a nursing staff in a single pick and blood test including haematological markers (haemoglobin, platelet count) and infection markers (white blood cells, neutrophil%, Lymphocyte%, C-reactive proteins and Erythrocyte sedimentation rate) were analyzed. Results: There were 60% male neonates while rest 40% were females. About 44.78% had a weight between 2.5-3.5kg. The mean platelet count was 182.95±156 x109/L whereas lymphocytes% mean value was 41.81±11.0% with a very high ESR reported as 21.08±14.2mm/hour. The frequency of thrombocytopenia was observed in 129(67.89%) neonates wherein it was observed as severe in 35(18.4%) neonates and the frequency of mortality was observed as fourfold increased in the cases of thrombocytopenia. Practical Implication: Factors like age, low birth weight, platelet count and severity of thrombocytopenia are related with outcomes of neonatal sepsis among neonates. Conclusion: There is a high frequency of thrombocytopenia within the cases of neonatal sepsis. The mortality is higher in cases with severe thrombocytopenia. Keywords: Frequency, Thrombocytopenia, Associated mortality, neonate, neonatal sepsis

Role of perfusion index and plethysmography variability index for predicting outcomes in neonatal sepsis.

(i) To compare perfusion index (PI) and plethysmography variability index (PVI) between neonates with proven or probable sepsis versus no-sepsis, (ii) to examine an association of PI and PVI with in-hospital mortality. We enrolled neonates with clinically presumed sepsis. Culture-proven or probable sepsis were categorised as 'cases' and no-sepsis as 'controls'. PI and PVI were recorded hourly for 120 h and averaged in 20-time epochs (0-6 h to 115-120 h). We analysed 148 neonates with sepsis (proven sepsis = 77, probable sepsis = 71) and 126 with no-sepsis. Neonates with proven/probable sepsis and no-sepsis had comparable PI and PVI values. Among 148 neonates with sepsis, 43 (29%) died. Non-survivors had significantly lower PI values than survivors (mean difference 0.21 [95% CI 0.14-0.29], p-value <0.001). PI had a significant but modest discriminative ability to identify non-survivors. However, PI did not independently predict mortality. Neonates with proven/probable sepsis and no-sepsis had comparable PI and PVI values in the first 120 h of sepsis. PI but not PVI values were significantly lower in non-survivors than survivors. PI did not independently predict in-hospital mortality. Due to modest discriminative ability, PI should be interpreted along with other vital signs to take clinical decisions.

Risk Factors and Microbiological Outcome in Neonatal Sepsis: A Clinical Study

Infection is the predominant cause of neonatal deaths universally. Neonatal deaths (30-50%) every year is caused due to sepsis. Due to nosocomial infections and their associated morbidities, cost and mortality, betterment of neonatal outcomes is complicated as hospitals in developing countries are at major risk for the transmission of infection. The present study aimed to analyse sepsis risk factors and microbiological outcome in the NICU and post-natal ward. The study diagnosed the affected neonates as earliest possible so that suitable antibiotic treatment can be done without adding to the burden of antibiotic resistance. In this study, 94% of babies with neonatal sepsis were discharged and 6% of babies succumbed to the illness. Low birth weight between 1500-2500 grams was noted as an important contributing factor to sepsis in babies. PROM was found to be greater than 18 hours in (46%) of cases. Klebsiella pneumoniae was the common pathogen amongst gram negative bacteria in the present study and thus was the common cause of septicemia in neonates, and Coagulase negative Staphylococcus and Staphylococcus aureus were common bacteria among the gram-positive bacteria. A higher mortality rate in cases of late onset sepsis was observed and was explained probably due to prolonged NICU stay, multiple interventions such as mechanical ventilation, umbilical venous catheterization, and central lines.

Vasoactive inotropic score as a predictor of mortality in neonatal septic shock.

Although many improvements in neonatal care have been achieved, mortality rates for sepsis and septic shock in newborns are still high. The vasoactive inotropic score (VIS) was designed and studied to predict mortality in different settings. There are currently no data on the predictive ability of the VIS for mortality in newborn patients with septic shock. Patients with late-onset neonatal sepsis who required inotropes because of fluid-refractory septic shock during the study period were included in the study. Four distinct VISvalues were calculated for each septic shock episode after inotropic treatment had begun, that is, at the initiation of inotropic treatment and at 24 and 48 h after inotropic treatment had begun, and the highest VIS (VISmax) at any time after initiation of inotropic agents. The 98 episodes studied were divided into two groups according to the outcomes of their sepsis episodes as survivors (n = 39) or nonsurvivors (n = 59). The areas under the curve of the VIS values for the prediction of mortality were the VISmax (0.819, p < 0.001), followed by the VIS48 (0.802, p < 0.001), VIS24 (0.762, p = 0.001) and VIS0 (0.699, p = 0.015). Patients with a VISmax of greater than 20 had significantly higher odds of mortality (p < 0.001, β = 14.7, 95% confidence interval [4.7-45.9]). We found that the VISmax was an easy-to-use and helpful tool for predicting a poor outcome in neonatal sepsis. Physicians should be aware that the prognosis is poor for any newborn with a VIS of 20 or greater at any point after the onset of sepsis.

Elevated neutrophil - to - monocyte ratio as a prognostic marker for poor outcomes in neonatal sepsis

ObjectivesNeonatal sepsis is one of the leading causes of neonatal death. The aim of this study was to evaluate the value of neutrophil - to - monocyte ratio (NMR) in predicting mortality in neonatal sepsis. MethodsIn this present retrospective study, a total of 134 neonates with sepsis were included. Baseline laboratory parameters were collected. The best cutoff value of NMR was determined by receiver operating characteristic (ROC) curve. Univariate and multivariate analysis were carried out to survey the predict value of NMR. ResultsThe results showed that NMR in non-survival group was significantly higher than that in survival group. Results from multivariate analysis showed that high NMR was an independent risk factor for neonatal sepsis (Hazard ratio (HR): 7.519, p = 0.001). ROC displayed that the area under curve (AUC) of NMR was 0.740, sensitivity and specificity of NMR were 80% and 65.8% when 7.65 was selected. ConclusionsNMR could be a promising prognostic factor for neonatal sepsis.

Incidence of Early and Late Onset Neonatal Sepsis in Suriname: A National Tertiary Hospital Birth-cohort Study.

Early onset neonatal sepsis (EONS) and late onset neonatal sepsis (LONS) are important causes of neonatal mortality and morbidity. A pressing need for reliable and detailed data of low- and middle-income countries exists. This study aimed to describe the incidence and outcome of neonatal sepsis in the only tertiary hospital of Suriname, a middle-income country in South America. Infants born at the Academic Hospital of Paramaribo from May 2017 through December 2018 were prospectively included at birth. Perinatal data, duration of antibiotic treatment, blood culture results and mortality data were gathered. Neonatal sepsis was defined as positive blood culture with a pathogenic microorganism within the first 28 days of life. Of the 2190 infants included, 483 (22%) were admitted to neonatal (intensive) care. The incidence of EONS was 2.1 (95% CI: 0.9-5) per 1000 live births, with no deaths. Antibiotics for suspected EONS were administrated to 189 (8.6%) infants, of whom 155 (82%) were born prematurely. The incidence of LONS cases was 145 (95% CI: 114-176) per 1000 admissions. Gramnegative bacteria accounted for 70% (48 out of 70) of causative organisms. Seventeen deaths were directly caused by sepsis (35 per 1000 admissions). Findings from this tertiary center birth cohort study in a middle-income setting indicate EONS incidence and outcomes comparable to high-income settings, whereas LONS is a more prevalent and significant challenge with a predominance of gram-negative bacteria, and high mortality.

Prevalence, Risk Factors and Predictors of Mortality Outcome in Neonatal Sepsis in KSA: Systematic Review

The systemic reaction to infection in newborn infants during the first 28 days of life has been referred to as neonatal sepsis. Global health issues include neonatal sepsis. Furthermore, newborn sepsis contributes significantly to morbidity and mortality in underdeveloped nations. This study examined the prevalence, risk factors, aetiology, death rate, and outcomes of neonatal sepsis in newborns in the Kingdom of Saudi Arabia. On the same subject, a thorough search of the literature was done using online databases like PubMed, Embase, and Google Scholar. After removing 45 duplicates, a total of 119 articles were found in the initial systematic search. 25 studies were removed after title and abstract screening on 74 study papers. Only 16 papers out of 49 total items that underwent full-text evaluation met the requirements for inclusion in this meta-analysis. We took research that were released between January 1997 and December 2021. We only looked for English-language studies during our search. Neonatal sepsis is a major public health problem due to its rising occurrence; therefore, it is crucial to look at its epidemiology, risk factors, and clinical characteristics. Since gluten is now well recognised as a precipitating factor, current research is helping to better understand the other aspects of this syndrome.

Association between the timing of antibiotics administration and outcome of neonatal sepsis

BackgroundSepsis is a life-threatening condition that requires aggressive and rapid intervention. However, data on the association between antibiotic administration timing in neonatal sepsis and neonatal outcomes is limited, particularly in the gulf area. ObjectiveThis study aimed to evaluate the association between the timing of antibiotic administration and the outcome of neonatal sepsis. Design and settingThis retrospective comparative study was conducted through data collection from medical records of patients with neonatal sepsis. The patients were categorized into two groups based on the time interval between antibiotic prescription and drug administration: non-delayed group consisted of patients who received antibiotics within 3 h and the delayed group consisted of those who received antibiotics after 3 h. ResultsA total of 237 neonates diagnosed with sepsis were included, of which 9.3% had necrotizing enterocolitis, 35% had bronchopulmonary dysplasia, and 6.3% had maternal chorioamnionitis. Additionally, 18.6% of the neonates’ mothers were prescribed with antibiotics during labor, and 5.5% had maternal fever. Staphylococcus epidermidis was the most commonly isolated strain (24.1%). Of the total neonates, 87.3% received antibiotics within the first 3 h from the prescription. Survival rate was significantly higher and the risk of complications such as necrotizing enterocolitis, and bronchopulmonary dysplasia was significantly lower in the non-delayed group. Moreover, the length of hospital stay was significantly shorter in the non-delayed group. ConclusionEarly antibiotic administration in patients with neonatal sepsis can improve the survival rate and reduce the incidence of complications.

Outcome of Neonatal Sepsis in Neonatal Intensive Care Unit in Zagazig University Hospitals

Outcome of Neonatal Sepsis in Neonatal Intensive Care Unit in Zagazig University Hospitals

Molecular Characterisation and Profile of Extended Spectrum Beta Lactamase Producing Enterobacteriaceae Isolates Causing Neonatal Sepsis at a Tertiary Care Center

Introduction: Emergence of extended spectrum beta-lactamase producing strains of gram-negative bacteria is increasing and it affects outcome of neonatal sepsis. Present study was done to assess the prevalence, antibiogram and molecular characterisation of ESBL producing enterobacteriaceae organisms in neonatal sepsis. Methods: A cross-sectional study was conducted at a tertiary care centre in Agra from January 2016 to June 2017. Total 700 patients satisfying inclusion and exclusion criteria were enrolled. Workup for sepsis screen, blood culture, antibiotic susceptibility, disk approximation test for detection of ESBL producing organism and polymerase chain reaction were performed. Results: Out of 700 patients, blood culture was positive in 238 (34%) cases. Among all the blood-culture isolates, Gram - positive, Gram - negative and candida species were (54%), (39%) and (7%) respectively. Among gram - negative isolates, Klebsiella (16%), E. coli (10%), Pseudomonas (6%), and Burkholderia (5%) were isolated. Prevalence of ESBL producing Enterobacteriaceae isolates was 42.42%. Among ESBL producers 13 were E. Coli and 15 were Klebsiella. ESBL producing bacilli were more common in males (p = 0.015) and out born patients (p = 0.042). CNS symptoms were the commonest manifestations (35.71%). All ESBL producing Klebsiella and 92.3% of E. coli were resistant to co-amoxyclav. All the ESBL producing Klebsiella and E. coli were sensitive to imipenem and colistin. CTXm gene was the commonest gene present in ESBL producing E. coli (61.54%) and Klebsiella (26.67%). Conclusions: ESBL producing Klebsiella and E. coli were resistant to most of the commonly used antibiotics but they were sensitive to carbapenems and colistin. CTXm gene was the commonest gene, associated with ESBL producing enterobacteriaceae.

Perceived Demographic and Socio-Economic Factors Contributing to Poor Outcome of Neonatal Sepsis at Paediatric Unit Kenyatta National Hospital

Introduction: Globally sepsis is still a known case of high mortality and mobility rates among neonates. This is despite having been advances in healthcare quality. The World Health Organization estimates that more than 40% of deaths occurring among infants aged below five years happen during the neonatal phase and they result in 3.1 infant deaths annually. Objective: This study sought to establish the perceived demographic and socioeconomic status of poor outcomes of neonatal sepsis at Kenyatta national hospital paediatric unit. Methodology: This was a hospital-based descriptive cross-sectional study conducted in the Paediatric Unit of Kenyatta National Hospital. A total of 175 mothers of neonates with neonatal sepsis admitted in KNH selected using consecutive sampling methods were recruited into the study. A validated researcher-administered semi-structured questionnaire was used to collect the data. Descriptive statistics involved the calculation of measures of central tendencies like means, modes and medians between variables. Association between the study variables was estimated using both chi-square and odds ratio statistics at a 95% confidence interval. The study results were presented in tables, graphs and charts, as appropriate. Results: Maternal demographic factors associated with poor outcomes of neonatal sepsis included - younger or advanced maternal age (X2 = 4.735, df = 2, p = 0.031); low education level (X2 = 6.362, df = 1, p = 0.012) and short birth intervals of &lt; 2 years (X2 = 5.108, df = 2, p = 0.023). Maternal socioeconomic factors associated with poor outcomes of neonatal sepsis included - low household income level (X2 = 6.163, df = 1, p = 0.014); large family sizes of ≥5 members (X2 = 4.844, df = 1, p = 0.028) and lack of a health insurance cover (X2 = 5.382, df = 1, p = 0.019). Conclusion: Various maternal demographics, maternal socio-economic were significant perceived determinants of poor outcomes of neonatal sepsis in Kenyatta National Hospital’s Paediatric Unit. Recommendations: The national government with the help of county governments and development partners should invest in community empowerment programs that aim to improve the socioeconomic status of caregivers and their households. In addition, further investments in the health care system are needed to make it more affordable to all and particularly to the low-income group.

Outcome of Bacterial Sepsis in Neonate with Determination of Pathogens and Their Antimicrobial Susceptibility

Background: Sepsis in neonate remains a significant cause of mortality and morbidity in developing countries. Neonatal sepsis requires accurate and timely clinical and laboratory diagnosis and proper management for better outcome. In this study an attempt has been made to know the positivity rate of neonatal sepsis, identify the bacterial isolates responsible for EOS and LOS and determine their sensitivity pattern to various antimicrobial agents, and outcome of neonatal sepsis. Methods: A cross sectional descriptive single-centre study was conducted on neonates , over a period of 12 months. Essential investigations were sent by collecting samples under aseptic precautions. Empirical antimicrobial therapy was started according to antimicrobial guidelines in this NICU. Results: Out of 1423 screened blood cultures 13.49% reported as positive and EOS and LOS accounted for 33.85% and 66.15% of cases respectively. Over half (52.60%) of neonates had sepsis with gram negative bacteria and 47.40% with gram positive bacteria and ratio was 1.1:1. Common organisms were Coagulase-Negative Staphylococci-CONS (42.19%), Acinetobacter (22.40%),Enterobacter (18.75%).Total mortality rate was 6.96% &amp; death rate was 23.96% in culture proven sepsis &amp; 04.31% in culture negative isolates (p-value: &lt;0.00001). In culture-proven sepsis the mortality rate 30.71% &amp; 10.77% (P-value: 0.00219) in LOS &amp; EOS; and 30.69% &amp;16.48% (p-value: 0.02126) in gram positive &amp; gram negative sepsis respectively. Acinetobacter (44.19%) showed higher death rate followed by MRSA (33.33%), E.Coli (33.33%). In EOS, gram positive &amp; gram negative bacteria accounted for 55.38% &amp; 44.62%; and in LOS, 43.31% &amp; 56.69% respectively. CONS (50.77%), the commonest followed by Acinetobacter (18.46%) and Enterobacter (13.85%) in EOS. In LOS, CONS (37.80%) was the most isolated prevalent organism followed by Acinetobacter (24.41%) and Enterobacter (21.26%). Gram positive organisms showed higher level of sensitivity to Vancomycin (91%), Linezolid (90%), Netilmicin (65%). Among the Staphylococci (Coagulase negative &amp; positive), around 86% were resistant to Cloxacillin/Methicillin. Gram negative bacteria had best susceptibilities to Colistin (74%) &amp; Polymyxin-B (70%) than Cotrimoxazole (51%), Netilmicin (32%), Ciprofloxacin (32%), Piperacillin+ Tazobactem (27%), and Levofloxacin (24%). Among the commonly used antibiotics, the susceptibilities were remarkably low to Ampicillin (5.73%), Gentamicin (26.04%), Amikacin (11.46%), Ceftazidime (4.69%), Cefepime (2.08%) in comparison to Ciprofloxacin (31.25%), Imipenem/Meropenem (35.42%) &amp; Netilmicin (47.92%) for both gram positive &amp; negative isolates. Conclusion: Present study indicated that more mortality observed in culture-proven sepsis especially in gram negative sepsis. CONS continue to be the predominant causative organism in both EOS and LOS followed by Acinetobacter, Enterobacter. The antibiotic susceptibility profile suggested that for a given cohort empiric Netilmicin- Imipenem / Vacomycin or Netilmicin- Ciprofloxacin / Vancomycin initial choice where patient can not improve with initial empiric antimicrobial therapy (Ampicillin and Gentamicin) in EOS before blood culture reports are available or can considered be for initial empiric therapy in LOS. Early intervention with evidence based unit specific empiric chemotherapy before availability of culture reports that will improve outcome of neonate with sepsis and can reduce the morbidity and mortality as well. Bangladesh Crit Care J September 2021; 9 (2): 79-86

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

SummaryBackgroundSepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis.MethodsIn BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability.FindingsBetween Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis.InterpretationOur data raise questions about the empirical use of combined ampicillin–gentamicin for neonatal sepsis in LMICs because of its high resistance and high rates of frequency of resistance and low probability of target attainment. Accessibility and affordability need to be considered when advocating antibiotic treatments with variance in economic health structures across LMICs.FundingThe Bill & Melinda Gates Foundation.

Epidemiology of Early and Late Onset Neonatal Sepsis in Very Low Birthweight Infants: Data From the German Neonatal Network.

Sepsis is a major cause of death in neonates. Knowledge about epidemiology, risk factors, causative pathogens and outcome of neonatal sepsis is important to improve neonatal care. For Germany, only few data on neonatal sepsis in very low birth weight (VLBW) infants exist. Data from 14,926 preterm infants with birth weight <1500 g and gestational age between 22 0/7 weeks and 31 6/7 collected between January 2009 and December 2017 were analyzed for frequency of early-onset sepsis (EOS) and late-onset sepsis (LOS) and for causative pathogens. Risk factors for the development of EOS and LOS and outcomes after EOS and LOS were analyzed by multivariate logistic regression models. EOS occurred in 1.1% of infants and LOS in 11.9%. Escherichia coli was the most common pathogen in EOS, coagulase-negative staphylococci in LOS. Multidrug-resistant organisms were detected in 8.4% of EOS and 3.9% of LOS cases. Risk factors for EOS were lower gestational age, intra-amniotic infection and spontaneous delivery. Risk factors for LOS were lower gestational age, small for gestational age, central lines, endotracheal ventilation and history of EOS. Both EOS and LOS were independently associated with adverse neonatal outcome. These data from a large German neonatal cohort confirm neonatal sepsis as the most common cause of morbidity and mortality in VLBW infants, as well as E. coli and coagulase-negative staphylococci as the most prevalent pathogens. Multidisciplinary approaches such as antibiotic stewardship, hygiene and feeding strategies are necessary to further reduce the burden of sepsis in VLBW infants.