Outcome Of Neonatal Sepsis Research Articles

Clinical, Bacteriological Profile & 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 & 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

Procalcitonin versus C-Reactive Protein in Neonatal Sepsis

Objectives: To compare between C-reactive protein (CRP) and Procalcitonin (PCT) regarding diagnosis and outcome of neonatal sepsis.

Study on Correlation between Sepsis Screening and Blood Culture in Neonatal Sepsis

Objective: Neonatal septicemia is a major cause of morbidity and mortality in newborn inborn. As the clinical manifestations are vague and nonspecific, it is pertinent that an early diagnosis is made to prevent serious morbidity and mortality. So, an attempt was made to establish correlation between sepsis screening & blood culture in neonate presenting with features of sepsis to accelerate the diagnostic process. Research and Methods: In our study we tried to study (1) early indicators of sepsis screen & their statistical correlation with blood culture (considered as gold standard); (2) different aspects of outcome in neonatal sepsis. Results: Though individual sepsis screen parameters showed little correlation with blood culture status, yet on combination it was found that specificity and positive predictive accuracy increased while sensitivity decreased them individual tests. Also combination of tests yield better results than single tests. Conclusion: The combination of parameters yielded better results than single tests and proved to be an invaluable aid for early diagnosis of neonatal sepsis.

Late-onset Leclercia adecarboxylata sepsis in a premature neonate

The epidemiology, etiology and outcome of neonatal sepsis are changing over time. While monitoring longitudinal trends in neonatal sepsis in our institution, we encountered a case of late-onset neonatal sepsis due to Leclercia adecarboxylata. A Gram-negative rod previously not encountered in the clinical setting, L. adecarboxylata has recently emerged as a human pathogen, primarily in immunosuppressed patients. This report describes the clinical and laboratory features of this case of late-onset L. adecarboxylata sepsis, and reviews significant features of infection associated with this emerging pathogen.

Patient characteristics, Bacteriological profile & outcome of Neonatal Sepsis: A Hospital Based Study

Neonatal sepsis is a major cause of mortality and morbidity in newborn. 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. A prospective descriptive study over the period of one year was conducted at the Department of Neonatal Intensive care unit of Ad-din Women’s Medical College and Hospital, Dhaka, Bangladesh.Organisms were isolated from 8.7% of collected blood samples. The male female ratio of culture proven sepsis was 1.7:1. More than half (52.8%) of the evaluated neonates were preterm. & 56.3% had low birth weight. The gram positive and gram negative bacteria accounted for 24.1% and 75.9% of the isolates respectively. Around three fourth of the neonates (75.8%) presented with early onset sepsis, while 24.2% presented with late onset sepsis. Acinetobacter was the most common pathogen both in early onset (70%) and late onset (30%) sepsis. Pseudomonas (89.4%) was the second most common pathogen in early onset sepsis. Total mortality rate was 5.7%. Pre term, low birth weight and gram negative sepsis contributes majority of mortality.Gram negative organism especially Acinetobacter found to be commonest cause of sepsis. Pseudomonas was second most common but contributed highest in late onset sepsis and neonatal death due to sepsis. DOI: http://dx.doi.org/10.3329/cbmj.v2i1.14184 Community Based Medical Journal Vol.2(1) 2013 49-54

Post-natal CMV infection via mother's milk in ELBW infants born to CMV seropositive mothers

s for 2nd International Conference on Clinical Neonatology Comparison of conventional blood culture method and BacT/Alert system with respect to yield and time to positivity in neonatal sepsis Arti Maria⁎, Sumitha Phalgun, Charoo Hans, N. Dubey, Deepak Goyal PGIMER & Associated Dr RML Hospital, New Delhi, India ⁎Corresponding author. Efficient and faster ways of diagnosing neonatal sepsis than conventional blood culture are needed in clinical practice. Recently, automated systems have been developed to address this issue. We hypothesized that automated compared to conventional methods of blood culture may give better isolation performances and shorter time to yield in the diagnosis of neonatal sepsis. This was a single-center, prospective, cohort study enrolling neonates with suspected neonatal sepsis in tertiary neonatal referral unit of north India. From May 2008 to April 2009, ninety consecutive neonates with suspected sepsis were enrolled with the objective of comparing the sensitivity and the time needed to yield positivity of conventional vs. BacT/Alert blood culture. Conventional and automated cultureswere collected in standardized manner from each baby, the order being alternate in consecutive babies. Refusal to consent, being ELBW and showing hemodynamical unstability were the only exclusion criteria for the neonates screened for inclusion in the study. Statistical analysis was conducted with the SPSS software version 11.0. The results showed that positivity by BacT/Alert was 38.8% (35/90) compared to 14.4% (13/90)with conventionalmethod (p<0.05). BacT/ Alert detected 30% isolates as early as within 12 h and 100% by 48 h whereas conventional detected none before 48 h and 69.2% by 72 h (p<0.001). Staphylococcus aureus was the commonest isolated microorganism (40% of cases). We concluded that a greater yield and earlier detection of pathogens by the Bact/Alert system make it more suitable for early definitive diagnosis of neonatal sepsis. This has implications for timely rational antibiotic therapy with possible favourable outcomes in neonatal sepsis. doi:10.1016/j.earlhumdev.2010.12.021 Safety of aqueous chlorhexidine gluconate for skin antisepsis in VLBW infants Maria Grazia Capretti⁎, Marica Spinelli, Elisabetta Tridapalli, Santo Arcuri, Anna Malavolti, Emanuela Callea, Giacomo Faldella Neonatal Intensive Care Unit, St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy Infection Control Unit, St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy ⁎Corresponding author. No guidelines are available for antisepsis in infants with age <2 months. The aim of this study is to evaluate the efficacy and safety of aqueous chlorhexidine gluconate (aCG) at different concentrations for skin disinfection in VLBW (birth weight <1500 g) infants. Two different protocols for skin antisepsis were prospectively used. The rate of nosocomial infection and adverse effects were compared. In the first period (January 2007 to December 2008) we used 2%aCG solution, regardless of gestational age (GA) and birth weight (BW); in the second period (January 2009 to October 2010) 0.1%aCG was used in the first ten days of life in newborns with GA=27 weeks and/or BW=750 g and 1%aCG, in the remaining cases. Microbiological culture of CVC-tips, blood samples, urine and respiratory tract specimens were collected when infection was suspected. First period infants 15/124 vs second period infants 14/103 were found infected after 72 h of life (p=0.842); among infants with BW<750 g, 9/31were infected in the first period vs 3/21 in the second period (p=0.318). Five ELBW infants (BW<1000 g) showed burns using 2%aCG prior to insertion of umbilical venous or peripherally inserted central catheters. No burns or other adverse events were observed in the second period. Our data show that 2%aCG may not be safe when used in ELBW infants in the first days of life, suggesting that antisepsis solution in premature should be differentiated according to GA and chronologic age. doi:10.1016/j.earlhumdev.2010.12.022 Post-natal CMV infection via mother's milk in ELBW infants born to CMV seropositive mothers

Comparison of conventional blood culture method and BacT/Alert system with respect to yield and time to positivity in neonatal sepsis

s for 2nd International Conference on Clinical Neonatology Comparison of conventional blood culture method and BacT/Alert system with respect to yield and time to positivity in neonatal sepsis Arti Maria⁎, Sumitha Phalgun, Charoo Hans, N. Dubey, Deepak Goyal PGIMER & Associated Dr RML Hospital, New Delhi, India ⁎Corresponding author. Efficient and faster ways of diagnosing neonatal sepsis than conventional blood culture are needed in clinical practice. Recently, automated systems have been developed to address this issue. We hypothesized that automated compared to conventional methods of blood culture may give better isolation performances and shorter time to yield in the diagnosis of neonatal sepsis. This was a single-center, prospective, cohort study enrolling neonates with suspected neonatal sepsis in tertiary neonatal referral unit of north India. From May 2008 to April 2009, ninety consecutive neonates with suspected sepsis were enrolled with the objective of comparing the sensitivity and the time needed to yield positivity of conventional vs. BacT/Alert blood culture. Conventional and automated cultureswere collected in standardized manner from each baby, the order being alternate in consecutive babies. Refusal to consent, being ELBW and showing hemodynamical unstability were the only exclusion criteria for the neonates screened for inclusion in the study. Statistical analysis was conducted with the SPSS software version 11.0. The results showed that positivity by BacT/Alert was 38.8% (35/90) compared to 14.4% (13/90)with conventionalmethod (p<0.05). BacT/ Alert detected 30% isolates as early as within 12 h and 100% by 48 h whereas conventional detected none before 48 h and 69.2% by 72 h (p<0.001). Staphylococcus aureus was the commonest isolated microorganism (40% of cases). We concluded that a greater yield and earlier detection of pathogens by the Bact/Alert system make it more suitable for early definitive diagnosis of neonatal sepsis. This has implications for timely rational antibiotic therapy with possible favourable outcomes in neonatal sepsis. doi:10.1016/j.earlhumdev.2010.12.021 Safety of aqueous chlorhexidine gluconate for skin antisepsis in VLBW infants Maria Grazia Capretti⁎, Marica Spinelli, Elisabetta Tridapalli, Santo Arcuri, Anna Malavolti, Emanuela Callea, Giacomo Faldella Neonatal Intensive Care Unit, St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy Infection Control Unit, St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy ⁎Corresponding author. No guidelines are available for antisepsis in infants with age <2 months. The aim of this study is to evaluate the efficacy and safety of aqueous chlorhexidine gluconate (aCG) at different concentrations for skin disinfection in VLBW (birth weight <1500 g) infants. Two different protocols for skin antisepsis were prospectively used. The rate of nosocomial infection and adverse effects were compared. In the first period (January 2007 to December 2008) we used 2%aCG solution, regardless of gestational age (GA) and birth weight (BW); in the second period (January 2009 to October 2010) 0.1%aCG was used in the first ten days of life in newborns with GA=27 weeks and/or BW=750 g and 1%aCG, in the remaining cases. Microbiological culture of CVC-tips, blood samples, urine and respiratory tract specimens were collected when infection was suspected. First period infants 15/124 vs second period infants 14/103 were found infected after 72 h of life (p=0.842); among infants with BW<750 g, 9/31were infected in the first period vs 3/21 in the second period (p=0.318). Five ELBW infants (BW<1000 g) showed burns using 2%aCG prior to insertion of umbilical venous or peripherally inserted central catheters. No burns or other adverse events were observed in the second period. Our data show that 2%aCG may not be safe when used in ELBW infants in the first days of life, suggesting that antisepsis solution in premature should be differentiated according to GA and chronologic age. doi:10.1016/j.earlhumdev.2010.12.022 Post-natal CMV infection via mother's milk in ELBW infants born to CMV seropositive mothers

Clinical features of neonatal sepsis caused by resistant Gram‐negative bacteria

Clinical features and outcomes of neonatal sepsis caused by resistant Gram-negative bacteria are not well described in Jordan. The aim of the present study was therefore to describe microbiology and clinical features, laboratory findings and outcomes of early- and late-onset Gram-negative neonatal sepsis. All patients with Gram-negative bacteremia between July 2003 and June 2005 were retrospectively included. Resistance profiles, clinical features and outcomes of early and late-onset neonatal sepsis were compared. A total of 79 patients (after excluding all nine cases of Gram-positive bloodstream infection (BSI) were identified as having Gram-negative BSI (25 had early-onset and 54 had late-onset neonatal sepsis). Respiratory distress, metabolic acidosis and requirement of ventilation were found in 74.7%, 40.5%, and 58.2%, respectively. Hypotension was found in 22.9% of patients. Klebsiella pneumoniae was responsible for 43 cases (54.4.2%). Klebsiella pneumoniae resistance rates to ampicillin and ceftazidime were 100% and 50%, respectively. Mortality rate was 30.9%. Forty-eight percent of deaths occurred within 3 days of sepsis. Meningitis was diagnosed in five cases. Elevated C-reactive protein (CRP) and thrombocytopenia were seen in 28% and 24% of infants with early-onset sepsis, respectively, and in 79.6%, 59.3% of infants with late-onset sepsis respectively. Both early- and late-onset neonatal sepsis are caused by highly resistant Gram-negative bacteria. Mortality of sepsis is high. Elevated CRP and thrombocytopenia is seen more commonly in late-onset neonatal sepsis.

Characterization, Antibiotics Utilization and Outcomes of Neonatal Sepsis in Patients Admitted to a University Teaching Hospital in Malaysia: The Limits of the Evidence

Characterization, Antibiotics Utilization and Outcomes of Neonatal Sepsis in Patients Admitted to a University Teaching Hospital in Malaysia: The Limits of the Evidence

Bacterial Sepsis

SummaryBacterial sepsis remain a major cause of mortality and morbidity in the newborn. The severe outcome of neonatal sepsis, despite the advances in perinatal and neonatal care and use of potent antibiotics, is related to the neonatal reduced immune defenses and the complex interactions between the infecting microorganism and the host responses. An early diagnosis, based on the clinical picture, the isolation of microorganisms and the positivity of inflammatory indexes, is mandatory. A timely treatment should be aimed to the elimination of pathogens with antimicrobials. Intravenous immunoglobulin and hematopoietic growth factors may be considered to improve the disturbed immune homeostasis.

Aetiology of neonatal sepsis in Blantyre, Malawi: 1996–2001

The aim of this retrospective study was to report causes, antibiotic resistance and outcome of neonatal sepsis (often fatal in developing countries) in Malawi. All blood and cerebrospinal fluid isolates collected between January 1996 and December 2001 from inpatients aged 0-30 days with suspected sepsis at Queen Elizabeth Central Hospital, Blantyre, Malawi were reviewed. In vitro resistance to antibiotics commonly used in Malawi was assessed. Case fatality rate was analysed with respect to age, bacterial pathogen and infection site. A total of 801 bacteria were isolated from 784 neonates over 6 years-599 isolates from blood and 202 from cerebrospinal fluid. Overall, 54% of bacteria were gram-positive and 46% gram-negative. The commonest causes of neonatal sepsis were group B Streptococcus (17%) and non-typhoidal Salmonella (14%). In vitro antibiotic susceptibility to the first-line antibiotic combination of penicillin and gentamicin was 78% for all isolates, but in vitro sensitivities to gentamicin for Klebsiella spp and non-typhoidal Salmonella were only 33% and 53%, respectively. In-hospital case fatality rate was known for only 301 cases and was high at 48%. Group B Streptococcus was associated with the best outcome. Mortality was significantly higher if presentation was in the 1st week of life or if sepsis was caused by gram-negative bacteria. The causes of neonatal sepsis in this population show a different pattern from other studies in developing countries.

Antibiotic regimens for management of intraamniotic infection.

Intraamniotic infection is associated with maternal morbidity and neonatal sepsis, pneumonia and death. Although antibiotic treatment is accepted as the standard of care, few studies have been conducted to examine the effectiveness of different antibiotic regimens for this infection and whether to administer antibiotics intrapartum or postpartum. To study the effects of different maternal antibiotic regimens for intraamniotic infection on maternal and perinatal morbidity and mortality. We searched the Cochrane Pregnancy and Childbirth Group trials register (May 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002). Trials where there was a randomized comparison of different antibiotic regimens to treat women with a diagnosis of intraamniotic infection were included. The primary outcome was perinatal morbidity. Data were extracted from each publication independently by the authors. Two eligible trials (181 women) were included in this review. No trials were identified that compared antibiotic treatment with no treatment. Intrapartum treatment with antibiotics for intraamniotic infection was associated with a reduction in neonatal sepsis (relative risk (RR) 0.08; 95% confidence interval (CI) 0.00, 1.44) and pneumonia (RR 0.15; CI 0.01, 2.92) compared with treatment given immediately postpartum, but these results did not reach statistical significance (number of women studied = 45). There was no difference in the incidence of maternal bacteremia (RR 2.19; CI 0.25, 19.48). There was no difference in the outcomes of neonatal sepsis (RR 2.16; CI 0.20, 23.21) or neonatal death (RR 0.72; CI 0.12, 4.16) between a regimen with and without anaerobic activity (number of women studied = 133). There was a trend towards a decrease in the incidence of post-partum endometritis in women who received treatment with ampicillin, gentamicin and clindamycin compared with ampicillin and gentamicin alone, but this did not reach statistical significance (RR 0.54; CI 0.19, 1.49). The conclusions that can be drawn from this meta-analysis are limited due to the small number of studies. For none of the outcomes was a statistically significant difference seen between the different interventions. Current consensus is for the intrapartum administration of antibiotics when the diagnosis of intraamniotic infection is made; however, the results of this review neither support nor refute this although there was a trend towards improved neonatal outcomes when antibiotics were administered intrapartum. No recommendations can be made on the most appropriate antimicrobial regimen to choose to treat intraamniotic infection.

Profile of Neonatal sepsis

Objective: To study the clinical presentation, investigational profile and outcome of neonatal sepsis in general and with special reference to inborn (intramural) or out born (extramural), sex and weight of the neonate. Materials and method: Retrospective descriptive study of neonates admitted during 2 years from July 2007 to June 2009 in special care neonatal unit of the department of Pediatrics, College of Medical Sciences-Teaching Hospital, Bharatpur, Nepal. Results: Majority of neonates were out born and referred (72.2%) to this institution. Significant number of babies was having sepsis in out born group (59%) as compared to inborn (35%). Male sex was found to have more sepsis as compared to female. Sepsis was observed to be inversely related to birth weight, 65% in low birth weight (LBW, &lt;2.5Kg) as compared to 42.6% in normal birth weight group (&gt; 2.5kg). Conclusions: High index of suspicion for diagnosis of neonatal sepsis is required especially in the presence of risk factors. Prevalence of sepsis is inversely related to birth weight. More number of out born delivered babies developed sepsis. Neonatal sepsis related morbidity and mortality can be significantly reduced by comprehensive obstetric and neonatal care at multiple levels right from community to health institutions. Key words: Neonatal sepsis; Inborn; Out born; Low birth weight (LBW). DOI: 10.3126/jcmsn.v6i2.3609 Journal of college of Medical Sciences-Nepal, 2010, Vol.6, No-2, 1-6