Neonatal Septicemia Research Articles

Bovine Lactoferrin Impairs in-vitro Growth of Neonatal Sepsis-causingEscherichia Coli Clinical Isolates

Abstract Background E. coli is a dominant cause of neonatal sepsis with no prevention currently available. Lactoferrin (LF) is an iron-sequestering antibacterial protein that has been shown to decrease all-cause neonatal late-onset sepsis. However, the impact of LF on impairing growth of neonatal E. coli septicemia isolates carrying various iron acquisition virulence genes has not been investigated. We aimed to determine the effects of bovine lactoferrin (bLF) on in vitro growth of neonatal E. coli septicemia strains and to determine the presence of iron-acquisition virulence genes in the isolates. Methods We tested six clinical E. coli strains obtained from blood of septic neonates, including the archetypal RS218 strain. Isolates represent the most frequent phylogroups (B2 and D) and multi-locus sequence types (ST95, ST69, and ST131) among neonatal E. coli septicemia strains. The nonpathogenic strain DH5α was used as control. Strains were grown in media containing 0, 0.1, 1.0, and 10 mg/mL bLF. Optical density (OD) readings were obtained every 30 min. for 20 h. Experiments were repeated 3 times. OD area under the curve (AUC) values were compared with ANOVA. Whole genome sequencing (WGS) was obtained to determine the presence of iron-acquisition virulence genes using VirulenceFinder v. 2.0.3 (J Clin Micro 2020. 58 (10):e01269-20). Results For all strains, the growth decrease with 10 mg/mL bLF compared to zero bLF was highly significant (p < 0.001) (Fig.1). Growth was also significantly reduced at 1 mg/mL for most strains (p ≤ 0.02). Growth decrease at 0.1 mg/mL was only significant for isolate SCB31. Growth suppression at 10 mg/mL was greatest in DH5α. WGS analyses showed that all pathogenic strains carried several iron acquisition virulence genes, with chuA (hemin receptor), fyuA (siderophore receptor) in irp2 (protein 2 peptide synthetase) and sitA (iron transport protein) found in all (Fig. 2). DH5α had no iron acquisition virulence genes. Conclusion Bovine LF is effective in impairing growth of neonatal sepsis-causing E. coli regardless of the presence of iron acquisition genes known to contribute to virulence. Future studies will examine additional isolates and the effect of greater bLF concentrations. These data have the potential to inform dosing regimens for additional in vivo studies to further assess bLF’s protective effects against neonatal sepsis. Figure 1. Comparison of growth curve data among E. coli strains. Optical density AUC values of six neonatal septicemia E. coli isolates growth with increasing concentrations of bovine lactoferrin. DH5α is a nonpathogenic control strain. Bars depict means and standard deviations for each condition tested. Asterisks indicate statistically significant differences compared to the 0 mg/mL bLF condition (*p < 0.001, **p < 0.05). Figure 2. Presence of iron acquisition virulence genes in E. coli isolates. WGS analyses detected several genes, which are indicated in black. White indicates absence of gene. ST, Sequence type; chuA, Outer membrane hemin receptor; fyuA, Siderophore receptor (yersiniabactin); iroN, Siderophore receptor; irp2, High-molecular-weight protein 2 nonribosomal peptide synthetase; iucC, Aerobactin siderophore synthetase; iutA, Ferric aerobactin siderophore receptor; sitA, Iron transport protein. *Multi-drug resistant isolate.

Application of serum SAA, CRP, PCT, WBC and N% in the diagnosis of neonatal septicemia

To explore the application value of SAA (serum amyloid A), CRP (C reactive protein), PCT (procalcitonin), WBC (white blood cell) and N% (neutrophil %) in the diagnosis of neonatal septicemia. This study was a retrospective study. 173 children with clinically diagnosed septicemia and 66 children with definitely diagnosed septicemia admitted to the Department of Neonatology, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China,from January 2022 to January 2024 were selected as the case group, and 148 children with neonatal jaundice who were hospitalized during the same period were selected as the control group. Fasting venous blood was collected within 24 hours after the children's admission to detect the levels of serum WBC, N%, SAA, CRP and PCT. One-way analysis of variance and Kruskal-Wallis H test were used to compare the general data and inflammatory index levels of the three groups of children. The correlation analysis between SAA and other inflammatory indicators was conducted using Spearman correlation analysis. The receiver operating characteristic (ROC) curve was used to determine the diagnostic efficacy of different inflammatory indicators for patients with definitely diagnosed septicemia and those with clinically diagnosed septicemia, and for those with clinically diagnosed septicemia and those without infection. The results showed that the levels of WBC [(16.88±5.64)×109/L], N% [70.00 (63.00, 75.00)], PCT [2.22 (1.20, 5.55) mg/L], CRP [3.00 (0.50, 10.30) mg/L], SAA [19.70 (10.82, 49.90) mg/L] in the clinically diagnosed septicemia group and WBC [(16.10±7.48)×109/L], N% [73.50 (61.50, 80.93)], PCT [5.35 (0.69, 20.07) mg/L], CRP [15.52 (4.98, 30.50) mg/L], SAA [43.95 (14.00, 175.98) mg/L] in the definitely diagnosed septicemia group were all higher than those in the control group (11.17±3.38)×109/L, 49.81 (36.93, 62.75), 0.20 (0.07, 0.99) mg/L, 0.54 (0.20, 1.40) mg/L, 5.15 (3.60, 8.68) mg/L, and the differences were all statistically significant (all P<0.05). Spearman correlation analysis showed that the level of SAA was positively correlated with WBC, N%, PCT and CRP (rs=0.453, 0.540, 0.343, 0.550, all P<0.05). ROC curve analysis showed that the area under ROC curve(AUC) of SAA for the definitely diagnosed septicemia group and the clinically diagnosed septicemia group was higher than that of other inflammatory indicators, among them, the AUC of SAA for diagnosing the definitely diagnosed neonatal septicemia group was 0.933 (95%CI: 0.809-1.000, P<0.05), with a sensitivity of 92.90% and a specificity of 99.30%. The AUC of SAA for diagnosing the clinically diagnosed septicemia group was 0.861 (95%CI: 0.818-0.904, P<0.05), with a sensitivity of 83.20% and a specificity of 81.80%. In conclusion, compared with CRP, PCT, WBC and N%, SAA has higher sensitivity and specificity for distinguishing neonatal septicemia (including definitely diagnosed septicemia and clinically diagnosed septicemia), and has certain auxiliary diagnostic value for neonatal septicemia.

Effects of dexamethasone on short-term and long-term outcomes in late preterm infants with twin pregnancy: an observational study

Objective: To investigate the effect of prenatal dexamethasone on short-term outcomes and long-term neurological development in late preterm infants with twin pregnancy. Methods: A total of 315 pregnant women with twin pregnancy and their preterm infants who delivered in Peking University Third Hospital from January 2019 to December 2022 were retrospectively analyzed. The clinical data of pregnant women and preterm infants were collected. They were divided into non-medication group (93 pregnant women and 186 preterm infants), medication after 34 weeks group (123 pregnant women and 246 preterm infants), and medication before 34 weeks group (99 pregnant women and 198 preterm infants). Short-term outcomes of preterm infants were analyzed, including the incidence of neonatal respiratory distress syndrome (NRDS), wet lung, hypoglycemia, neonatal septicemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD) and neonatal necrotizing enterocolitis (NEC). "Ages and Stages Questionnaire-Third Edition (ASQ-3) scale" was used to follow up the late neurological development of preterm infants at the corrected age of 6-54 months, and the level of neurological development was compared. Results: (1) General conditions: the gestational age at delivery in the non-medication group [36.1 weeks (35.6, 36.6 weeks)] was later than that in the medication after 34 weeks group [36.1 weeks (35.2, 36.4 weeks)] and medication before 34 weeks group [35.2 weeks (34.2, 36.2 weeks)] groups, and the differences were statistically significant (all P<0.05). After correcting for gestational age, there was no significant difference in birth weight among the three groups (H=3.808, P=0.149). There were no significant differences in gender and the proportion of small for gestational age among the three groups (all P>0.05). (2) Short-term outcome: the incidence of wet lung was 7.0% (13/186), 11.0% (27/246) and 16.2% (32/198) in the non-medication group, medication after 34 weeks group and medication before 34 weeks group, respectively, and the difference was statistically significant (P=0.018). There were no significant differences in the incidence rates of NRDS, hypoglycemia, sepsis, IVH, BPD, and NEC among the three groups (all P>0.05). Logistic regression analysis with gestational age and newborn birth weight as confounding factors showed that early gestational age (OR=0.884, 95%CI: 0.837-0.933, P<0.001) and increased incidence of selective intrauterine growth restriction type I (OR=2.967, 95%CI: 1.153-7.639, P=0.024) could both lead to an increased incidence of wet lung. (3) Long-term outcomes: a total of 109 pregnant women completed the follow-up, and 218 preterm infants with a corrected age of 6-54 months at the end of follow-up were enrolled, including 86 cases in the non-medication group, 66 cases in the medication after 34 weeks group, and 66 cases in the medication before 34 weeks group. There were no significant differences in the scores of communication, gross motor, fine motor, problem solving and personal-social among the three groups (all P>0.05). Conclusion: Prenatal administration of a single course of dexamethasone does not affect the neonatal birth weight and short-term outcomes of twin late preterm infants, and has no adverse effect on the neurological development of twin late preterm infants with a corrected age of 6-54 months.

A Comparative Study of Bacteriological Profile and Susceptibility Pattern by Rapid Direct Manual Identification and Antimicrobial Susceptibility Testing with Routine Blood Culture Method in Neonatal Septicemia.

A Comparative Study of Bacteriological Profile and Susceptibility Pattern by Rapid Direct Manual Identification and Antimicrobial Susceptibility Testing with Routine Blood Culture Method in Neonatal Septicemia.

Analysis of the causes of neonatal death and genetic variations in congenital anomalies: a multi-center study.

Neonatal deaths often result from preventable conditions that can be addressed with appropriate interventions. This study aims to analyze the distribution of the causes of neonatal death and explore genetic variations that lead to congenital anomalies in Northwest China. This multi-center observational study was conducted across six medical centers in Shaanxi province, Northwest China. Clinical data were retrospectively collected from neonates admitted between 2016 and 2020. Kaplan-Meier analysis was utilized to estimate survival rates, while high-throughput sequencing platforms were employed to detect mutations causing congenital anomalies. Among 73,967 neonates requiring hospital care, 424 neonatal deaths were recorded, leading to a neonatal mortality rate of 0.57%. The primary causes of death included neonatal respiratory distress syndrome (23.8%), birth asphyxia (19.8%), neonatal septicemia (19.3%), and congenital anomalies (13.6%). The leading causes of neonatal deaths due to congenital anomalies were congenital heart defects (38.6%), bronchopulmonary dysplasia (14.0%), and inherited metabolic disorders (10.5%). Genetic analysis identified 83 pathogenic or likely pathogenic variants in 23 genes among the neonates with congenital anomalies, including four novel mutations (c.4198+1G>T, c.1075delG, c.610-1G>A, c.7769C>T) in the ABCC8, CDKL5, PLA2G6, and NIPBL genes. Congenital anomalies represent a significant and preventable cause of neonatal deaths in Northwest China. Early detection of congenital anomalies through genetic testing and comprehensive prenatal care are crucial for reducing neonatal mortality rates and improving pregnancy outcomes.

Aerobic Bacteria and Their Antibiotic Resistance Profile in Neonatal Septicaemia: A cross Sectional Study in a Tertiary Care Hospital of Rajshahi, Bangladesh

Objective: Neonatal sepsis is an infection of the bloodstream in infants younger than 28 days old. It continues to be the major cause of morbidity and mortality among newborns, particularly in middle- and low-income nations. The objective of this study was to isolate and identify aerobic bacteria of neonatal sepsis by blood culture using FAN method followed by subculture and relevant biochemical tests. Methods: It was a cross sectional type of descriptive study where the sample size was 95 and data were collected purposively from the clinically suspected neonatal septicaemia cases from inpatient Pediatric department in Rajshahi Medical College Hospital, Rajshahi. Results: Most 34 (35.79%) of the cases were culture positive, whereas 61 (64%) were culture negative. 7 (21%) of the 34 positive cases were Gram-positive, while 27 (79%) were Gram-negative. S. aureus was found in 6 (17.65%) of the culture-positive isolates, followed by CoNS with 1 (02.94%), E. coli with 14 (41.17%), Klebsiella spp. with 6 (17.65%), P. aeruginosa with 6 (17.65%), and Acinetobacter with 1 (02.94%). Gram-positive bacteria were extremely susceptible to Vancomycin (90%), Gentamicin (90%), and Ciprofloxacin (80%) based on antibacterial susceptibility testing. Colistin (100%) and ampicillin (100%) exhibited the greatest resistance. Meropenem (90%), Amikacin (90%), and Colistin (89%) were the most effective antibiotics against Gram-negative bacteria, whereas Ceftazidime (60%) was the least effective. Vancomycin (100%) and ampicillin (100%) exhibited the highest degree of resistance. Conclusion: Both Gram-positive and Gram-negative aerobic bacteria were related with newborn septicaemia, and a significant proportion of them were resistant to multiple medicines. CME J 2024; 3(2); 4-11

Characterization of Clinical Presentation, Etiology, and Antibiotic Sensitivity Patterns in Neonatal Septicemia: A Comprehensive Analysis of Bacterial Isolates.

Neonatal septicemia remains a significant healthcare challenge, particularly in resource-limited settings, with both early-onset neonatal septicemia (EONS) and late-onset neonatal septicemia (LONS) presentations contributing to morbidity and mortality. This study aimed to characterize the clinico-etiological profile and antibiotic susceptibility patterns of neonatal septicemia in a tertiary care setting in north India. An analytical cross-sectional study was conducted from March 2021 to February 2022, encompassing neonates admitted to the Department of Pediatrics with suspected neonatal septicemia, confirmed by positive blood cultures. A total of 96 neonates were included, predominantly male (71.9%). Gram-negative bacteria constituted 61.6% of isolates, and the most common organism isolated was non-lactose fermenter group (38.4%) followed by coagulase-negative staphylococci (CoNS) (33.4%). Non-lactose fermenter group bacteria were prominent in EONS cases (44.6%), while CoNS predominated in LONS cases (51.6%). Birthplace, birth weight, and perinatal score were significantly associated with both EONS and LONS. Linezolid exhibited high efficacy against gram-positive bacteria, while ciprofloxacin and meropenem demonstrated effectiveness against various gram-negative pathogens. Methicillin-resistant Staphylococcus aureus (MRSA) strains exhibited resistance to all the antibiotics used in the study except for linezolid. These findings underscore the importance of tailored empirical therapy guided by local epidemiological data to optimize clinical outcomes and mitigate antimicrobial resistance.

C-reactive protein and thrombocytopenia as essential early indicators: Subtle approach to neonatal sepsis.

Early diagnosis of neonatal sepsis is very essential part of newborn care to prevent mortality and decrease morbidity in newborns. The aim of this study is to correlate an increase in C-reactive protein (CRP) titre and a decrease in platelet count with an increased incidence of neonatal septicemia, for an effective subtle approach in neonatal septicemia. A retrospective study was conducted in the neonatal intensive care unit (NICU) of a tertiary care hospital from Jan 2022 to July 2023. Neonates admitted to the NICU with suspected sepsis were screened for sepsis. Screening was done by taking blood culture samples before administration of antibiotics, serum samples for CRP and blood samples for platelet count. A total of 270 newborns with suspected sepsis were included in the study. Blood culture positivity was seen in 27.7 (27/75) cases. About 32.9% (89/270) of the neonates with suspected sepsis and 61.3% (46/75) neonates with confirmed sepsis had raised CRP; 32.2% (87/270) neonates with suspected sepsis and 64% (48/75) with confirmed sepsis had decreased platelet count. Both an increase in CRP and a decrease in platelets were seen in 61.3% (46/75) of confirmed cases. In our study, both raised CRP and decreased platelet count were seen in around 60% of confirmed cases of sepsis. So, CRP titre and platelet count can be used as early, rapid diagnostic markers for confirmed sepsis.

Evaluation of hematological parameter, glycemic status and risk factors responsible for neonatal septicemia and bacterial agents causing neonatal sepsis in chattogra, Bangladesh

Evaluation of hematological parameter, glycemic status and risk factors responsible for neonatal septicemia and bacterial agents causing neonatal sepsis in chattogra, Bangladesh

Exploring the resistome, virulome, and mobilome of multidrug-resistant Klebsiella pneumoniae isolates: deciphering the molecular basis of carbapenem resistance

BackgroundKlebsiella pneumoniae, a notorious pathogen for causing nosocomial infections has become a major cause of neonatal septicemia, leading to high morbidity and mortality worldwide. This opportunistic bacterium has become highly resistant to antibiotics due to the widespread acquisition of genes encoding a variety of enzymes such as extended-spectrum beta-lactamases (ESBLs) and carbapenemases. We collected Klebsiella pneumoniae isolates from a local tertiary care hospital from February 2019–February 2021. To gain molecular insight into the resistome, virulome, and genetic environment of significant genes of multidrug-resistant K. pneumoniae isolates, we performed the short-read whole-genome sequencing of 10 K. pneumoniae isolates recovered from adult patients, neonates, and hospital tap water samples.ResultsThe draft genomes of the isolates varied in size, ranging from 5.48 to 5.96 Mbp suggesting the genome plasticity of this pathogen. Various genes conferring resistance to different classes of antibiotics e.g., aminoglycosides, quinolones, sulfonamides, tetracycline, and trimethoprim were identified in all sequenced isolates. The highest resistance was observed towards carbapenems, which has been putatively linked to the presence of both class B and class D carbapenemases, blaNDM, and blaOXA, respectively. Moreover, the biocide resistance gene qacEdelta1 was found in 6/10 of the sequenced strains. The sequenced isolates exhibited a broad range of sequence types and capsular types. The significant antibiotic resistance genes (ARGs) were bracketed by a variety of mobile genetic elements (MGEs). Various spontaneous mutations in genes other than the acquired antibiotic-resistance genes were observed, which play an indirect role in making these bugs resistant to antibiotics. Loss or deficiency of outer membrane porins, combined with ESBL production, played a significant role in carbapenem resistance in our sequenced isolates. Phylogenetic analysis revealed that the study isolates exhibited evolutionary relationships with strains from China, India, and the USA suggesting a shared evolutionary history and potential dissemination of similar genes amongst the isolates of different origins.ConclusionsThis study provides valuable insight into the presence of multiple mechanisms of carbapenem resistance in K. pneumoniae strains including the acquisition of multiple antibiotic-resistance genes through mobile genetic elements. Identification of rich mobilome yielded insightful information regarding the crucial role of insertion sequences, transposons, and integrons in shaping the genome of bacteria for the transmission of various resistance-associated genes. Multi-drug resistant isolates that had the fewest resistance genes exhibited a significant number of mutations. K. pneumoniae isolate from water source displayed comparable antibiotic resistance determinants to clinical isolates and the highest number of virulence-associated genes suggesting the possible interplay of ARGs amongst bacteria from different sources.

BACTERIOLOGICAL PROFILE OF CLINICALLY SUSPECTED SEPTICEMIA AMONG NEONATES AND THE ANTIBIOTIC SUSCEPTIBILITY PATTERN OF THEIR ISOLATES: A CROSS-SECTIONAL STUDY IN A TERTIARY CARE HOSPITAL OF JHARKHAND

Objectives: Neonatal septicemia is a generalized bacterial infection that occurs during the first 4 weeks of life and is one of the four primary causes of neonatal mortality and morbidity in India. This study aims to determine the bacteriological profile and antibiotic sensitivity patterns of isolates from blood cultures of suspected septicemic neonates in a tertiary care hospital. Methods: Two hundred and twenty-eight blood samples were collected and processed from patients in accordance with standard protocol. The antibiotic susceptibility of the isolates was determined by the disk diffusion method according to Clinical and Laboratory Standards Institute recommendations. Results: Blood culture results were positive in 44.7% of the patients. Late-onset sepsis was present in 53.92%, and early-onset sepsis was observed in 46.08% of the cases. The best overall sensitivity among Gram-negative isolates was to Amikacin, followed by Gentamycin and Meropenem. Gram-positive isolates had sensitivity to Chloramphenicol, tetracycline, Linezolid, Tetracycline, Vancomycin, and Piperacillin. Conclusion: The most common causes of newborn sepsis in this study were Gram-negative organisms (Klebsiella pneumoniae, Escherichia coli, and Citrobacter freundii) and Gram-positive organisms (Staphylococcus aureus), the majority of which are antibiotic-resistant.

Bacteriological profile and antibiotic susceptibility pattern of neonatal septicemia in a tertiary care hospital

ABSTRACT Background: Among the various reasons for neonatal mortality, septicemia continues to be a major cause of neonatal morbidity and mortality worldwide. Incidence varies from country to country, but it is much higher in developing countries than in developed countries. In India, the incidence of blood culture-proven sepsis was reported as 8.5 per 1000 live births. The bacteriological profile for causative organisms of neonatal sepsis differs significantly between developed and developing countries. Klebsiella pneumoniae is the most common bacterial agent in developing countries. This study was undertaken to determine the common bacterial agents causing neonatal sepsis from the tertiary care hospital and their antibiotic susceptibility and resistance. Methods: About 150 blood samples of suspected cases of neonatal septicemia admitted in NICU. Bacterial identification and speciation were done by standard laboratory procedures. Isolates and susceptibility were performed on Automation system. Results: Ninety-one babies presented within the first 72 h of life constituting early-onset sepsis, whereas 59 presented as late-onset sepsis. Among the 150 samples, blood culture was positive in 47 samples. Out of 47 culture-positive cases, 27 (58%) were Gram-negative bacilli, 18 (38%) were Gram-positive cocci, and two (4%) were fungal isolate. K. pneumoniae was the most commonly isolated Gram-negative bacilli. Conclusion: Neonatal septicemia is a life-threatening emergency and rapid treatment with antibiotics is mandatory for favorable outcomes. There is also a need for regular periodic surveillance of the causative organisms of neonatal sepsis as well as their antibiotic susceptibility patterns to inform the choice of empirical antibiotic prescription while awaiting blood culture results.

Chinese Medicine in the Treatment of Suspect Neonatal Septicemia in Two Bull Calves

Two neonatal beef calves diagnosed clinically with acute septicemia were treated with a combination of 2 Chinese herbal formulas, Gao Mao Ling and Huo Xiang Zheng Qi San. The responses were dramatic, with complete recoveries in 5 days. The rapid responses were correlated with the administration of the herbal formulas, which had been prescribed based on the Chinese philosophical understanding of disease progression.

Establishment and application of a rapid molecular diagnostic platform for the isothermal visual amplification of group B Streptococcus based on recombinase polymerase.

With growing concerns about Group B streptococcal (GBS) infections and their adverse effects on perinatal pregnancies, including infection, premature delivery, neonatal septicemia, and meningitis, it is urgent to promote GBS screening at all pregnancy stages. The purpose of this study is to establish a device-independent, fast, sensitive, and visual GBS detection method. Taking advantage of the characteristics of the recombinase polymerase isothermal amplification (RPA), the activity of the nfo nuclease cleavage base analog (tetrahydrofuran, THF) site, and the advantages of visual reading of the lateral flow chromatography strip (LFS), a GBS detection method was developed. This method focused on the conservative region of the Christie-Atkins-Munch-Petersen factor encoded by the cfb gene, a virulence gene specific to GBS. Two forward primers, two biotin-labeled reverse primers, and one fluorescein isothiocyanate (FITC)-labeled and C3spacer-blocked probe were designed. The study involved optimizing the primer pair and probe combination, determining the optimal reaction temperature and time, evaluating specificity, analyzing detection limits, and testing the method on 87 vaginal swabs from perinatal pregnant women. The results showed that the visual detection method of GBS-RPA-LFS, using the cfb-F1/R2/P1 primer probe, could detect GBS within 15 min at the temperature ranging from 39°C to 42°C. Furthermore, the method specifically amplified only GBS, without cross-reacting with pathogens like Lactobacillus iners, Lactobacillus crispatus, Candida albicans, Listeria monocytogenes, Yersinia enterocolitica, Klebsiella Pneumoniae, Enterobacter cloacae, Citrobacter freundii, Vibrio alginolyticus, Vibrio parahaemolyticus, Salmonella typhimurium, Staphylococcus aureus, Pseudomonas aeruginosa, or Trichomonas vaginalis. It could detect a minimum of 100 copies per reaction. In clinical 98 samples of vaginal swabs from pregnant women, the agreement rate between the GBS-RPA-LFS method and TaqMan real-time fluorescence quantification method was 95.92%. In conclusion, this study successfully established a combined RPA and LFS GBS in situ detection platform, with short reaction time, high sensitivity, high specificity, portability, and device independence, providing a feasible strategy for clinical GBS screening.

Novel sequence type of carbapenem-resistant Acinetobacter pittii ST1451 with enhanced virulence isolated from septicaemic neonates in India.

The clinical relevance of Acinetobacter pittii is increasing, but reports of this organism causing neonatal sepsis are rare. To understand the mechanisms of resistance and virulence of A. pittii isolated from neonatal blood belonging to a novel sequence type. Antibiotic susceptibility, MLST, WGS, phylogenomic comparison with a global collection of carbapenemase-harbouring A. pittii were done. To study the pathogenic potential of novel A. pittii, in vitro and in vivo assays were carried out. Two novel multidrug-resistant A. pittii from neonatal blood belonging to a novel sequence type 1451 (ST1451) were isolated. WGS revealed that the isolates were almost similar (147 SNP distant) and harbouring two carbapenem resistance genes blaNDM-1 with upstream ISAba125 and downstream bleMBL along with blaOXA-58 with upstream ISAba3. Other resistance genes included blaADC-25, blaOXA-533, aph(3″)-Ib, aph(3')-VIa, aph(6)-Id, aac(3)-IId, mph(E), msr(E), sul2 and tet(39), different efflux pump genes and amino acid substitutions within GyrA (Ser81Leu) and ParC (Ser84Leu; Glu88Ala) were detected among the isolates. The study genomes were closely related to four strains belonging to ST119. The isolates showed biofilm production, serum resistance, growth under iron limiting condition, surface-associated motility and adherence to host cell. Isolates induced cytokine production in the host cell and showed mice mortality. This study is the first report of the presence of blaNDM-1 in A. pittii from India along with another carbapenemase blaOXA-58. Emergence of highly virulent, multidrug-resistant A. pittii with attributes similar to A. baumannii calls for surveillance to identify the novel strains and their pathogenic and resistance potential.

Assessment of the prevalence of meningitis in clinically suspected cases of early and late onset neonatal sepsis

Background: Meningitis is more common in the neonatal period than any other time in life and is an important cause of morbidity and mortality globally. In India, rate of neonatal sepsis is reported 0.5 per 1000 live births. The major burden of neonatal sepsis and meningitis occurs in the developing world. According to WHO estimates there are approximately 5 million neonatal deaths in a year. The objective of the study is to assess the prevalence of meningitis in neonates with clinical suspicion of sepsis. Methods: The study was conducted among suspected cases of neonatal septicemia in neonatal intensive care unit (NICU), department of pediatrics, VPIMS, Lucknow. It is a prospective observational study. A total of 180 neonates were included in the study. Results: Out of 180 neonates, CSF examination of 131 (72.78%) neonates was normal, of 37 (20.56%) was suggestive of meningitis. Prevalence of meningitis in neonatal sepsis was 20.0%. It was 18.0% in early neonatal sepsis and 32.6% in late neonatal sepsis cases. Conclusions: The findings of present study suggested that there is a high risk of meningitis among neonatal sepsis cases. Cases with risk factors like twin birth, anemia, low TLC, low platelet count, acid-base imbalance and X-ray findings suggestive of pneumonitis should be kept in a high-risk category.

Floppy Neonate as a Case of Congenital Cytomegalovirus Infection with Multisystemic Involvement

Cytomegalovirus infection is the most common infection worldwide. Majority of the neonates infected in utero have long-term consequences which can lead to hearing loss, developmental delays and even death. Early diagnosis and treatment are very critical. Most of the cases being asymptomatic poses an additional challenge in early identification of the cases. This is a case of neonate presenting with cryptorchidism, hypotonia due to cCMV. The initial diagnosis made was early onset neonatal septicemia and not cCMV. This case report highlights the importance of including TORCH panel in neonatal screening as well as in antenatal period. Keywords: congenital cytomegalovirus infection, screening, congenital infection, hypotonia

Relevance and antimicrobial resistance profile of Klebsiella pneumoniae in neonatal sepsis

Background Newborns are particularly susceptible to infection in hospitals, with neonatal sepsis being the most common infection symptom and the third leading cause of neonatal death. Klebsiella pneumoniae is a gram-negative bacterium of Enterobacteriaceae, which is a common pathogen of neonatal septicemia. In this study, we will analyze and evaluate the current status, clinical characteristics, and drug resistance of Klebsiella pneumoniaesepsis infection in Neonatal Intensive Care Unit (NICU), with the aim of providing effective basis for timely and accurate clinical diagnosis and treatment in clinical practice. Methods Statistical analysis was performed on 75 cases of Enterobacteriaceae septicemia in infants admitted to NICU in a special obstetrics and gynecology hospital in Shanghai from January 2020 to June 2022. Based on bacterial identification, isolates were divided into the Klebsiella pneumoniae (KP) group (n = 49) and the non-KP Enterobacteriaceae group (n = 26). The infection, clinical characteristics, and bacterial resistance of the two groups of infected patients were compared. Results Comparing the clinical characteristics of the two groups, the results showed that most of the subjects in the KP and non-KP groups were premature infants, accounting for 100% and 92.3% of subjects, respectively; late onset was the main disease in both groups, accounting for 93.9% and 80.8% of subjects, respectively. All patients received Peripherally Inserted Central Catheter(PICC). The levels of pro calcitonin and CRP (C-reactive protein) were significantly higher in the KP group compared with those in the non-KP group (p < .05). At the same time, the incidence of thrombocytopenia in the KP group was significantly higher than that in the non-KP group (p < .05). The proportion of antimicrobial drug exposure in the KP group is higher than that in the non-KP group. The drug resistance of the KP group to ceftazidime, ceftriaxone, cefepime, ampicillin/sulbactam, aztreonam, ciprofloxacin and compound sulfamethoxazole was significantly higher than that of the non-KP group, whereas the drug resistance rate to cefotetan, gentamycin and to bramycin was significantly lower than that of the non-KP group, Statistically significant differences (p < .05). 38 cases of Klebsiella pneumoniae producing ESBLs were tested for related resistance genes. The results showed that the main resistance types were SHV and TEM, with detection rates of 60.6% and 28.9%. Conclusions This study shows that neonatal sepsis caused by Klebsiella pneumoniae infection has a high incidence and drug resistance in premature and low birth weight infants, and has become a serious public health problem; Clinicians should pay attention to differential diagnosis, Reasonable selection of antibiotics to reduce the generation of drug-resistant bacteria.

Evaluating the impact of culture-guided antibiotic therapy on clinical outcomes in neonatal septicemia: A cross-sectional study

Background: Neonatal sepsis is a critical health issue worldwide, with high morbidity and mortality rates, especially in developing countries. Effective management of neonatal sepsis includes timely administration of appropriate antibiotics based on antimicrobial susceptibility patterns. Aims and Objectives: This cross-sectional study aimed to investigate the choice of empiric and definitive antibiotics in neonatal septicemia, assess bacterial susceptibility patterns, and correlation with clinical outcomes, and highlight the importance of antimicrobial stewardship. Materials and Methods: The study was conducted at a tertiary care center and enrolled neonates diagnosed with septicemia over 2 months. Blood cultures were obtained, and antibiotics were initiated empirically based on local guidelines. Definitive antibiotics were started after culture sensitivity reports and compared with empiric treatment for clinical outcomes and bacteriological profiles were analyzed with appropriate statistical methods. Results: In this study, Piperacillin-Tazobactam and Amikacin were used as empiric treatment in all cases. Meropenem showed high sensitivity in definitive treatment post-culture. No significant difference between empiric and definitive treatment groups was observed in clinical outcomes. Conclusion: This study found no significant difference in clinical outcomes between empiric and definitive antibiotic regimens for neonatal sepsis. However, high meropenem susceptibility suggests the potential for more targeted therapy. Regularly updating local antibiogram, data remain crucial to optimize empiric treatment and combat resistance in this vulnerable population.

Effect of holder pasteurization and storage of donor human milk on Bacillus cereus survival

Abstract Introduction Human milk, which constitutes the best composed nutrition for infants, is not a sterile biofluid. Besides nutritional and bioactive components, many microorganisms have been found in human milk, including Bacillus cereus. Those pathogenic bacteria can be responsible for causing pneumonia or septicemia in neonates. Although Bacillus cereus infections are not common, they represent one of the increasing factors of a high mortality rate in the preterm infants group. Donor human milk (DHM) may be a significant source of this pathogen. Materials and Methods Given the high ability of Bacillus cereus spores to survive under different thermal conditions, we tested the effect of the holder pasteurization and storage points (4 °C and −21 °C) on sporulation and vegetative forms’ survival in inoculated human milk samples by culture method and light microscopy. Results Studies confirmed that holder pasteurization is effective against vegetative forms of Bacillus cereus. Additionally, during storage endospores were observed in all analyzed inoculated donor milk samples, both the pasteurized and unpasteurized samples, thus possibly promoting the occurrence of Bacillus cereus in DHM. Conclusions Bacillus cereus is considered a contamination in DHM and in the human milk banks’ (HMB) environment. There is a need to further develop methods of identifying, transmitting, and preventing bacteria forming spores, which could be applied in HMB.