Treatment Of Neonatal Sepsis Research Articles

Treatment of Infection Caused by Vancomycin-Resistant Enterococci in Extremely Preterm Neonate

Background: Enterococci are facultative anaerobic microorganisms and opportunistic pathogens. Risk factors for enterococcal infection in neonates are prematurity, low birth weight, long-term hospitalization in the neonatal intensive care unit, immaturity of the innate and adaptive immune response, mechanical ventilation and other invasive procedures. Vancomycin-resistant Enterococci has increased significantly over the last two decades as important cause of nosocomial infections. Case description: The preterm male neonate was born by vaginal delivery at 255/7 weeks of gestation with birth weight of 900 g and Apgar score of 2 in the first minute after birth. After initial stabilization in Maternity Hospital, the neonate was admitted to the Institute of Neonatology on the 3rd day of life in severe condition. On the 28th day of life, the neonate developed signs of systemic infection. Complete blood count showed leukocytes of 6300/mm3 and increased concentration of C-reactive protein (90.2 mg/L). Analysis of cerebrospinal fluid obtained by lumbar and ventricular puncture showed pleocytosis, hyperproteinorachia and hypoglycorrhachia. We received a positive result of the tracheal aspirate for Enterococcus faecalis with sensitivity only on linezolid. Because of that, we added linezolid in the therapy. However, Enterococcus faecium grew in the blood and cerebrospinal fluid. In accordance to the antibiogram, the antibiotic therapy was replaced to chloramphenicol. Head ultrasound showed posthemorrhagic ventricular dilatation, increased thickness, irregularity and echogenicity of the ependyma, the presence of intraventricular debris and stranding and fibrin sept formation in left lateral ventricle. During treatment by chloramphenicol the neonate had a mild gray skin color, but count of blood cells, and function of liver and kidneys were normal. After the completion of treatment of neonatal sepsis complicated by meningitis and ventriculitis, ventriculoperitoneal shunt implantation was performed. Conclusion: There is a need for implementation of strategies for control of colonization by vancomycin-resistant Enterococci in pregnant women, as wells as preventive measures in daily work and rational use of antibiotics in the neonatal intensive care unit. Chloramphenicol could be used as a new treatment option for neonatal sepsis caused by vancomycin-resistant Enterococci, especially associated with infection of central nervous system with monitoring complete blood count, liver and kidney function of the neonate.

Occurrence of virulence genes icaADBC and antibiotic resistance genes blaZ, mecA, and aac(6’)-Ie-aph (2’’)-Ia in coagulase-negative staphylococci isolates from neonates with sepsis at a regional referral hospital in Dar es Salaam, Tanzania

BackgroundCoagulase-negative staphylococci (CoNS) have been linked to severe conditions such as bloodstream infection, with biofilm formation regarded as the major virulence mechanism. This study determined virulence genes (VGs) (icaA, icaB, icaC, and icaD) responsible for biofilm formation and antibiotic resistance genes (ARGs) (blaZ, mecA, and aac(6’)-Ie-aph(2’’)-Ia) in CoNS isolated from blood samples of 70 neonates with sepsis in Dar es Salaam, Tanzania. We used VITEK®MS (BioMérieux, France) for speciation and phenotypically detected biofilm production using the Congo red agar. Polymerase chain reaction was performed for ARGs and VGs detection; principal component analysis was used to ascertain their relationship.ResultsOut of 70 CoNS, Staphylococcus epidermidis, 27 (36.8%) was the most commonly isolate, subsequently to Staphylococcus haemolyticus, 24 (34.3%). The intercellular adhesion genes (ica) were detected in all isolates, with IcaD found in 70 (100.0%), followed by icaB 69 (98.6%), icaC 69 (98.6%), and icaA 65 (92.9%). Four virulence gene combinations (icaADBC, icaBCD, icaACD, and icaABD) were detected, predominantly icaADBC 63 (90.0%). Sixty-one (87.1%) isolates harbored three ARGs, mostly the mecA gene 69 (98.6%), followed by blaZ 67 (95.7%) and aac (6’)-Ie-aph (2’’)-Ia, 65 (92.7%). We observed a moderate positive correlation between mecA and icaA genes (r = 0.4341). Sixty-five (97.0%) isolates resistant to penicillin harbored blaZ genes, and all 62 (100%) resistant to oxacillin harbored mecA genes. Of the 66 isolates resistant to gentamycin, 62 (93.9%) harbored the aac (6’)-Ie-aph (2’’)-Ia gene. The mecA gene contributed most of the resistance, followed by aac(6’)-Ie-aph(2’’)-Ia genes. However, the icaA and icaD genes significantly influenced the virulence of CoNS.ConclusionsMost CoNS isolated from blood samples of neonates with sepsis harbor a variety of clinically relevant virulence and resistance genes, indicating their ability to cause severe infections that are difficult to treat. Significantly, 59 (84.3%) isolates were phenotypically penicillin, gentamycin, and oxacillin resistant; the antibiotics recommended in the national guidelines for empiric treatment of neonatal sepsis.

Uncommon Organisms in Neonatal Meningitis: Two Case Reports

These case reports describe two neonates, born at term, diagnosed with bacterial meningitis and septicemia caused by uncommon organisms. The clinical presentation, diagnostic reasoning, national guidelines, hospital course, and follow-up are discussed. Meningitis is among the differential diagnoses when there is a concern for neonatal sepsis. Concern for sepsis can arise from a variety of antepartum, intrapartum, and postpartum risk factors and present with a variety of symptoms. Neonatal sepsis is a significant cause of mortality, with 750,000 infant deaths annually. Effective treatment of neonatal sepsis requires timely diagnosis and tailored antimicrobial therapy that targets the causative pathogens.

Acinetobacter spp. in neonatal sepsis: an urgent global threat

Neonatal sepsis causes substantial morbidity and mortality, the burden of which is carried by low-income countries (LICs). The emergence of multidrug-resistant pathogens in vulnerable neonatal populations poses an urgent threat to infant survival. Acinetobacter spp. are increasingly responsible for severe disease in neonates globally. The cause of this escalation remains unclear, but host, pathogen and environmental factors are all likely to contribute. Acinetobacter spp. strains are frequently resistant to the first line empirical treatment for neonatal sepsis as recommended by the World Health Organization (WHO), ampicillin and gentamicin, rendering these antibiotics ineffectual in many critically ill neonates. The resultant escalation to broader spectrum antibiotic regimens in neonatal intensive care units (NICUs) worldwide has led to the emergence of more resistant strains, including carbapenem-resistant Acinetobacter baumanii (CRAB), resulting in infections that are ever more difficult to treat. While some existing antimicrobial agents are under consideration for treatment of Acinetobacter spp. infections, the majority remain a long way from clinical use in neonates. Further research into the clinical phenotype of these infections, transmission dynamics and preventative measures are urgently needed to reduce neonatal deaths. This review aims to summarise the role of Acinetobacter spp. in neonatal sepsis, including host, pathogen and environmental factors, the global epidemiology and clinical features of the disease, the treatment options, and future research priorities.

Assessment of three antibiotic combination regimens against Gram-negative bacteria causing neonatal sepsis in low- and middle-income countries

Gram-negative bacteria (GNB) are a major cause of neonatal sepsis in low- and middle-income countries (LMICs). Although the World Health Organization (WHO) reports that over 80% of these sepsis deaths could be prevented through improved treatment, the efficacy of the currently recommended first- and second-line treatment regimens for this condition is increasingly affected by high rates of drug resistance. Here we assess three well known antibiotics, fosfomycin, flomoxef and amikacin, in combination as potential antibiotic treatment regimens by investigating the drug resistance and genetic profiles of commonly isolated GNB causing neonatal sepsis in LMICs. The five most prevalent bacterial isolates in the NeoOBS study (NCT03721302) are Klebsiella pneumoniae, Acinetobacter baumannii, E. coli, Serratia marcescens and Enterobacter cloacae complex. Among these isolates, high levels of ESBL and carbapenemase encoding genes are detected along with resistance to ampicillin, gentamicin and cefotaxime, the current WHO recommended empiric regimens. The three new combinations show excellent in vitro activity against ESBL-producing K. pneumoniae and E. coli isolates. Our data should further inform and support the clinical evaluation of these three antibiotic combinations for the treatment of neonatal sepsis in areas with high rates of multidrug-resistant Gram-negative bacteria.

Reintroduction of Legacy Antibiotics in Neonatal Sepsis: The Special Role of Fosfomycin and Colistin.

Neonatal sepsis is a leading cause of morbidity and mortality in neonates, particularly in low- and middle-income countries. The emergence of antimicrobial resistance is a rapidly growing global problem. A significant proportion of the pathogens that commonly cause neonatal sepsis are resistant to multiple antibiotics. Therefore, for the empirical treatment of neonatal sepsis, the repurposing of older antibiotics that are effective against multidrug-resistant pathogens is being investigated. This review aims to provide an overview of current research and experience using the repurposed antibiotics colistin and fosfomycin for the empirical treatment of neonatal sepsis. Based on current knowledge, colistin and fosfomycin may be potentially helpful for the empirical treatment of sepsis in neonates due to their efficacy against a wide range of pathogens and acceptable safety profile.

Clinical practice guidelines for meropenem therapy in neonatal sepsis (2024)

Meropenem is one of the most widely used special-grade antimicrobial agents in the treatment of neonatal sepsis. However, its irrational use has led to an increasingly severe problem of bacterial multidrug resistance. The guideline was developed following standardized methods and procedures, and provides 12 recommendations specifically addressing 9 clinical issues. The recommendations cover various aspects of meropenem use in neonates, including timing of administration, recommended dosage, extended infusion, monitoring and assessment, antimicrobial adjustment strategies, treatment duration, and treatment strategies for carbapenem-resistant Enterobacteriaceae infections. The aim of the guideline is to provide evidence-based recommendations and guidance for the rational use of meropenem in neonates with sepsis.

Survival Status and Predictors of Mortality Among Low-birth-weight Neonates in Southern Ethiopia: A Prospective Follow-up Study

Background Due to anatomical and physiological immaturity low-birth-weight (LBW) neonates are at risk for different complications which may lead to death at a specified period after birth. Therefore, this study aimed to assess the survival rate and predictors of mortality among LBW neonates. Methods A hospital-based prospective cohort study design was conducted among 768 LBW neonates. The Cox proportional hazard model was used to identify predictors of mortality among LBW neonates. Result The mortality rate of low birth weight was 38.8 (95% CI: 33.9–44.3) per 1,000 child-day observations. Parity (AHR = 1.47 [95% CI: 1.06–2.05]), Birth weight <1000 gram (AHR = 4.70 [95% CI: 2.36–9.35]), Birth weight <1500 gram (AHR = 1.62 [95% CI: 1.16–2.27]), Neonatal sepsis (AHR = 2.41 [95% CI: 2.25–2.91]), Birth asphyxia (AHR = 1.46 [95% CI = 1.02–2.08]), Kangaroo mother care (KMC) (AHR = 0.35 [95% CI: 0.24–0.49]), were statistically significantly associated with mortality. Conclusions The findings of this study revealed that the incidence rate of mortality among LBW neonates was high. Practising KMC for all LBW neonates and appropriate treatment of neonatal sepsis and birth asphyxia were strongly recommended to reduce mortality among LBW neonates.

How does pentoxifylline adjunct to antibiotics compare with placebo or no intervention for the treatment of sepsis in neonates?

How does pentoxifylline adjunct to antibiotics compare with placebo or no intervention for the treatment of sepsis in neonates?

Comparative evaluation of effectiveness and safety of meropenem in term and preterm neonates with neonatal sepsis

Background: Neonatal sepsis is one of the most common causes of substantial neonatal morbidity and mortality. In India, it is estimated that 7.5 lakh neonates die every year, which is the highest neonatal mortality rate (NMR) in the world. This is despite the fact that NMR declined from 44/1000 lives birth in 2000–28/1000 live births in 2013. The rate of decline has been slow and lags behind that of the infant mortality rate and the under-five mortality rate. Aims and Objectives: To study the effectiveness and safety of meropenem in the treatment of sepsis affecting term and preterm neonates. Materials and Methods: The study was a prospective, observational study conducted at Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. A total of 76 subjects were enrolled (38 term and 38 preterm neonates). All neonates, preterm or term, admitted to the Neonatal Intensive Care Unit with neonatal sepsis, either clinical or culture-proven sepsis, who had not received meropenem before admission and would be given meropenem as empirical or culture-sensitive were included. All enrolled neonates were evaluated for the effectiveness of meropenem. Pre- and post-meropenem dose clinical and laboratory data were evaluated using the presumptive clinical cure score (PCCS). Results: There was a significant difference between pre- and post-PCCS of all the neonates (P < 0.001) in both groups. There was no significant difference in the effectiveness of meropenem therapy in neonatal sepsis in term and preterm neonates (P = 0.253). There was no significant difference in the adverse reaction profile between preterm and term neonates for skin rash (P = 0.614) and diarrhea (P = 1.00). Conclusion: Meropenem is quite effective and safe for neonatal sepsis in both term and preterm neonates. So, giving meropenem as a second or third line in a dose of 20–40 mg/kg 8 hours a day according to gestation is a good drug for the treatment of neonatal sepsis.

Argon inhalation attenuates systemic inflammation and rescues lung architecture during experimental neonatal sepsis.

Neonatal sepsis is a systemic inflammatory infection common in premature infants and a leading cause of mortality. Argon is an emerging interest in the field of noble gas therapy. Neonates with severe sepsis are frequently mechanically ventilated creating an opportunity for inhalation therapy. We aimed to investigate argon inhalation as a novel experimental therapy in neonatal sepsis. Sepsis was established in C57BL/6 neonatal mice by a lipopolysaccharide intraperitoneal injection on postnatal day 9. Septic pup mice were exposed to room air as well as non-septic controls. In the argon group, septic pup mice were exposed to argon (70% Ar, 30% O2) for 6h in a temperature-controlled environment. At 6h, survival was significantly enhanced when septic mice received argon compared to septic controls. Serum profiles of cytokine release were significantly attenuated as well as lung architecture restored. Our findings suggest that argon inhalation as a novel treatment for neonatal sepsis, reducing mortality and counteracting the acute systemic inflammatory response in the blood and preserving the architecture of the lung. This research can contribute to a paradigm shift in the treatment and outcome of neonates with sepsis.

Improving the Treatment of Neonatal Sepsis in Resource-Limited Settings: Gaps and Recommendations.

Neonatal sepsis causes significant global morbidity and mortality, with the highest burden in resource-limited settings where 99% of neonatal deaths occur. There are multiple challenges to achieving successful treatment of neonates in this setting. Firstly, reliable and low-cost strategies for risk identification are urgently needed to facilitate treatment as early as possible. Improved laboratory capacity to allow identification of causative organisms would support antimicrobial stewardship. Antibiotic treatment is still hampered by availability, but also increasingly by antimicrobial resistance - making surveillance of organisms and judicious antibiotic use a priority. Finally, supportive care is key in the management of the neonate with sepsis and has been underrecognized as a priority in resource-limited settings. This includes fluid balance and nutritional support in the acute phase, and follow-up care in order to mitigate complications and optimise long-term outcomes. There is much more work to be done in identifying the holistic needs of neonates and their families to provide effective family-integrated interventions and complete the package of neonatal sepsis management in resource-limited settings.

The relationship between platelet to lymphocyte ratio with neonatal sepsis at Wangaya General Hospital

Background: Neonatal sepsis is still a major health problem throughout the world and one of the leading causes of morbidity and mortality in neonates. This disease often goes undetected and causes death. The diagnosis and treatment of neonatal sepsis is still a problem today. According to current research, the platelet-to-lymphocyte ratio (PLR) plays a significant role in the inflammatory process. This study aims to contribute to the research on whether PLR is connected with the incidence of neonatal sepsis and can be used as a biomarker of neonatal sepsis. Methods: This cross-sectional observational analytic study examines the link between platelet-to-lymphocyte ratio and neonatal sepsis. Based on medical records, this investigation's total number of samples was 36 newborns. Results: From June 2022 to June 2023, there were 539 newborns in the hospital. The prevalence of neonatal sepsis was 23 neonates (4,2%) and there were 14 neonates (2,6%) that fulfilled the criteria in this study. Based on the characteristics of PLR, the mean value in neonatal sepsis was found to be 125.71. Bivariate analysis using statistical Chi-square revealed that PLR had a p-value of 0.009, odds ratio of 6.7, and 95% CI of 1.5 - 29.6. Conclusion: There was a correlation between PLR and neonatal sepsis in Wangaya Hospital. Patients with increased PLR were six times the odds of having neonatal sepsis compared to patients with non-increased PLR.

Incidence and risk factors of neonatal bacterial infections: a community-based cohort from Madagascar (2018–2021)

BackgroundFew studies on neonatal severe bacterial infection are available in LMICs. Data are needed in these countries to prioritize interventions and decrease neonatal infections which are a primary cause of neonatal mortality. The BIRDY project (Bacterial Infections and Antimicrobial Drug Resistant among Young Children) was initially conducted in Madagascar, Senegal and Cambodia (BIRDY 1, 2012–2018), and continued in Madagascar only (BIRDY 2, 2018–2021). We present here the BIRDY 2 project whose objectives were (1) to estimate the incidence of neonatal severe bacterial infections and compare these findings with those obtained in BIRDY 1, (2) to identify determinants associated with severe bacterial infection and (3) to specify the antibiotic resistance pattern of bacteria in newborns.MethodsThe BIRDY 2 study was a prospective community-based mother and child cohort, both in urban and semi-rural areas. All pregnant women in the study areas were identified and enrolled. Their newborns were actively and passively followed-up from birth to 3 months. Data on clinical symptoms developed by the children and laboratory results of all clinical samples investigated were collected. A Cox proportional hazards model was performed to identify risk factors associated with possible severe bacterial infection.FindingsA total of 53 possible severe bacterial infection and 6 confirmed severe bacterial infection episodes were identified among the 511 neonates followed-up, with more than half occurring in the first 3 days. For the first month period, the incidence of confirmed severe bacterial infection was 11.7 per 1,000 live births indicating a 1.3 -fold decrease compared to BIRDY 1 in Madagascar (p = 0.50) and the incidence of possible severe bacterial infection was 76.3, indicating a 2.6-fold decrease compared to BIRDY 1 in Madagascar (p < 0.001). The 6 severe bacterial infection confirmed by blood culture included 5 Enterobacterales and one Enterococcus faecium. The 5 Enterobacterales were extended-spectrum β-lactamases (ESBL) producers and were resistant to quinolones and gentamicin. Enterococcus faecium was sensitive to vancomycin but resistant to amoxicillin and to gentamicin. These pathogns were classified as multidrug-resistant bacteria and were resistant to antibiotics recommended in WHO guidelines for neonatal sepsis. However, they remained susceptible to carbapenem. Fetid amniotic fluid, need for resuscitation at birth and low birth weight were associated with early onset possible severe bacterial infection.ConclusionOur results suggest that the incidence of severe bacterial infection is still high in the community of Madagascar, even if it seems lower when compared to BIRDY 1 estimates, and that existing neonatal sepsis treatment guidelines may no longer be appropriate in Madagascar. These results motivate to further strengthen actions for the prevention, early diagnosis and case management during the first 3 days of life.

The changing profile of neonatal pathogens and susceptibility pattern: prospective observational study from a tertiary center in South India

Introduction: Changing the pattern of neonatal pathogens poses challenges to the management of neonatal sepsis. Profile and antimicrobial susceptibility of neonatal pathogens were evaluated in this prospective observational study in a tertiary center. Methods: Neonates with risk factors and clinical features of sepsis were screened. Blood culture performed in positive-screen babies. Antimicrobial susceptibility was also evaluated. Statistical significance was tested by the chi-square test and t test accordingly. Univariate analysis was performed to study possible correlations in this regard. Results: Out of 431 suspected cases, 89 neonates (20.65%) had sepsis. The rate of early and late-onset sepsis (LOS) was 48.3% and 51.7%, respectively. The clinical spectrum included septicemia 68 (76.5%), congenital pneumonia 13 (14.7%), meningitis 5 (5.7%), and septic arthritis 3 (3.4%), respectively. Gram-positive bacteria constituted 61 (68.5%), while gram-negative was 28 (31.5%) (P&lt;0.05). Staphylococcus aureus (23.6%) and methicillin-resistant S. aureus (MRSA) (22.5%) were the most common isolates. Acinetobacter (15.8%), coagulase-negative staphylococcus areus (CoNS) (11%), Klebsiella (7.9%), enterococci (8%), E. coli (4.5%), and ß hemolytic streptococci (1 case) were other detected pathogens. MRSA, Acinetobacter, and coagulase-negative S. aureus as a single entity involved in sepsis pathogenesis (50.6%) showed a positive correlation with inborn babies, pre-term, low birth weight, and early-onset sepsis (OR; 95% CI: 2.20; 0.94–5.20, 1.82; 0.79–4.22, 1.25; 0.55–2.89 and 1.05; 0.46–2.50 respectively). Susceptibility pattern was penicillin (12.3%), ampicillin (6.7%), cloxacillin (42.9%), cefotaxime (8%), cefazolin (37.9%), cefoperazone sulbactam (81.5%), piperacillin-tazobactam (68.9%), gentamicin (63.5%), amikacin (47.9%), vancomycin (88.9%), linezolid (88.6%), co-trimoxazole (55.4%), and clindamycin (50%). Conclusion: Gram-positive pathogens and opportunistic pathogens like Acinetobacter predominate over the conventional gram-negative pathogens in neonates. Of note, penicillin, ampicillin, and cefotaxime are not suitable for the empiric treatment of neonatal sepsis.

Insight Into Neonatal Sepsis: An Overview.

There are approximately 1.3 million cases of neonatal sepsis reported worldwide with deathsoccurring more commonly in preterm and low-weight newborns. Neonatal sepsis is the third major cause of neonatal deaths resulting in 203,000 deaths per year. It is divided into two subtypes based on time of occurrence: early-onset neonatal sepsis (ENS), occurring within the first 72 hours of birth usually due to perinatal risk factors, and late-onset neonatal sepsis (LOS) usually occurring after the first week of life and up to 28th day of life. There are many complications associated with neonatal sepsis including septic shock, multiple organ failure, and death. It is vital for clinicians to know the signs and symptoms of neonatal sepsis in order to diagnose it early. Preventive measures, early diagnosis, appropriate antibiotic administration, timely supportive management, and the establishment of efficient management are vital in the prevention of severe complications or death. In this review, we aim to provide the most up-to-date information regarding risk factors, pathophysiology, signs and symptoms, diagnosis, and treatment of neonatal sepsis. We discuss the maternal and neonatal risk factors involved in the pathogenesis of neonatal sepsis and the signs and symptoms of early and late neonatal sepsis.We focus on the different pathogens involved and the markers used in the diagnosis and treatments available for each.

3-(Bromoacetyl) coumarin is a potential therapeutic agent against neonatal sepsis-associated Pseudomonas extremorientalis.

Neonatal sepsis is a severe bacterial infection that can lead to life-threatening complications in newborns. Pseudomonas extremorientalis is a Gram-negative bacterium andthese Gram-negative organismshave been identified as a major cause of neonatal sepsis. The virulence factors produced by this bacterium play a crucial role in its pathogenicity. Therefore, targeting these virulence factors could be a potential strategy to treat neonatal sepsis caused by P. extremorientalis. In this study, we investigated the efficacy of 3-(bromoacetyl) coumarin (3-BC) in reducing the virulence factors of P. extremorientalis strains isolated from neonatal sepsis. Our results showed that 3-BC effectively reduced the production of various virulence factors, including protease, elastase, siderophore, and exopolysaccharide in these strains. Furthermore, at a concentration of 125µg/ml, 3-BC also inhibited the biofilm formation ability of these strains in combination with ciprofloxacin. It was discovered that 3-BC was functionally effective in protecting C. elegans against bacterial infection. Moreover, the in vitro and in vivo outcomes were strongly correlated with docking studies of various activator proteins. Overall, our findings suggest that 3-BC could be a potential therapeutic agent for the treatment of neonatal sepsis caused by P. extremorientalis. Further studies are needed to explore the mechanism of action of 3-BC and its potential use in clinical settings.

DETERMINING THE PATHOGENS OF NEONATAL SEPSIS AT THE NATIONAL CHILDREN'S HOSPITAL (2019 – 2021)

Sepsis is a life-threatening condition responding to an infectious agent causesdamage to tissues and organs. Sepsis causes serious consequences in neonates due tohighrates of mortality and sequelae and disability. Currently, the treatment ofneonatal sepsis is still facing many difficulties due to late diagnosis, inappropriateantibiotic selection for the pathogen model. The mortality rate of the disease is stillhigh. Determining the pathogens of neonatal sepsis at the National Children'sHospital (2019 – 2021). A descriptive study was conducted on 85 positive bloodculture samples of full-term infants admitted to the Neonatal Center of VietnamNational Children’s Hospital in the period from 12/2019 to 4/2021.Gram-negative bacteria accounted for the highest percentage 51%, Grampositive bacteria accounted for 38.8%, Candida accounted for 9.4%. S. aureus is thecommon cause of disease (28.2%), E. coli and K. pneumonia account for a highproportion (16.5%). Antibiotics with high sensitivity are vancomycin, aztreonam,moxiflocaxin, ertapenem, levofloxacin, meronem.

Machine learning applications on neonatal sepsis treatment: a scoping review

IntroductionNeonatal sepsis is a major cause of health loss and mortality worldwide. Without proper treatment, neonatal sepsis can quickly develop into multisystem organ failure. However, the signs of neonatal sepsis are non-specific, and treatment is labour-intensive and expensive. Moreover, antimicrobial resistance is a significant threat globally, and it has been reported that over 70% of neonatal bloodstream infections are resistant to first-line antibiotic treatment. Machine learning is a potential tool to aid clinicians in diagnosing infections and in determining the most appropriate empiric antibiotic treatment, as has been demonstrated for adult populations. This review aimed to present the application of machine learning on neonatal sepsis treatment.MethodsPubMed, Embase, and Scopus were searched for studies published in English focusing on neonatal sepsis, antibiotics, and machine learning.ResultsThere were 18 studies included in this scoping review. Three studies focused on using machine learning in antibiotic treatment for bloodstream infections, one focused on predicting in-hospital mortality associated with neonatal sepsis, and the remaining studies focused on developing machine learning prediction models to diagnose possible sepsis cases. Gestational age, C-reactive protein levels, and white blood cell count were important predictors to diagnose neonatal sepsis. Age, weight, and days from hospital admission to blood sample taken were important to predict antibiotic-resistant infections. The best-performing machine learning models were random forest and neural networks.ConclusionDespite the threat antimicrobial resistance poses, there was a lack of studies focusing on the use of machine learning for aiding empirical antibiotic treatment for neonatal sepsis.

Bioinformatic Analysis and Machine Learning Methods in Neonatal Sepsis: Identification of Biomarkers and Immune Infiltration.

The disease neonatal sepsis (NS) poses a serious threat to life, and its pathogenesis remains unclear. Using the Gene Expression Omnibus (GEO) database, differentially expressed genes (DEGs) were identified and functional enrichment analyses were conducted. Three machine learning algorithms containing the least absolute shrinkage and selection operator (LASSO), support vector machine recursive feature elimination (SVM-RFE), and random forest (RF) were applied to identify the optimal feature genes (OFGs). This study conducted CIBERSORT to present the abundance of immune infiltrates between septic and control neonates and assessed the relationship between OFGs and immune cells. In total, 44 DEGs were discovered between the septic and control newborns. Throughout the enrichment analysis, DEGs were primarily related to inflammatory signaling pathways and immune responses. The OFGs derived from machine learning algorithms were intersected to yield four biomarkers, namely Hexokinase 3 (HK3), Cystatin 7 (CST7), Resistin (RETN), and Glycogenin 1 (GYG1). The potential biomarkers were validated in other datasets and LPS-stimulated HEUVCs. Septic infants showed a higher proportion of neutrophils (p < 0.001), M0 macrophages (p < 0.001), and regulatory T cells (p = 0.004). HK3, CST7, RETN, and GYG1 showed significant correlations with immune cells. Overall, the biomarkers offered promising insights into the molecular mechanisms of immune regulation for the prediction and treatment of NS.