Treatment Of Neonatal Sepsis Research Articles

Retraction Note: Eficacy of pentoxifylline treatment for neonatal sepsis: a meta-analysis of randomized controlled studies

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s13052-019-0697-8

Clinical Application of Serum Inflammatory Factors Combined with Dynamic Detection in the Diagnosis and Treatment of Neonatal Sepsis.

Background:To investigate the clinical application value of the combination of the inflammatory factors and dynamic detection in the diagnosis and treatment of neonatal sepsis by detecting serum inflammatory factor C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) levels before and after treatment of neonatal infection.Methods:A total of 138 neonates with different degrees of infection were randomly enrolled, including 88 cases in the sepsis group and 50 cases in the virus infection group. Another 50 non-infected newborns in the same period were enrolled as the normal control group. Venous blood of all subjects for CRP, PCT, IL-6 detection, and send bacterial blood culture for sepsis and virus infection groups were collected at the same time. In the recovery period, venous blood of children in sepsis group was collected again to review CRP, PCT, IL-6, and differences in each test index of each group were compared.Results:The serum CRP, PCT, IL-6 levels in the sepsis group were significantly higher than those in the virus infection group (all P <0.05); serum CRP, PCT, IL-6 levels in the sepsis group were significantly lower than before treatment (P <0.05); the sensitivity and accuracy of the combined detection of indicators for the diagnosis of neonatal sepsis were significantly improved.Conclusion:The inflammatory factors CRP, PCT, and IL-6 are closely related to the occurrence and development of neonatal sepsis. Combined detection can effectively improve the diagnostic accordance rate, which is beneficial to the early diagnosis and early clinical intervention of neonatal sepsis.

What's New in Shock, February 2021?

What's New in Shock, February 2021?

COVID-19 in Neonates, A Case Series Study from Tertiary Neonatal Centers in Iran

Introduction: The Novel coronavirus, sars-cov-2, is responsible for the recent pandemic. Although it mostly affects adults, children of all ages, including neonates, can become ill with Covid-19, as well. The real prevalence rate of coronavirus disease 2019 (COVID-19) in children is unknown. However, the severity of symptoms in children and neonates is less than in adults. Regarding the new presentation of this disease, the current study has reported a case series of COVID-19 in neonates. Case Presentation: In this article, 10 neonates with COVID- 19 admitted to our neonatal intensive care units are reported. All reported neonates had general suspicious symptoms of COVID- 19 with positive results for SARS-CoV-2 assessed by polymerase chain reaction (PCR) from the nasopharynx area or nose of the patients. All neonates, except for two of them, were term neonates. One case had open-heart surgery for congenital heart disease (transposition of the great arteries (TGA)). The mean patients age was 7.8 days on admission. The most frequent symptom was fever. Severe respiratory symptoms were reported in two cases. Also, abnormal radiologic findings in the chest X-ray were detected in two cases. Regarding the lack of significant respiratory symptoms in most of the patients, the lung computed tomography (CT) scan was taken just from one neonate. Leukopenia (WBC &lt; 5000/mm3) was detected in one case, with no lymphopenia in all neonates. The positive C-reactive protein test was not found in all cases. No patient was treated by special anti-viral agents for COVID-19, and usual antibiotic treatment for neonatal sepsis was administered for all cases. All patients, except for one, survived with no significant sequela of the disease. Conclusions: This study demonstrated that clinical manifestations, as well as laboratory and radiologic findings of COVID-19, are milder in neonates than in the older ages. Hence, it can be argued that the prognosis of COVID-19 in the neonatal period is generally good.

From the laboratory to the end-user: a primary packaging study for microneedle patches containing amoxicillin sodium

As microneedle (MN) patches progress towards commercialisation, there is a need to address issues surrounding their translation from the laboratory to the end-user. One important aspect of MN patches moving forward is appropriate primary packaging. This research focuses on MN patches containing amoxicillin (AMX) sodium for the potential treatment of neonatal sepsis in hot and humid countries. A MN patch consists of a hydrogel-forming MN array and a drug-containing reservoir. Improper primary packaging in hot and humid countries may result in degradation of active pharmaceutical ingredients, with the use of substandard medicines a major health concern. The research presented here, for the first time, seeks to investigate the integrity of MN patches in different primary packaging when stored under accelerated storage conditions, according to international guidelines. At pre-defined intervals, the performance of the MN patch was investigated. Major causes of drug instability are moisture and temperature. To avoid unnecessary degradation, suitable primary packaging was sought. After 168 days, the percentage of AMX sodium recovered from drug-containing reservoirs packaged in Protect™ 470 foil was 103.51 ± 7.03%. However, packaged in poly(ester) foil, the AMX sodium content decreased significantly (p = 0.0286), which is likely due to the degradation of AMX sodium by the imbibed moisture. Therefore, convincing evidence was provided as to the importance of investigating the stability of MN patches in primary packaging intended for MN-mediated transdermal delivery so that they are ‘fit for purpose’ when it reaches the end-user. Future work will include qualitative studies to assess MN patch usability.Graphical abstract

Challenges in Treatment Strategies for Management of Neonatal Sepsis

Background: Neonatal sepsis is an important cause of morbidity and mortality in newborns. The symptoms and signs of neonatal sepsis are often non-specific and similar to other common neonatal diseases, investigation results are also non-specific and low sensitivity of blood culture also causes diagnostic dilemma and often empirical antibiotic treatment is given. This is why, there is challenges in making the diagnosis and treating neonatal sepsis.&#x0D; Objectives: To find the etiology, sensitivity and specificity of clinical features and investigations and optimal and effective treatment for neonatal sepsis.&#x0D; Materials and methods: The study was a prospective study done in the neonatal ward of a tertiary hospital in Bangladesh; total 100 neonates diagnosed as neonatal sepsis, were enrolled in this study. All study subjects were fully evaluated clinically, thoroughly investigated and properly treated as per protocol.&#x0D; Results: The sensitivity and specificity of clinical features and investigations were statistically significant (i.e. p &lt;0.05) and etiologic agents were isolated by urine culture and sensitivity to antibiotics were shown and outcome measure e.g. mortality was 22% (OR 3.54; 95% CI 2.04- 6.13; P &lt;0.05).&#x0D; Conclusion: There are challenges in making diagnosis and treating neonatal sepsis, yet sincere approach to diagnosis and rational and appropriate use of antibiotics along with necessary adjuvant therapy can mitigate the challenges.&#x0D; J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 23-28

Risk factors for neonatal sepsis in Lubumbashi, Democratic Republic of Congo: A retrospective case-control study

Purpose: Neonatal sepsis (NS) is a major cause of neonatal morbidity and mortality, particularly in developing countries. Delays in the identification and treatment of NS are the main contributors to the high mortality. This study aims to identify risk factors for NS in newborns in the two university hospitals in Lubumbashi, in the Democratic Republic of Congo. Methods: This hospital-based case-control study was carried out on 486 mother-newborn pairs using the systematic sampling method during November 2019 to October 2020. Data were analyzed using STATA software (version 15). Binary and multivariable logistic regression analyses were computed to identify the associated factors at 95% CI. Results: A total of 162 cases and 324 controls were included in this study. Multiple logistic regression analysis showed that the possible risk factors for NS in this study were low level of education (AOR = 9.16 [2.23-37.67]), maternal genitourinary tract infections (AOR = 42.59 [17.90-101.37]), premature rupture of membranes (AOR = 19.95 [7.27-54.76]), peripartum fever (AOR = 26.25 [2.31-297.83]), prolonged labor (AOR = 14.16 [3.88-51.71]), cesarean section (AOR = 3.57 [1.48-8.61]), obstructed vaginal delivery (AOR = 13.40 [1.32-136.19]), birth weight &lt;1500 grams (AOR = 70.38 [8.64-572.95]), and between 1500-2500 grams (AOR = 7.90 [3.04-20.52]). Conclusion: The study found that maternal and neonatal factors were strongly associated with the risk of developing NS. The present study suggests the possibility of routine assessment of sepsis in newborns born with the above characteristics.

Changing Trends of Antimicrobial Resistance in Neonatal Sepsis: Experience from a Tertiary Care Hospital from West Bengal, India

Introduction: Sepsis is the second leading cause of neonatal mortality in India. Emergence of highly resistant microorganisms as an aetiology of neonatal sepsis is a matter of serious concern. Aim: To study the prevailing aetiological agents in neonatal sepsis and their antimicrobial susceptibility pattern. Materials and Methods: A prospective observational study was performed in a tertiary care teaching hospital in neonatal care units in North Bengal Medical College and Hospital, West Bengal, India, over a period of two years from March 2017 to February 2019. All the neonates having clinical features suggestive of sepsis were subjected to blood culture using BacT/ALERT® PF Plus. Microbial identification and antibiotic susceptibility testing was done by VITEK-2 automated systems. Chi-square test was done using Epi info software version 7.1 and p-value &lt;0.05 was considered significant. Results: Out of 403 neonates investigated for suspected sepsis, 156 (38.7%) were found to be culture positive. Klebsiella pneumoniae was the most common organism isolated (n=90, 57.7%) followed by Staphylococcus aureus (n=24, 15.4%) and Acinetobacter baumannii (n=10, 6.4%). Klebsiella pneumoniae showed a very high degree of resistance to ampicillin, amoxycillin- clavulenic acid (100% each), cefotaxime (93.4%), ceftazidime (92.3%), gentamycin (94.5%) and tobramycin (94.5%). High resistance of Staphylococcus aureus was seen against ampicillin (100%), cloxacillin (62.5%), amoxicillin-clavulenic acid (70.9%), and cefotaxime (79.2%). Few isolates of Klebsiella pneumonia (6.6%), Acinetobacter baumannii (60%) and Enterobacter cloacae (50%) were sensitive only to colistin and tigecycline. Conclusion: Most of the isolates showed very high degree of resistance against first line of antibiotics recommended by World Health Organisation (WHO) (ampicillin and gentamycin or amikacin) for empirical treatment of neonatal sepsis. Emergence of highly resistant organisms sensitive only to colistin and tigecycline should be considered as an eye opener. Strict adherence to sepsis prevention along with regular surveillance of organisms and their sensitivity patterns is the need of the hour to improve survival by contributing to antibiotic stewardship.

新生儿败血症抗生素治疗的研究进展

新生儿败血症抗生素治疗的研究进展

MicroRNA-96 is Downregulated in Sepsis Neonates and Attenuates LPSInduced Inflammatory Response by Inhibiting IL-16 in Monocytes.

Neonatal sepsis (NS) remains one of the leading causes of mortality among newborns. This study found the deregulated microRNA-96 (miR-96) in NS neonates, and aimed to evaluate the clinical significance of miR-96, as well as its effect on LPS-induced inflammatory response in monocytes. In addition, the relationship of interleukin-16 (IL-16) and miR-96 was investigated to understand the underlying mechanisms. Expression of miR-96 was examined using real-time quantitative PCR. Monocytes stimulated by LPS was used to mimic excessive inflammation in the pathogenesis of NS. The enzyme-linked immunosorbent assay was applied to evaluate pro-inflammatory cytokine levels. A luciferase reporter assay was used to confirm the interaction between miR-96 and IL-16. Serum miR-96 expression was decreased in NS newborns and had considerable diagnostic value for NS screening. LPS inhibited miR-96 expression in monocytes, and the overexpression of miR-96 could reverse the effects of LPS on the inflammation of monocytes. IL-16 was a target gene of miR-96 and negatively correlated with miR-96 levels in NS neonates. The inhibited inflammatory responses induced by miR-96 overexpression was abolished by the elevated IL-16 in monocytes. All the data reveal that serum decreased miR-96 may serve as a candidate noninvasive biomarker for NS diagnosis. In addition, miR-96 inhibits LPS-induced inflammatory responses by targeting IL-16 in monocytes. The miR-96/IL-16 axis may provide novel therapeutic targets for NS treatment.

Sensitivity and Resistance of the Microorganisms Responsible for Neonatal Sepsis to Antibiotics

Background: Sepsis is a major neonatal disease that requires appropriate early treatment. Objectives: The current study aimed to determine the resistance and sensitivity to antibiotics in neonates admitted to the neonatal intensive care unit (NICU) due to sepsis. Methods: In this cross-sectional study, 268 neonates with definitive sepsis (positive blood culture with clinical signs of infection) hospitalized during 2009 - 2019 are investigated. Identification of microorganism and antibiogram test were performed according to the standard microbiological method. Antibiotics susceptibility testing was performed by disk diffusion and microdilution method according to Clinical and Laboratory Standards Institute (CLSI) (2013). A researcher-made questionnaire, including characteristics of neonates and types of microorganisms (Gram-positive or negative) in the neonatal ward, as well as sensitivity and resistance to common microorganisms in neonatal sepsis, was used to collect data. Results: According to the antibiogram results, the microorganism found in NICU showed sensitivity to vancomycin (97%), imipenem (71%), and co-trimoxazole (56%), as well as norfloxacin, cephalotin, and cefazolin (50%). Gram-negative bacteria showed complete sensitivity (100%) to piperacillin, clavulanic acid, colistin, tazobactam, and meropenem and high sensitivity (&gt; 86%) to imipenem, norfloxacin, and ciprofloxacin. There was high resistance to amoxicillin, ampicillin, amikacin, gentamicin, cephalotin, cefotaxime, ceftriaxone, ceftizoxime, cephalexin, and clindamycin. Gram-positive bacteria showed full sensitivity (100%) to doxycycline, piperacillin, and tobramycin and reasonable sensitivity (&gt; 75%) to vancomycin, imipenem, and tetracycline. Azithromycin, ampicillin, gentamicin, cefepime, meropenem, penicillin, erythromycin, oxacillin, and amoxicillin showed resistance in 100% of cases. Conclusions: This study demonstrated high-sensitivity drugs for definitive treatment of neonatal sepsis (i.e., piperacillin, tazobactam, and meropenem for Gram-negatives, and piperacillin, and tobramycin for Gram-positive microorganisms).

Cut-off value of white blood cell count in the diagnosis of early-onset sepsis in neonates

Objective To study the clinical significance and cut-off value of white blood cell (WBC) count in the diagnosis of early-onset sepsis (EOS) in neonates. Methods A retrospective analysis was performed on 306 neonates with EOS who were admitted from January 2019 to March 2020. A total of 580 children without infection who were admitted during the same period of time were enrolled as the control group. General status and WBC count were compared between the two groups. The diagnostic value of WBC count was analyzed based on the diagnostic and therapeutic protocol of neonatal sepsis in 2003 (referred to as the 2003 diagnostic and therapeutic protocol) and the expert consensus on the diagnosis and treatment of neonatal sepsis (2019 edition) (referred to as the 2019 expert consensus). Results According to the two different diagnosis and treatment protocols, the statistical analysis showed that WBC count had a relatively positive rate (51.3% and 32.0% respectively) but a relatively high specificity (93.3% and 98.6% respectively). The receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve of WBC count in the 2003 diagnostic and therapeutic protocol was larger than that in the 2019 expert consensus (P Conclusions The cut-off value of WBC ≥25×109/L in the 2003 diagnostic and therapeutic protocol is more reasonable in the diagnosis of EOS.

Study of Antibiotic Susceptibility among Bacterial Isolates in Neonatal Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Neonatal sepsis is a major cause of neonatal morbidity and mortality worldwide, especially in developing countries like Nepal. Antibiotic resistance among microorganisms poses new challenges in the treatment of neonatal sepsis. The present study is conducted with the objectives of determining clinico-bacteriological profile and antibiotic susceptibility among isolated bacteria in a neonatal intensive care unit. A descriptive cross-sectional study was conducted from January 1, 2017, to December 31, 2019, in the neonatal intensive care unit of a tertiary care hospital after obtaining ethical clearance from Institutional Review Committee (Reference Number: 2020-064). The sample size was calculated and 77 neonates with culture-proven sepsis were included in the study. The antibiotic susceptibility tests of the isolates were done by Kirby-Bauer disc diffusion method. Data entry was done in Statistical Packages for the Social Sciences version 20. Of the 841 specimens (blood, cerebrospinal fluid, urine, tracheal aspirate and pus) processed for culture, bacteria were isolated in 84 (10.0%) specimens. Among the 84, gram-negative bacilli were the predominant isolates 76 (90.5%); of which Acinetobacter baumannii was the most common 27 (32.1%). Both the Gram-negative and the Gram-positive bacteria showed high resistance to Penicillin and Cephalosporins. Gram-negative bacteria showed maximum sensitivity to Colistin, Carbapenems, Tigecycline and Fluoroquinolones. Gram-positive bacteria showed maximum susceptibility to Amikacin, Vancomycin and Carbapenems. Judicious use of antibiotics based on the updated knowledge of prevalent organisms in the local hospital setting and their antibiotic sensitivity pattern is of utmost importance for the effective treatment of neonatal sepsis.

Resistance to antimicrobials and vancomycin treatment in neonatal sepsis in a hospital in Brazil

Objective: To describe the antimicrobial resistance profile of strains isolated from neonates with septicemia undergoing vancomycin treatment, to determine the agreement of treatment with guideline and blood cultures, to assess the presence of acute kidney injury (AKI) and the clinical outcome in a hospital in Brazil. Methods: A total of 51 newborns treated with vancomycin were studied in the period from January to December 2017. Treatment assessment was verified by the compliance with the Rational Use and Insurance Policy of Antibiotics in Neonatology and blood culture. The presence of AKI was based on the results of serum creatinine. The data were monitored by the computerized system of the laboratory. Results: The main isolated strain was Staphylococcus (coagulase negative) (82.9%), 93.5% with resistance to oxacillin for early infections and 100% for late infections. The same strain showed 54.8% resistance to gentamicin for cases of early sepsis and 66.6% for late sepsis. There were no cases of resistance to vancomycin. The treatments agreed with the reference protocol in 46.3% and with the results of blood cultures in 56%. Only two cases of AKI are observed. Conclusions: The oxacillin-resistant coagulase-negative staphylococcus strains were the main causes of neonatal sepsis. The use of gentamicin for sensitive strains may reduce the use of vancomycin. The results suggest the need for better standardization of the treatment to reduce the risk of toxicity and rational use of therapeutic resources.

Neonatal sepsis: within and beyond China.

Sepsis remains a significant cause of neonatal morbidity and mortality in China. A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimize neonatal health care both regionally and globally. Literature cited in this review was retrieved from PubMed using the keywords "neonatal sepsis," "early-onset (EOS)" and "late-onset (LOS)" in English, with the focus set on population-based studies. This review provides an updated summary regarding the epidemiology, pathogen profile, infectious work-up, and empirical treatment of neonatal sepsis within and beyond China. The incidence of neonatal EOS and the proportion of Group B Streptococcus (GBS) within pathogens causing EOS in China seem to differ from those in developed countries, possibly due to different population characteristics and intrapartum/postnatal health care strategies. Whether to adopt GBS screening and intrapartum antibiotic prophylaxis in China remains highly debatable. The pathogen profile of LOS in China was shown to be similar to other countries. However, viruses as potential pathogens of neonatal LOS have been underappreciated. Growing antimicrobial resistance in China reflects limitations in adapting antibiotic regimen to local microbial profile and timely cessation of treatment in non-proven bacterial infections. This review stresses that the local epidemiology of neonatal sepsis should be closely monitored in each institution. A prompt and adequate infectious work-up is critically important in diagnosing neonatal sepsis. Adequate and appropriate antibiotic strategies must be overemphasized to prevent the emergence of multi-resistant bacteria in China.

Adherence to World Health Organisation guidelines for treatment of early onset neonatal sepsis in low-income settings; a cohort study in Nepal

BackgroundNeonatal sepsis is one of the major causes of death during the first month of life and early empirical treatment with injectable antibiotics is a life-saving intervention. Adherence to World Health Organisation guidelines on first line antibiotics is crucial to mitigate the risks of increased antimicrobial resistance. The aim of this paper was to evaluate if treatment of early onset neonatal sepsis in a low-income facility setting observe current guidelines and if compliance is influenced by contextual factors.MethodsThis cohort study used data on antimicrobial treatment of neonatal sepsis onset within 72 h of life from 12 regional hospitals participating in a scale-up trial of a neonatal resuscitation quality improvement package intervention in Nepal. Infants treated according to guidelines were compared with those receiving other antimicrobials. A multiple logistic regression analysis adjusted for the intervention and time trend was applied.Results1564 infants with a preliminary diagnosis of early onset sepsis were included. A majority (74.9%) were treated according to guidelines and adherence was increasing over time. Infants born at larger facilities (adjusted Odds Ratio 5.6), those that were inborn (adjusted Odds Ratio 1.97) or belonging to a family of dis-advantaged caste (adjusted Odds Ratio 2.15) had higher odds for treatment according to guidelines. A clinical presentation of lethargy or tachypnoea was associated with adherence to guidelines.ConclusionAdherence to guidelines for antibiotic treatment of early neonatal sepsis was moderately high in this low-income setting. Odds for observing guidelines increased with facility size, for inborn infants and if the family belonged to a dis-advantaged caste. Cefotaxime was a common alternative choice when guidelines were not followed, highly relevant for the risk of increased antimicrobial resistance.Trial registrationISRCTN, ISRCTN30829654, registered 17th of May, 2017.

Neonatal sepsis at Mulago national referral hospital in Uganda: Etiology, antimicrobial resistance, associated factors and case fatality risk.

BackgroundSepsis is the third most common cause of death among neonates, with about 225,000 newborns dying every year globally. Data concerning the microbial etiology of neonatal sepsis and antimicrobial resistance profiles of its causative agents are necessary to inform targeted and effective treatment and prevention strategies.ObjectiveTo determine the proportion of newborns with symptoms and signs of sepsis who had a positive blood culture, its bacterial etiology, the antimicrobial resistance patterns as well as the factors associated with culture-positivity and case fatality at Mulago national referral hospital in Uganda.MethodsWe conducted a cross-sectional study among 359 neonates with symptoms and signs of sepsis who presented to the pediatric emergency care unit of Mulago national referral hospital from mid-January to end of December 2018. We performed blood culture and antimicrobial susceptibility testing, and conducted polymerase chain reaction to identify methicillin-resistant Staphylococcus aureus (MRSA) isolates. We used multivariable logistic regression to estimate the association between potential risk factors and culture-positive neonatal sepsis.FindingsOf the 359 neonates recruited, 46 (12.8%; 95% CI 9.5%, 16.7%) had a positive blood culture. The predominant isolated bacteria were Staphylococcus aureus in 29 (63.0%), Escherichia coli in seven (15.2%), and Klebsiella pneumoniae in five (10.9%). Of the 46 pathogens, 73.9% were resistant to ampicillin, 23.9% to gentamicin and 8.7% to ceftriaxone. We isolated MRSA from the blood specimens of 19 (5.3%) of the 359 neonates, while 3 (0.8%) grew extended spectrum beta lactamase producers. The case fatality risk among neonates with neonatal sepsis was 9.5% (95% CI: 6.6%, 13.0%). Cesarean section delivery was strongly associated with culture-positive sepsis (adjusted odds ratio 3.45, 95% CI: 1.2, 10.1).ConclusionOne in eight neonates with clinical signs of sepsis grew a likely causative bacterial pathogen. S. aureus was the main pathogen isolated and a third of these isolates were MRSA. A significant proportion of the isolated bacterial pathogens were resistant to the first and second line antibiotics used for the treatment of neonatal sepsis. There is need to revisit the current treatment guidelines for neonatal sepsis.

A Study of Clinico-pathological Profile of Suspected and Confirmed Neonatal Sepsis at Kathmandu Medical College

Neonatal sepsis is a common reason for neonatal morbidity and mortality. Only clinical manifestations are inadequate to diagnose neonatal sepsis. In context of Nepal, there has been few studies correlating bacterial and clinical profile but none till now has managed to define the most adequate parameters to diagnose neonatal sepsis with certainty. Hence, this study is conducted to describe and compare clinical and laboratory characteristics of culture positive and clinically suspected sepsis (blood culture negative) and then assess whether differences exist between them. A descriptive prospective study was carried out for a period of one year starting from April 2017 to March 2018 at the NICU of Kathmandu Medical College. A total of 129 culture proven and suspected septic neonates were included. Clinical features, septic screening including blood culture, biochemical tests and radiological findings were taken into consideration. The incidence of definite neonatal sepsis was 22.4%. The most common bacterial isolates were gram negative bacteria. Klebsiella spp (48%) followed by CoNS (17%), Acinetobacter spp (14%), Enterobacter spp (7%), Pseudomonas (7%) and Staphylococcus aureus (7%) were isolated. Different non specific clinical features like respiratory and gastro-intestinal symptoms were seen. The neonates with clinical features had positive correlation with abnormal laboratory parameters with statistically significant p value, suggesting that septic neonates showed abnormal laboratory parameters. This data emphasizes the role of laboratory parameters other than blood culture for the diagnosis and empirical treatment of neonatal sepsis.

Efficacy of cefotaxime combined with gamma globulins on C-reactive protein and procalcitonin in neonatal sepsis

C-reactive protein (CRP) is encoded by CRP or PTX1 gene and procalcitonin (PCT) is produced by the CALC-1 gene induction. Both PCT and CRP are known as valued biomarkers markers in prediction of Serious Bacterial Infections (SBI) in children. This experiment carried out to analyze the efficacy of cefotaxime combined with gamma globulins on neonatal sepsis and the effect on CRP and PCT. For this purpose, a total of 120 sepsis children were selected and randomly divided into observation and control groups. Children in the control group were treated with cefotaxime, while children in the observation group were treated with cefotaxime combined with gamma globulins. The two groups were compared in terms of the relative measures of efficacy, the total effective rate of treatment, the incidence of complications and serum CRP and PCT levels before and after treatment. The clinical measures of the observation group were all lower than those of the control group, and the total effective rate of the treatment was higher than that of the control group, while the incidence of complications was lower than that of the control group. In addition, before treatment, there was no difference in CRP and PCT between the two groups; after treatment, the above measures in the observation group were lower than those in the control group. It is concluded that Cefotaxime combined with gamma globulins in the treatment of neonatal sepsis has significant efficacy and is clinically more effective than cefotaxime monotherapy. This combination can shorten clinical symptom remission time and hospital stay, improve serum CRP and PCT levels and promote the recovery of children, worthy of promotion.

Antimicrobial susceptibility pattern of blood culture isolates from patients with suspected neonatal sepsis in a tertiary care hospital in Pakistan

Introduction: Neonatal septicemia is one of the commonest reasons for neonatal morbidity and mortality in developing countries. Knowledge of microbial flora and their susceptibility will help paediatricians decide on empirical treatment of neonatal sepsis. Objective: To determine the antimicrobial susceptibility of blood culture isolates from patients with suspected neonatal sepsis in a tertiary care hospital in Pakistan. Study design: A laboratory based prospective study was carried out in the Department of Pathology, Combined Military Hospital, Sialkot, from March 2017 to February 2019. Methods: Blood culture and sensitivity testing was carried out on patients admitted for suspected neonatal sepsis from March 2017 to February 2019. Antimicrobial susceptibility testing of blood culture isolates was carried out by disk diffusion method using the Clinical Laboratory Standard Institute (CLSI) guidelines. Results: During the study period, 345 blood cultures from 345 neonates (age range 1 day-28 days; mean age 13 days) were received by the laboratory, of which76 were culture positive. Gram negative bacilli were isolated from 44 cultures and Gram positive cocci from the remaining 32. Staphylococcus aureus was the commonest isolate (n=28) followed by Escherichia coli (n=10), Klebsiella pneumoniae (n=9) and Acinetobacter spp. (n=8). Methicillin resistant S. aureus (MRSA) constituted (n=19) 25% of culture positive isolates. Pseudomonas aeruginosa was isolated from six patients. Serratia spp., Enterobacter spp. and Enterococcus spp. from four patients each and Proteus spp. isolated from three patients. Linezolid was the most effective antimicrobial against the isolated Gram positive cocci, with 93.7% sensitivity demonstrated by MRSA, methicillin sensitive S. aureus and enterococcus spp. followed by sensitivity to clindamycin at 92.8%. Among Gram negative isolates, more than 80% of E. coli, K. pneumonia and Acinetobacter spp. were multidrug resistant. Susceptibility to polymyxin-B and tigecycline was shown by 88% and 71% of these isolates. Conclusion: A high degree of antibiotic resistance was observed in both Gram positive and Gram negative isolates which reflects a dire need for culture facilities and antimicrobial susceptibility testing in hospitals in Pakistan. No group B β hemolytic streptococci were isolated, most likely due to predominantly late onset neonatal sepsis in this cohort.