1
|
Kaur S, Singh K. Early-Onset Neonatal Sepsis: Role of C-Reactive Protein, Micro-ESR, and Gastric Aspirate for Polymorphs as Screening Markers. Int J Pediatr 2021; 2021:1544553. [PMID: 34899922 PMCID: PMC8660252 DOI: 10.1155/2021/1544553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Early-onset neonatal sepsis is a major cause of morbidness and death in newborn children. Its timely diagnosis is usually a challenge in developing countries like India. AIM To study the efficacy of C-reactive protein (CRP), micro-ESR, and gastric aspirate for polymorphs in the diagnosis of early-onset neonatal sepsis. MATERIALS AND METHODS This study included sixty term and preterm children, inborn and referred cases. The children who presented before day seven of life with clinical suspicion of sepsis or who were at high risk of developing sepsis were included. These were further investigated. Significant values for screening tests were taken as C - reactive protein > 0.6 mg/dl, micro-ESR-after 1 hour, fall in the column of blood in capillary tube was measured, and result was taken as mm fall in 1 hr, and gastric aspirate for polymorphs > 5 polymorphs/HPF. Sepsis screen positive result was 2 or more positive tests. The statistical evaluation was done using Fisher, and ANOVA tests using SPSS 20.0 version. RESULTS Sixty children were included in the study with forty as the referred ones. Most of them had tachypnea (45%). CRP showed high sensitivity, whereas micro-ESR and gastric aspirate for polymorphs showed high specificity. CONCLUSIONS Neonatal sepsis screening is required for the detection of infection as the blood culture report may not be positive in all the cases, and even if positive, the result takes few hours. CRP showed high sensitivity, whereas micro-ESR and gastric aspirate for polymorphs showed high specificity independently as well as when combined.
Collapse
Affiliation(s)
- Sukhdeep Kaur
- Department of Pediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab, India
| | - Kunwarpal Singh
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar, Punjab, India
| |
Collapse
|
2
|
Dhir SK, Sundaram V, Gautam V, Munda VS, Tiewsoh JBA, Angurana SK, Kumar J, Saini SS, Dutta S, Kumar P. Microorganisms Profile and Antimicrobial Resistance Pattern in Outborn Neonates in Northern India: A Hospital-Based Observational Study. J Trop Pediatr 2021; 67:6354690. [PMID: 34410001 DOI: 10.1093/tropej/fmab068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neonates born somewhere else (outborn) and treated in a referral centre have different microbiological profile. We report the microorganism's profile and antimicrobial resistance (AMR) in blood culture proven sepsis in outborn neonates. METHODS Culture positive neonatal sepsis from a neonatal unit of a referral institute catering to outborn neonates was studied over an 18 months duration. Data from the hospital information system were used to analyse the culture positivity rates, the spectrum of the microorganisms isolated and AMR pattern. RESULTS Out of 5258 admitted neonates, 3687 blood samples were sent for suspect sepsis. The blood cultures were positive in 537 (14.6%) samples from 514 neonates. Gram-positive cocci (GPC) were the most common [240 (45%)] followed by gram-negative bacilli (GNB) [233 (43.4%)] and fungi [64 (11.9%)]. Coagulase negative staphylococcus (CONS) contributed to two-thirds of GPC followed by Klebsiella [93 (17.3%)] and Acinetobacter species [52 (9.7%)]. In 403 (75%) neonates, organisms grew in the samples sent at or within 24 h of admission. The case fatality rate was significantly higher in those with culture positive sepsis. The resistance to meropenem and imipenem was documented in 57.1% and 49.7%, respectively and 48% of the GNB was multidrug resistant. CONCLUSIONS CONS followed by Klebsiella species were the most common organisms isolated. Three-fourths of the neonates had organisms grown at or within 24 h from admission. More than half of the GNB were multidrug resistant. The case fatality rate was significantly higher in those with culture positive sepsis.
Collapse
Affiliation(s)
- Shashi Kant Dhir
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Venkataseshan Sundaram
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vikas Gautam
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vimal Singh Munda
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jutang Babat Ain Tiewsoh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Suresh Kumar Angurana
- Pediatric Critical Care Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jogender Kumar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shiv Sajan Saini
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sourabh Dutta
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| |
Collapse
|
3
|
Fleischmann C, Reichert F, Cassini A, Horner R, Harder T, Markwart R, Tröndle M, Savova Y, Kissoon N, Schlattmann P, Reinhart K, Allegranzi B, Eckmanns T. Global incidence and mortality of neonatal sepsis: a systematic review and meta-analysis. Arch Dis Child 2021; 106:archdischild-2020-320217. [PMID: 33483376 PMCID: PMC8311109 DOI: 10.1136/archdischild-2020-320217] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neonates are at major risk of sepsis, but data on neonatal sepsis incidence are scarce. We aimed to assess the incidence and mortality of neonatal sepsis worldwide. METHODS We performed a systematic review and meta-analysis. 13 databases were searched for the period January 1979-May 2019, updating the search of a previous systematic review and extending it in order to increase data inputs from low-income and middle-income countries (LMICs). We included studies on the population-level neonatal sepsis incidence that used a clinical sepsis definition, such as the 2005 consensus definition, or relevant ICD codes. We performed a random-effects meta-analysis on neonatal sepsis incidence and mortality, stratified according to sepsis onset, birth weight, prematurity, study setting, WHO region and World Bank income level. RESULTS The search yielded 4737 publications, of which 26 were included. They accounted for 2 797 879 live births and 29 608 sepsis cases in 14 countries, most of which were middle-income countries. Random-effects estimator for neonatal sepsis incidence in the overall time frame was 2824 (95% CI 1892 to 4194) cases per 100 000 live births, of which an estimated 17.6% 9 (95% CI 10.3% to 28.6%) died. In the last decade (2009-2018), the incidence was 3930 (95% CI 1937 to 7812) per 100 000 live births based on four studies from LMICs. In the overall time frame, estimated incidence and mortality was higher in early-onset than late-onset neonatal sepsis cases. There was substantial between-study heterogeneity in all analyses. Studies were at moderate to high risk of bias. CONCLUSION Neonatal sepsis is common and often fatal. Its incidence remains unknown in most countries and existing studies show marked heterogeneity, indicating the need to increase the number of epidemiological studies, harmonise neonatal sepsis definitions and improve the quality of research in this field. This can help to design and implement targeted interventions, which are urgently needed to reduce the high incidence of neonatal sepsis worldwide.
Collapse
Affiliation(s)
- Carolin Fleischmann
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Felix Reichert
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Alessandro Cassini
- Infection Prevention and Control Hub, Integrated Health Services, World Health Organization HQ, Geneva, GE, Switzerland
| | - Rosa Horner
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Berlin, Germany
| | - Thomas Harder
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Berlin, Germany
| | - Robby Markwart
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Berlin, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Marc Tröndle
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Berlin, Germany
| | - Yoanna Savova
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Berlin, Germany
| | - Niranjan Kissoon
- University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Peter Schlattmann
- Institute for Medical Statistics, Computer Science and Data Science, Jena University Hospital, Jena, Germany
| | - Konrad Reinhart
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Benedetta Allegranzi
- Infection Prevention and Control Hub, Integrated Health Services, World Health Organization HQ, Geneva, GE, Switzerland
| | - Tim Eckmanns
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Berlin, Germany
| |
Collapse
|
4
|
Nazir A. Multidrug-resistant Acinetobacter septicemia in neonates: A study from a teaching hospital of Northern India. J Lab Physicians 2020; 11:23-28. [PMID: 30983798 PMCID: PMC6437821 DOI: 10.4103/jlp.jlp_129_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Acinetobacter species are typical nosocomial pathogens causing infections and high mortality, almost exclusively in compromised hospitalized patients. Acinetobacter sp. are intrinsically less susceptible to antibiotics and have propensity to acquire resistance. Multidrug-resistant (MDR) Acinetobacter sp. blood infection in the neonatal intensive care unit patients create a great problem in hospital settings. AIMS: A prospective data analysis was performed over a one year period of all neonates admitted with sepsis who developed Acinetobacter infection and their antibiotic susceptibility pattern was carried out. MATERIALS AND METHODS: Blood samples of infected neonates were collected aseptically and cases of Acinetobacter septicemia were identified. Speciation of Acinetobacter species was done. Various risk factors were identified and their drug-sensitivity test was performed. RESULTS: The incidence of neonatal septicemia due to Acinetobacter species was 13.7% (49/357). Predominant species isolated was Acinetobacterbaumannii (98%). The major symptoms were lethargy and poor feeding. The major signs were tachypnea, intercostal retraction, and respiratory distress. The major fetal risk factors were low birth weight and prematurity. High degree of resistance was observed to the various antibiotics used. Majority of the isolates (95.9%) were MDR while 93.68% were resistant to carbapenems as well as extensively drug resistant. However, all the strains were sensitive to colistin. CONCLUSION: MDR Acinetobacter septicemia in neonatal patients is becoming alarmingly frequent and is associated with significant mortality and morbidity. Therefore, rational antibiotic use is mandatory along with an effective infection control policy in neonatal intensive care areas of each hospital to control Acinetobacter infection and improve outcome.
Collapse
Affiliation(s)
- Asifa Nazir
- Department of Microbiology, Government Medical College, Srinagar, Jammu and Kashmir, India
| |
Collapse
|
5
|
Mobbs NA, Ditai J, Abeso J, Faragher EB, Carrol ED, Gladstone M, Medina-Lara A, Olupot-Olupot P, Weeks AD. In search of a primary outcome for community-based newborn infection trials in Eastern Uganda: a nested cohort study within the BabyGel pilot trial. Pilot Feasibility Stud 2019; 5:43. [PMID: 30911406 PMCID: PMC6415494 DOI: 10.1186/s40814-019-0428-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 02/25/2019] [Indexed: 12/21/2022] Open
Abstract
Background Due to their immature immune system, neonates are at high risk of infection. This vulnerability when combined with limited resources and health education in developing countries can lead to sepsis, resulting in high global neonatal mortality rates. Many of these deaths are preventable. The BabyGel pilot trial tested the feasibility of conducting the main randomised trial, with the provision of alcohol handgel to postpartum mothers for prevention of neonatal infective morbidity in the rural community. This secondary analysis sought to evaluate the methods of detecting infections in babies up to 3 months of age. Methods The pilot two-arm cluster randomised controlled trial took place in 10 villages around Mbale, Eastern Uganda. Women were eligible and recruited antenatally if their gestation was ≥ 34 weeks. All infants of mothers participating in the BabyGel pilot trial were followed up for the first 3 months of life. Evidence for infant infection was collected using five different methods: clinician diagnosed infection, microbiologically confirmed infection, maternally reported infection, a positive infection screen using the World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) screening criteria, and reported antibiotic use identified during home and clinic visits. These methods were assessed quantitatively regarding the detection rates of suspected infections and qualitatively by exploring the challenges collecting data in the rural community setting. Results A total of 103 eligible women participated in the BabyGel pilot trial, with 1 woman delivering twins. Of the 99 mother-infant pairs who consented to participate in the study, 55 infants were identified with infection in total. Maternal report of illness provided the highest estimate, with mothers reporting suspected illness for 45 infants (81.8% of the total suspected infections identified). The WHO IMCI screening criteria identified 30 infants with suspected infection (54.5%), and evidence for antibiotic use was established in 22 infants (40%). Finally, clinician-diagnosed infection identified 19 cases (34.5%), which were also microbiologically confirmed in 5 cases (9.1%). Data collection in the rural setting was hindered by poor communication between mothers and the research team, limited staff awareness of the study in health centres resulting in reduced safeguarding of clinical notes, and widespread use of antibiotics prior to notification and clinical review. Furthermore, identification of suspected infection may not have been limited to severe infections, with ambiguity and no official clinical diagnosis being given to those identified solely by maternal report of infection. Conclusions A high rate of suspected infection was identified spanning the five sources of data collection, but no ideal method was found for detection of community neonatal infection. Although maternal self-reports of infant infection provided the highest detection rate, data collection via each source was limited and may have identified minor rather than major infections. Future studies could utilise the IMCI screening tool to detect severe community infection leading to referral for clinical confirmation. This should be combined with weekly contact with mothers to detect maternally suspected illness. Obtaining more details of the symptoms and timescale will improve the accuracy when detecting the total burden of suspected disease, and advising participants to retain medication packaging and prescriptions will improve identification of antibiotic use. Trial registration Babygel pilot trial - trial registration: ISCRCTN 67852437. Registered 02/03/2015.
Collapse
Affiliation(s)
- N A Mobbs
- 1Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool and Liverpool Women's NHS Foundation Trust, members of Liverpool Health Partners, Crown Street, Liverpool, L8 7SS UK.,2University of Liverpool, Cedar House, Ashton Street, Liverpool, L3 5PS UK
| | - J Ditai
- 1Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool and Liverpool Women's NHS Foundation Trust, members of Liverpool Health Partners, Crown Street, Liverpool, L8 7SS UK.,3Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
| | - J Abeso
- 3Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda.,4Department of Paediatrics, Mbale Regional Referral Hospital, Mbale, Uganda
| | - E B Faragher
- 5Tropical Clinical Trials Unit, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - E D Carrol
- 6Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool, L69 7BE UK
| | - M Gladstone
- 7Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool and Alder Hey NHS Foundation Trust, members of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP UK
| | - A Medina-Lara
- 8Health Economics Group, University of Exeter, Exeter, UK
| | - P Olupot-Olupot
- 9Faculty of Health Sciences, Busitema University, P.o Box 1460, Mbale, Uganda
| | - A D Weeks
- 1Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool and Liverpool Women's NHS Foundation Trust, members of Liverpool Health Partners, Crown Street, Liverpool, L8 7SS UK
| |
Collapse
|
6
|
Seliem WA, Sultan AM. Etiology of early onset neonatal sepsis in neonatal intensive care unit - Mansoura, Egypt. J Neonatal Perinatal Med 2019; 11:323-330. [PMID: 30149469 DOI: 10.3233/npm-17128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study was conducted to find out the bacterial causes of early onset neonatal sepsis and their susceptibility pattern for different classes of antibiotics in neonates admitted to neonatal intensive care unit (NICU) of Mansoura-Egypt. METHODS A descriptive cross-sectional study was conducted. All admitted newborns to our study were infants at <72 hours of age with clinical features of sepsis or product of an in-house delivery at Mansoura University Hospital with risk factors for neonatal sepsis. Identification of Gram-negative isolates was confirmed by API 20E kits (bioMerieux). Antibiotic susceptibility was performed by Kirby-Bauer disc diffusion method. Bacteria resistant to ≥3 antimicrobial classes were counted as multidrug resistant. RESULTS One hundred eighty eight babies were admitted to our study. Positive blood culture was reported in 34.6% of newborn infants with prevalence of 4.02/1,000 live births. The most common isolated bacteria in early onset neonatal sepsis were coagulase negative staphylococci followed by Klebsiella pneumoniae and Serratia marcescens. The Gram-positive bacteria showed high resistance to ampicillin 93.9% while all the isolates were susceptible to vancomycin. The isolated Gram-negative bacteria were highly resistant to ampicillin [96.9%], amoxicillin-clavulanic acid [90.6%], cefotaxime [84.4%] and ceftazidime [84.4%]. Best sensitivity among all isolates was observed to imipenem. Multidrug resistance was observed among 45.5% of the Gram-positive and 68.8% of Gram-negative isolates. CONCLUSION Appropriate identification of the source of infection and initiation of an effective management can reduce both mortality and morbidity associated with neonatal sepsis. The challenge is to initiate immediate empirical antibiotic therapy according to a strictly implemented updated antibiotic policy based on an individualized community established antimicrobial sensitivity pattern of microorganisms causing early onset neonatal sepsis.
Collapse
Affiliation(s)
- W A Seliem
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - A M Sultan
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Department of Immunology and Medical Microbiology, Mansoura University, Mansoura, Egypt
| |
Collapse
|
7
|
Jajoo M, Manchanda V, Chaurasia S, Sankar MJ, Gautam H, Agarwal R, Yadav CP, Aggarwal KC, Chellani H, Ramji S, Deb M, Gaind R, Kumar S, Arya S, Sreenivas V, Kapil A, Mathur P, Rasaily R, Deorari AK, Paul VK. Alarming rates of antimicrobial resistance and fungal sepsis in outborn neonates in North India. PLoS One 2018; 13:e0180705. [PMID: 29953451 PMCID: PMC6023165 DOI: 10.1371/journal.pone.0180705] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is a paucity of data on the epidemiology of sepsis in outborn neonates being referred to level-3 units in low- and middle-income countries (LMIC). The objective of the present study was to evaluate the prevalence of sepsis and outcomes of outborn neonates with sepsis, and to characterize the pathogen profile and antimicrobial resistance (AMR) patterns of common isolates in them. METHODS In this prospective observational cohort study (2011-2015), a dedicated research team enrolled all neonates admitted to an outborn level-3 neonatal unit and followed them until discharge/death. Sepsis work-up including blood culture(s) was performed upon suspicion of sepsis. All the isolates were identified and tested for antimicrobial susceptibility. Gram-negative pathogens resistant to any three of the five antibiotic classes (extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and piperacillin-tazobactam) were labeled multi-drug resistant. RESULTS Of the total of 2588 neonates enrolled, culture positive sepsis and total sepsis-i.e. culture positive and/or culture negative sepsis-was diagnosed in 13.1% (95% CI 11.8% to 14.5%) and 54.7% (95% CI 52.8% to 56.6%), respectively. The case fatality rates were 23.4% and 11.0% in culture-positive and total sepsis, respectively. Sepsis accounted for two-thirds of total neonatal deaths (153/235, 63.0%). Bacterial isolates caused about three-fourths (296/401; 73.8%) of the infections. The two common pathogens-Klebsiella pneumoniae (n = 50, 12.5%) and Acinetobacter baumannii (n = 46, 11.5%)-showed high degree of multi-drug resistance (78.0% and 91.3%, respectively) and carbapenem resistance (84.0% and 91.3%, respectively). About a quarter of infections were caused by Candida spp. (n = 91; 22.7%); almost three-fourths (73.7%) of these infections occurred in neonates born at or after 32 weeks' gestation and about two-thirds (62.1%) in those weighing 1500 g or more at birth. CONCLUSIONS In this large outborn cohort, we report high burden of sepsis, high prevalence of systemic fungal infections, and alarming rates of antimicrobial resistance among bacterial pathogens.
Collapse
Affiliation(s)
- Mamta Jajoo
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Suman Chaurasia
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - M. Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Hitender Gautam
- Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Chander Prakash Yadav
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
- National Institute of Malaria Research, New Delhi, India
| | - Kailash C. Aggarwal
- Department of Pediatrics, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Harish Chellani
- Department of Pediatrics, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Siddharth Ramji
- Department of Pediatrics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India
| | - Monorama Deb
- Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajni Gaind
- Department of Microbiology, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Surinder Kumar
- Department of Microbiology, Maulana Azad Medical College and LNJP Hospital, New Delhi, India
| | - Sugandha Arya
- Department of Pediatrics, Vardhman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, JPNA Trauma Centre, AIIMS, New Delhi, India
| | - Reeta Rasaily
- Division of Reproductive Health & Nutrition, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Ashok K. Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod K. Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
8
|
Kiwanuka J, Bazira J, Mwanga J, Tumusiime D, Nyesigire E, Lwanga N, Warf BC, Kapur V, Poss M, Schiff SJ. The microbial spectrum of neonatal sepsis in Uganda: recovery of culturable bacteria in mother-infant pairs. PLoS One 2013; 8:e72775. [PMID: 24013829 PMCID: PMC3754959 DOI: 10.1371/journal.pone.0072775] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/11/2013] [Indexed: 12/05/2022] Open
Abstract
Neonatal sepsis in the developing world is incompletely characterized. We seek to characterize the microbial spectrum involved in sepsis and determine the role of maternal transmission by comparing organisms that can be cultured from septic newborn infants and their mothers. From 80 consecutive mother-infant pairs meeting clinical criteria for neonatal sepsis, we collected infant blood and spinal fluid, and maternal blood and vaginal specimens. Identifiable bacteria were recovered from the blood in 32.5% of infants, and from 2.5% of cerebrospinal fluid cultures, for a total of 35% recoverable putative causative agents. Bacteria recovered from vaginal specimens were not concordant with those recovered from infants. Similarly there was no concordance of bacteria recovered from blood and cerebrospinal fluid. We conclude that relying on traditional bacterial culture techniques does not adequately delineate the role of maternal versus environmental sources of neonatal sepsis in this setting. More sensitive molecular approaches will be needed to properly characterize the maternal and environmental microbial community involved in neonatal sepsis in such developing countries.
Collapse
MESH Headings
- Adult
- Bacteria/isolation & purification
- Colony Count, Microbial/methods
- Female
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/cerebrospinal fluid
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/microbiology
- Infectious Disease Transmission, Vertical
- Male
- Sepsis/blood
- Sepsis/cerebrospinal fluid
- Sepsis/epidemiology
- Sepsis/microbiology
- Uganda
Collapse
Affiliation(s)
- Julius Kiwanuka
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joel Bazira
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Juliet Mwanga
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dickson Tumusiime
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Eunice Nyesigire
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nkangi Lwanga
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Benjamin C. Warf
- Department of Neurosurgery, and Program for Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts, United States of America
| | - Vivek Kapur
- Department of Veterinary and Biomedical Sciences, Penn State University, University Park, Pennsylvania, United States of America
| | - Mary Poss
- Department of Veterinary and Biomedical Sciences, Penn State University, University Park, Pennsylvania, United States of America
- Center for Infectious Disease Dynamics, Department Biology, Penn State University, University Park, Pennsylvania, United States of America
| | - Steven J. Schiff
- Center for Neural Engineering, Departments of Neurosurgery, Engineering Science and Mechanics, and Physics, Penn State University, University Park, Pennsylvania, United States of America
| |
Collapse
|
9
|
Shete VB, Ghadage DP, Muley VA, Bhore AV. Acinetobacter septicemia in neonates admitted to intensive care units. J Lab Physicians 2013; 1:73-6. [PMID: 21938255 PMCID: PMC3167973 DOI: 10.4103/0974-2727.59704] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Acinetobacter species are gaining importance as potential pathogens in neonatal septicemia because of their frequent isolation and multidrug resistance. Aims and Objectives: The aim of the present study was to evaluate the role of Acinetobacter spp. as important pathogens in neonatal blood stream infection, to identify the associated risk factors, and to evaluate the drug sensitivity pattern. Materials and Methods: Blood samples of infected neonates were studied bacteriologically. Cases of Acinetobacter septicemia were identified. Speciation of Acinetobacter species was done. Various risk factors were identified. The drug-sensitivity test was done. Results: A total of 26 Acinetobacter septicemia cases were identified by blood culture. Acb complex strains predominated. Institutional birth and preterm birth were identified as the most frequent significant risk factors. 11.3% mortality rate was recorded. Acb complex strains exhibited a multi-drug resistant pattern. No carbapenem resistance was observed. Conclusion: Acinetobacter should be added to the list of organisms causing severe nosocomial infection in neonatal intensive care units. Continuous bacteriological surveillance, implementation of infection control policies, careful disinfection of intensive care equipment, and rational antibiotic use are required for control of such infections.
Collapse
Affiliation(s)
- Vishal B Shete
- Department of Microbiology, B.J. Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | | | | | | |
Collapse
|
10
|
Waters D, Jawad I, Ahmad A, Lukšić I, Nair H, Zgaga L, Theodoratou E, Rudan I, Zaidi AKM, Campbell H. Aetiology of community-acquired neonatal sepsis in low and middle income countries. J Glob Health 2011. [PMID: 23198116 PMCID: PMC3484773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND 99% of the approximate 1 million annual neonatal deaths from life-threatening invasive bacterial infections occur in developing countries, at least 50% of which are from home births or community settings. Data concerning aetiology of sepsis in these settings are necessary to inform targeted therapy and devise management guidelines. This review describes and analyses the bacterial aetiology of community-acquired neonatal sepsis in developing countries. METHODS A search of Medline, Embase, Global Health and Web of Knowledge, limited to post-1980, found 27 relevant studies. Data on aetiology were extracted, tabulated and analysed along with data on incidence, risk factors, case fatality rates and antimicrobial sensitivity. RESULTS The most prevalent pathogens overall were Staphylococcus aureus (14.9%), Escherichia coli (12.2%), and Klebsiella species (11.6%). However, variations were observed both between global regions and age-of-onset categories. Staphylococcus aureus and Streptococcus pneumoniae were most prevalent in Africa, while Klebsiella was highly prevalent in South-East Asia. A notably higher prevalence of Group B Streptococcus was present in neonates aged 7 days or less. The highest case fatality rates were recorded in South-East Asia. Klebsiella species showed highest antimicrobial resistance. CONCLUSION Data on community-acquired neonatal sepsis in developing countries are limited. Future research should focus on areas of high disease burden with relative paucity of data. Research into maternal and neonatal vaccination strategies and improved diagnostics is also needed. All of this could contribute to the formulation of community-based care packages, the implementation of which has significant potential to lower overall neonatal mortality and hence advance progress towards the attainment of Millennium Development Goal 4.
Collapse
Affiliation(s)
- Donald Waters
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK
| | - Issrah Jawad
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK
| | - Aziez Ahmad
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ivana Lukšić
- Department of Microbiology, Dubrava University Hospital, Zagreb, Croatia
| | - Harish Nair
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK
| | - Lina Zgaga
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK
| | - Evropi Theodoratou
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK
| | - Igor Rudan
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK,Joint senior authorship
| | - Anita K. M. Zaidi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan,Joint senior authorship
| | - Harry Campbell
- Centre for Population Health Sciences and Global Health Academy, The University of Edinburgh, Scotland, UK,Joint senior authorship
| |
Collapse
|
11
|
Tsering DC, Chanchal L, Pal R, Kar S. Bacteriological profile of septicemia and the risk factors in neonates and infants in sikkim. J Glob Infect Dis 2011; 3:42-5. [PMID: 21572608 PMCID: PMC3068578 DOI: 10.4103/0974-777x.77295] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Bacterial infections remain an important cause of pediatric mortality and morbidity. It might be possible to reduce these factors by early diagnosis and proper management. AIM The aim of the study was to analyze the bacteriological profiles with their antibiogram, and to register the risk factors for septicemia in neonates and infants. SETTING AND DESIGN This observational cross-sectional study was conducted in a tertiary care teaching hospital at Gangtok, Sikkim, India, and included clinically suspected cases of septicemia in neonates and infants. MATERIALS AND METHODS Blood culture reports were studied in 363 cases of clinically suspected septicemia in neonates and infants, using the standard technique of Mackie and McCartney. The antibiotic sensitivity was performed by Kirby-Bauer's disc diffusion method. Risk factors for sepsis in the children were registered. RESULTS Blood culture was positive in 22% of cases. Gram-negative septicemia was encountered in 61% of the culture-positive cases. Pseudomonas and Enterobacter species were the predominant pathogens amongst gram-negative organisms. Most gram-negative organisms were sensitive to Amikacin, Ciprofloxacin, and Co-trimoxazole. The most common gram-positive organism isolated was Staphylococcus aureus (97%). More than 70% of Staphylococci isolated were resistant to Penicillin, but were sensitive to Clindamycin (70%) and Vancomycin (40%). The most important risk factors of septicemia in our study population were preterm birth (31%), followed by respiratory distress (5%) and low birth weight (4%). CONCLUSION As the cultures showed variable antibiogram with complicated patterns of resistance, culture and sensitivity test should be performed in all cases of septicemia.
Collapse
Affiliation(s)
- Dechen C Tsering
- Department of Microbiology, Sikkim Manipal Institute of Medical Sciences (SMIMS) and Central Referral Hospital(CRH), Gangtok, Sikkim, India
| | | | | | | |
Collapse
|
12
|
Sharma M, Yadav S, Chaudhary U. Acinetobacter spp as emerging pathogen in neonatal septicemia. Indian J Pediatr 2009; 76:861. [PMID: 19802557 DOI: 10.1007/s12098-009-0176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
13
|
Mugalu J, Nakakeeto MK, Kiguli S, Kaddu-Mulindwa DH. Aetiology, risk factors and immediate outcome of bacteriologically confirmed neonatal septicaemia in Mulago hospital, Uganda. Afr Health Sci 2009; 6:120-6. [PMID: 16916305 PMCID: PMC1831983 DOI: 10.5555/afhs.2006.6.2.120] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
BACKGROUND Neonatal septicaemia remains a major cause of morbidity and mortality. The aetiology, risk factors and outcome of this problem need to understood. OBJECTIVE To determine the aetiology, risk factors and immediate outcome of bacteriologically confirmed neonatal septicaemia in Mulago hospital. METHODS Blood cultures were aseptically obtained from neonates presenting with clinical sepsis by WHO criteria to Mulago during a five month period between July and November 2002. Blood was placed in Brain Heart Infusion media and incubated within 30 minutes. Subcultures were plated daily up to 7 days on blood, chocolate and MacConkey agar and incubated in aerobic and 5% carbon dioxide conditions. Pure colonies were identified by Gram stain and biochemical tests and antibiotic sensitivities were obtained. RESULTS Gram positive organisms were predominant (69.2%) followed by E. coli (17%) and Group B Streptococci (GBS) (7%). Staphylococcus aureus and E. coli dominated isolates in early and late onset sepsis. S. aureus was more sensitive to gentamicin than to cloxacillin. The sensitivity of E. coli to ceftriaxone was 94.1%. Factors significantly associated with neonatal septicaemia were male sex, history of convulsions, hypoglycaemia, lack of antenatal care, late onset sepsis and umbilical pus discharge. Mortality in sepsis cases was 18.1%, and 84% of deaths occurred in the first 2 days of admission. Hypoglycaemia was significantly associated with death (p < 0.01). CONCLUSION S. aureus predominates the aetiology of neonatal septicaemia followed by E.coli. Most deaths occur in the first 48 hours of admission and hypoglycaemia is significantly associated with death.
Collapse
Affiliation(s)
- J Mugalu
- Department of Paediatrics and Child Health, Mulago Hospital.
| | | | | | | |
Collapse
|
14
|
Parenteral antibiotics for the treatment of serious neonatal bacterial infections in developing country settings. Pediatr Infect Dis J 2009; 28:S37-42. [PMID: 19106762 DOI: 10.1097/inf.0b013e31819588c3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A number of special issues must be considered when selecting simple, safe, inexpensive, and effective antimicrobial regimens for treatment of neonatal sepsis in developing country community settings. METHODS We reviewed available data regarding pharmacologic profiles of parenteral antibiotics with specific attention to properties relevant to their use in the treatment of neonatal infections in developing country communities. RESULTS For community-based management of neonatal infections, particularly attractive properties include efficacy and safety of extended-interval, intramuscular dosing regimens. The penicillins and cephalosporins have relatively favorable efficacy and safety profiles. Although the aminoglycosides have narrow therapeutic indices, when used appropriately, they are safe and effective. Although inexpensive and effective, the potential for significant life-threatening toxicity among neonates associated with chloramphenicol makes it the least preferred of the parenteral agents for empiric therapy. CONCLUSIONS The preferred parenteral regimens for community and first-level facility use are a combination of procaine penicillin G and gentamicin, or ceftriaxone given alone, which are safe and retain efficacy when dosed at extended intervals (> or =24 hours) by intramuscular administration.
Collapse
|
15
|
Abstract
INTRODUCTION Knowledge of pathogens causing infections in young infants (up to 90 days of life) is essential for devising community-based management strategies. Most etiological data from developing countries are hospital-based and may have little relevance to communities in which most babies are born at home. METHODS We searched the literature for studies from developing countries reporting etiology of community-acquired infections (sepsis, pneumonia, meningitis) published since 1980. Hospital-based studies reporting early onset sepsis, sepsis among babies admitted from, or born at home were included. RESULTS Of 63 studies, 13 focused on community-acquired infections, but limited data were available from home-born neonates. In the first week of life (3209 isolates), Klebsiella species (25%), Escherichia coli (15%), and Staphylococcus aureus (18%) were major pathogens. Group B streptococci (GBS) were relatively uncommon (7%), although regional differences existed. After the first week of life (835 isolates), S. aureus (14%), GBS (12%), Streptococcus pneumoniae (12%), and nontyphoidal Salmonella species (13%) were most frequent. S. pneumoniae (27%) was most common in the postneonatal period (among 141 isolates). Gram-negatives predominated (77%) among home-delivered babies (among 170 isolates). CONCLUSIONS Limited information is available on etiology of serious bacterial infections in community settings. Hospital-based studies suggest that most infections in the first week of life are due to Gram-negative pathogens, and many may be environmentally rather than maternally-acquired, owing to unhygienic delivery practices. Such practices may also explain the predominance of Gram-negative infections among home-born infants, although data from home settings are limited. These findings have implications for developing prevention and management strategies in communities and hospitals.
Collapse
|
16
|
Srivastava S, Shetty N. Healthcare-associated infections in neonatal units: lessons from contrasting worlds. J Hosp Infect 2007; 65:292-306. [PMID: 17350726 PMCID: PMC7172768 DOI: 10.1016/j.jhin.2007.01.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 01/18/2007] [Indexed: 11/20/2022]
Abstract
Neonatal intensive care units are vulnerable to outbreaks and sporadic incidents of healthcare-associated infections (HAIs). The incidence and outcome of these infections are determined by the degree of immaturity of the neonatal immune system, invasive procedures involved, the aetiological agent and its antimicrobial susceptibility pattern and, above all, infection control policies practised by the unit. It is important to raise awareness of infection control practices in resource-limited settings, since overdependence upon antimicrobial agents and co-existing lack of awareness of infection control is encouraging the emergence of multi-drug-resistant nosocomial pathogens. We reviewed 125 articles regarding HAIs from both advanced and resource-limited neonatal units in order to study risk factors, aetiological agents, antimicrobial susceptibility patterns and reported successes in infection control interventions. The articles include surveillance studies, outbreaks and sporadic incidents. Gram-positive cocci, viruses and fungi predominate in reports from the advanced units, while Gram-negative enteric rods, non-fermenters and fungi are commonly reported from resource-limited settings. Antimicrobial susceptibility patterns from surveillance studies determined the empirical therapy used in each neonatal unit. Most outbreaks, irrespective of the technical facilities available, were traced to specific lack of infection control practices. We discuss infection control interventions, with special emphasis on their applicability in resource-limited settings. Cost-effective measures for implementing these interventions, with particular reference to the recognition of the role of the microbiologist, the infection control team and antibiotic policies are presented.
Collapse
Affiliation(s)
- S Srivastava
- Department of Clinical Microbiology, Health Protection Agency Collaborating Centre, University College London Hospitals, London, UK
| | | |
Collapse
|
17
|
Arora U, Jaitwani J. Acinetobacter spp. - An Emerging Pathogen in Neonatal Septicemia in Amritsar. Indian J Med Microbiol 2006. [DOI: 10.1016/s0255-0857(21)02486-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
18
|
Zaidi AKM, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet 2005; 365:1175-88. [PMID: 15794973 DOI: 10.1016/s0140-6736(05)71881-x] [Citation(s) in RCA: 430] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hospital-born babies in developing countries are at increased risk of neonatal infections because of poor intrapartum and postnatal infection-control practices. We reviewed data from developing countries on rates of neonatal infections among hospital-born babies, range of pathogens, antimicrobial resistance, and infection-control interventions. Reported rates of neonatal infections were 3-20 times higher than those reported for hospital-born babies in industrialised countries. Klebsiella pneumoniae, other gram-negative rods (Escherichia coli, Pseudomonas spp, Acinetobacter spp), and Staphylococcus aureus were the major pathogens among 11,471 bloodstream isolates reported. These infections can often present soon after birth. About 70% would not be covered by an empiric regimen of ampicillin and gentamicin, and many might be untreatable in resource-constrained environments. The associated morbidity, mortality, costs, and adverse effect on future health-seeking behaviour by communities pose barriers to improvement of neonatal outcomes in developing countries. Low-cost, "bundled" interventions using systems quality improvement approaches for improved infection control are possible, but should be supported by evidence in developing country settings.
Collapse
Affiliation(s)
- Anita K M Zaidi
- Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan.
| | | | | | | | | | | |
Collapse
|
19
|
Abstract
96 consecutive inborn neonates with blood culture proven bacterial sepsis during the period January to June 1997 were studied. Lethargy with refusal of feeds (28%), fever (28%) and respiratory distress (31.3%) were the major presenting features. Half of them (n = 48) were of early onset (< 48 hours) and the remaining half were of late onset (> 48 hours). Staphylococcus aureus (n = 59, 61.5%) was the predominant pathogen and 66% of them were methicillin resistant followed by Klebsiella pneumoniae (n = 24, 21.9), Escherichia coli (n = 13, 13.5%) and streptococci (n = 3, 3.1%). Antibiotic resistance was common, with the sensitivity to various antibiotics being ampicillin 19%, gentamicin 21.6%, cefotaxime 32.8%, amikacin 50%, chloromycetin 59.6% and ciprofloxacin 90.3%.
Collapse
Affiliation(s)
- G Karthikeyan
- Department of Paediatrics, Government Kasturiba Gandhi Hospital for Women and Children, Chennai-600 005, India.
| | | |
Collapse
|
20
|
Bhat BA, Suri K, Gupta B. A clinico-epidemiological evaluation of infants born before arrival at hospital. Ann Saudi Med 2000; 20:483-4. [PMID: 17264658 DOI: 10.5144/0256-4947.2000.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- B A Bhat
- Department of Pediatrics, Khoula Hospital, Ministry of Health, Muscat, Oman
| | | | | |
Collapse
|
21
|
Thomas M, Padmini B, Srimathi G, Sundararajan V, Raju BA. Microbial profile of neonatal infection in Coimbatore. Indian J Pediatr 1999; 66:11-4. [PMID: 10798030 DOI: 10.1007/bf02752342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In this study, 187 consecutive neonates suspected of having septicaemia were investigated for isolation of micro organisms. Two samples of blood were collected for isolation of aerobes and anaerobes. Cultures were positive in 75 (40%) cases. Aerobic bacteria were the major etiological agent, accounting for 93% of positives including the 8% cases showing polymicrobial etiology. Anaerobic bacteria and Candida species were isolated in 6.6% and 8% of positive cases respectively. Bacteroides fragilis (amongst anaerobic) and Staphylococcus aureus (amongst aerobic) were the predominant organisms isolated. Clinical presentations were not specifically different to distinguish aerobic from anaerobic bacteria. In the present study, 6.6% of bacteremias were due to anaerobes, hence possibility of some of the bactermias being due to anaerobes should be kept in mind while treating cases of neonatal septicaemia. For a complete microbial profile both aerobic and anaerobic cultures should be done.
Collapse
Affiliation(s)
- M Thomas
- Department of Microbiology, PSGIMS and R, Coimbatore
| | | | | | | | | |
Collapse
|
22
|
Daoud AS, Abuekteish F, Obeidat A, el-Nassir Z, al-Rimawi H. The changing face of neonatal septicaemia. ANNALS OF TROPICAL PAEDIATRICS 1995; 15:93-6. [PMID: 7598444 DOI: 10.1080/02724936.1995.11747755] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A prospective study was undertaken over a 1-year period in northern Jordan to determine the incidence, causes and characteristics of neonatal septicaemia which is a major cause of mortality and morbidity in newborns. The study identified 47 septicaemic neonates, representing an incidence of 2.3/1000 live births. Respiratory distress and hyperbilirubinaemia were the prominent presenting clinical findings. Gram-negative organisms were cultured from 46 neonates with Klebsiella species, accounting for 64% of cases. There were no cases of infection with group B Streptococcus or Listeria monocytogenes. The overall mortality rate was 40%. Prematurity and low birthweight, early onset septicaemia and concomitant meningitis were associated with high mortality. The high incidence of Gram-negative septicaemia and the antibiotic sensitivity pattern of the organisms indicated the use of cefotaxime or ceftazidime as initial therapy while awaiting culture results. Continued surveillance of neonatal septicaemia is mandatory due to temporal changes in the causative organisms and their antibiotic sensitivity.
Collapse
Affiliation(s)
- A S Daoud
- Department of Paediatrics, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | | |
Collapse
|