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Jung YJ. Early- and late-onset candidemia in very low birth weight infants in the Korean neonatal network, 2013-2017. Pediatr Neonatol 2024:S1875-9572(24)00084-6. [PMID: 38862350 DOI: 10.1016/j.pedneo.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Candidiasis is a critical infection that is associated with very low birth weight (VLBW; <1500 g). This study investigated the characteristics and clinical presentation of candidiasis in Korean VLBW infants according to the onset of candidemia. METHODS All VLBW infants with candidemia, defined as blood culture-positive candidiasis and registered in a multicenter database with data from 70 neonatal units of the Korean Neonatal Network between 2013 and 2017, were included in this study. Early-onset candidemia (EOC; ≤10 days) and late-onset candidemia (LOC; >10 days) were analyzed. The demographic characteristics, clinical presentations, and outcomes of candidemia were also determined. RESULTS The overall incidence of candidemia was 2% (209/10,397) and 4% (173/3934) in VLBW and extremely very low birth weight (ELBW; <1000 g) infants, respectively. In ELBW infants, gestational age was significantly younger at EOC than at LOC (P = 0.015). Cesarean section, respiratory distress syndrome, severe bronchopulmonary disease, pulmonary hemorrhage, prior-bacteremia, neonatal seizures, and periventricular leukomalacia were significantly more common in the LOC group than in the EOC group (P < 0.05). The duration of invasive ventilation, total parenteral nutrition, and hospital stay were significantly longer in the LOC group than in the EOC group (P < 0.05). Most infections were caused by Candida spp. (91.8%). The mortality rate of ELBW infants with candidemia was 41%, which was higher than that of those without candidemia (29%) (P < 0.001). Mortality due to infection was also higher in infants with candidemia (55%) than in those without candidemia (15%) (P < 0.001); however, there were no significant differences between the EOC and LOC groups. CONCLUSIONS LOC was more common than EOC in VLBW infants. Considering the risk factors of LOC, active weaning from invasive ventilators and aggressive enteral feeding are required to decrease LOC. Furthermore, preventing candidemia is necessary to reduce mortality in VLBW infants.
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Affiliation(s)
- Yu Jin Jung
- Department of Pediatrics, Kosin University Gospel Hospital, No. 262 Gamcheon-ro, Seo-gu, Busan, Republic of Korea.
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Shah N, Gandhi H, Mansuriya R, Maru A, Rathod G, Parmar P. Role of Hematological Parameters in the Early Diagnosis of Neonatal Sepsis. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S434-S436. [PMID: 38595571 PMCID: PMC11001158 DOI: 10.4103/jpbs.jpbs_657_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 04/11/2024] Open
Abstract
The major cause of neonatal mortality and morbidity is bacterial sepsis. Blood culture is the most reliable method in neonatal sepsis. This study was conducted to study the usefulness of hematological parameters in the early diagnosis of neonatal sepsis and to assess the most sensitive and specific variables in diagnosing neonatal sepsis. This prospective study was conducted in a tertiary care hospital from January 2017 to January 2018. Peripheral blood smears were prepared from patients with clinical suspicion of sepsis or predisposing perinatal factors for sepsis and stained with Field's stain and examined. The hematological findings were analyzed according to the hematologic scoring system of Rodwell. It was found that immature PMN count, I: M ratio, and I: T ratio had the highest sensitivity (92.06%, 87.30%, and 74.60%, respectively) while I: M ratio, I: T ratio, and degenerative changes in PMN had the highest specificity (97.50%, 96.50%, and 94.0%, respectively) in the prediction of sepsis.
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Affiliation(s)
- Niyati Shah
- Department of Pathology, GMERS Medical College, Gotri, Vadodara, Gujarat, India
| | - Hardik Gandhi
- Department of Pathology, Dr. Kiran C Patel Medical College and Research Institute, Bharuch, Gujarat, India
| | - Ravikumar Mansuriya
- Department of Pathology, Pacific Institute of Medical Science, Umarda, Udaipur, Rajasthan, India
| | - Alpesh Maru
- Department of Pathology, GMERS Medical College, Morbi, Gujarat, India
| | - Gunvanti Rathod
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India
| | - Pragnesh Parmar
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS), Bibinagar, Hyderabad, Telangana, India
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Huang YH, Yeh YR, Lien RI, Chiang MC, Huang YC. Molecular characteristics and clinical features of Staphylococcus epidermidis healthcare-associated late-onset bacteremia among infants hospitalized in neonatal intensive care units. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:1214-1225. [PMID: 37709633 DOI: 10.1016/j.jmii.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Though Staphylococcus epidermidis was the most common pathogen of late-onset sepsis (LOS) in neonatal intensive care units (NICUs), there haves been scanty reports on molecular epidemiology of S. epidermidis isolates from infants stayed in NICU and on correlation of molecular characteristics with clinical features in these infants. METHODS We collected and characterized S. epidermidis bloodstream isolates from infants hospitalized in NICU of a medical center in Taiwan between 2018 and 2020. Medical records of these infants were retrospectively reviewed. RESULTS A total of 107 isolates identified from 78 episodes of bacteremia in 75 infants were included for analysis. Of the 78 isolates (episodes), 24 pulsotypes, 11 sequence types (STs), and 5 types of staphylococcal chromosomal cassette (type I-V) were identified. ST59 and its single locus variant ST1124 (37.2%) comprised the most common strain, followed by ST35 (14.1%), ST2 (11.5%), and ST89 (10.3%). All but 5 isolates (73/78, 93.6%) belonged to clonal complex (CC) 2. Comparing infants infected with genetically different strains, the patients with underlying immune disease were significantly associated with ST2 infection (P = 0.021), while no statistically significant differences were found in terms of clinical and laboratory characteristics. Only 3.8% of the isolates were susceptible to oxacillin. CONCLUSIONS More than 90% of S. epidermidis bloodstream isolates from infants in NICU in Taiwan were resistant to oxacillin. Though diverse, more than 90% of the isolates (episodes) belonged to CC2. No statistically significant differences were found in terms of clinical characteristics among the infants infected with genetically different strains.
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Affiliation(s)
- Yi-Hsuan Huang
- Department of Medical Education, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Yu-Rou Yeh
- College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Rey-In Lien
- College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- College of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan.
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Chung E, Seto W. Association between vancomycin therapeutic drug monitoring and clinical outcomes in treating neonatal sepsis. Int J Antimicrob Agents 2023; 62:106958. [PMID: 37633423 DOI: 10.1016/j.ijantimicag.2023.106958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Neonatal sepsis is commonly treated with vancomycin in the neonatal intensive care unit. Therapeutic drug monitoring of vancomycin is routinely used to personalise dosing to optimise effectiveness and avoid toxicity. OBJECTIVES This study aimed to define a target range by evaluating associations between vancomycin trough concentrations or area under the concentration time curve over 24 hours (AUC24h) and clinical outcomes in neonates. METHODS Neonates, who were admitted to the neonatal intensive care unit and received intravenous vancomycin, were included in this retrospective cohort study. For evaluating effectiveness, patients who received vancomycin for < 5 days were excluded. The AUC24h was estimated based on a study-derived population pharmacokinetic model. Primary outcomes were persistent/recurrent infections and mortality within 30 days. Secondary outcomes, including acute kidney injury (AKI), were also assessed. Logistic regression and classification and regression tree analyses were performed. RESULTS A total of 448 patients (123 patients for effectiveness analysis) were included. A vancomycin trough > 10 mg/L was associated with 70% lower odds of persistent/recurrent infections (adjusted OR 0.30, 95% CI 0.09-0.86; P = 0.023). Patients who took more than a day to reach target range had 1.4 times higher odds of persistent/recurrent infections or death (P = 0.04). A vancomycin trough > 15 mg/L was associated with a three times higher risk of AKI (P = 0.003). An AUC24h of 420-650 mg*h/L was also associated with the lowest risk of composite outcomes (adjusted OR 0.29, 95% CI 0.08-0.86; P = 0.025). CONCLUSION A vancomycin trough target range of 10-15 mg/L and achievement of this target within a day of treatment initiation were associated with the most optimal clinical outcomes in treating neonatal sepsis.
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Affiliation(s)
- Erin Chung
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | - Winnie Seto
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto Ontario, Canada
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Fenta Feleke S, Mulu B, Azmeraw M, Temesgen D, Dagne M, Giza M, Yimer A, Mengist Dessie A, Yenew C. Clinical Prediction Model Development and Validation for the Detection of Newborn Sepsis, Diagnostic Research Protocol. Int J Gen Med 2022; 15:8025-8031. [PMID: 36348975 PMCID: PMC9637368 DOI: 10.2147/ijgm.s388120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/28/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Neonatal sepsis is a leading cause of sickness and death in the entire world. Diagnosis is usually difficult because of the nonspecific clinical symptoms and the paucity of laboratory diagnostics in many low- and middle-income nations (LMICs). Clinical prediction models may increase diagnostic precision and rationalize the use of antibiotics in neonatal facilities, which could lead to a decrease in antimicrobial resistance and better neonatal outcomes. Early detection of newborn sepsis is critical to prevent serious consequences and reduce the need for unneeded drugs. OBJECTIVE The aim is to develop and validate a clinical prediction model for the detection of newborn sepsis. METHODS A cross-sectional study based on an institution will be carried out. The sample size was determined by assuming 10 events per predictor, based on this assumption, the total sample sizes were 467. Data will be collected using a structured checklist through chart review. Data will be coded, inputted, and analyzed using R statistical programming language version 4.0.4 after being entered into Epidata version 3.02 and further processed and analyzed. Bivariable logistic regression will be done to identify the relationship between each predictor and neonatal sepsis. In a multivariable logistic regression model, significant factors (P< 0.05) will be kept, while variables with (P< 0.25) from the bivariable analysis will be added. By calculating the area under the ROC curve (discrimination) and the calibration plot (calibration), respectively, the model's accuracy and goodness of fit will be evaluated.
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Affiliation(s)
- Sefineh Fenta Feleke
- Department of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia,Correspondence: Sefineh Fenta Feleke, College of Health Science, Department of Public Health, Woldia University, Woldia, Ethiopia, Tel +251928573882, Email
| | - Berihun Mulu
- Department of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Molla Azmeraw
- Department of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Dessie Temesgen
- Department of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Melsew Dagne
- Department of Nursing, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Mastewal Giza
- Department of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Ali Yimer
- Department of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Chalachew Yenew
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Cao I, Lippmann N, Thome UH. The Value of Perinatal Factors, Blood Biomarkers and Microbiological Colonization Screening in Predicting Neonatal Sepsis. J Clin Med 2022; 11:jcm11195837. [PMID: 36233706 PMCID: PMC9571877 DOI: 10.3390/jcm11195837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Neonatal sepsis is one of the most important causes of elevated morbidity and mortality rates in neonatal intensive care units worldwide. While the clinical manifestations of neonatal sepsis tend to be nonspecific, its rapid development and life-threatening potential call for reliable markers for early detection. Methods: We conducted a retrospective single-center study including all neonates suspected of having developed neonatal sepsis from 2013 to 2016. Perinatal and clinical characteristics as well as microbiological and laboratory findings were evaluated. Neonatal sepsis was defined as either culture-proven sepsis (positive blood culture) or clinical sepsis (at least one symptom and elevated C-reactive protein (CRP) concentrations within 72 h with negative blood culture). We further differentiated between early-onset (EOS) and late-onset (LOS) sepsis. Results: Microbiological colonization screening by throat and rectal swabs frequently did not detect the organism that subsequently caused the sepsis. Depending on the age of the newborn with sepsis (EOS or LOS), associations between different anamnestic and clinical factors (prenatal or postnatal ones) were found. In particular, the central−peripheral temperature difference showed a strong association with LOS. Laboratory results useful for the early detection of neonatal sepsis included interleukin-6 (IL-6) and CRP concentrations. Conclusions: Elevated IL-6 >100 ng/L was a strong marker for neonatal sepsis. When choosing the antibiotics for treatment, data from microbiological colonization screening should be considered but not solely relied on. Some indicators of infection also depended on postnatal age.
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Affiliation(s)
- Isabel Cao
- Divison of Neonatology, Center for Pediatric Research, University Hospital for Children, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Virology, University of Leipzig, 04103 Leipzig, Germany
| | - Ulrich H. Thome
- Divison of Neonatology, Center for Pediatric Research, University Hospital for Children, Liebigstraße 20a, 04103 Leipzig, Germany
- Correspondence:
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Eswaran L, Prabakaran V, Bethou A. Incidence of Sepsis and Its Determinants among Neonates Admitted in Level III Neonatal Unit - A Prospective Observational Study. J Caring Sci 2022; 11:188-196. [DOI: 10.34172/jcs.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/26/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: Neonates are prone for sepsis due to their immature immune system. Sepsis is preventable if we aware of the maternal and neonatal risk factors. This study aimed to identify the incidence of sepsis and its risk factors. Methods: A prospective observational study was carried out among 288 neonates in level III Neonatal unit. Convenience sampling technique was used to enroll the neonates who met the inclusion criteria. Data pertaining to neonatal and maternal demographic and clinical characteristics, incidence of sepsis, risk factors of sepsis were collected by direct observation and from medical record. Data regarding number of skin pricks for blood sample and intravenous cannulation and number of handling of the baby were collected from Tally counters. Data were analysed using chi square test, t-test and logistic regression with SPSS software version 25. Results: The incidence of sepsis was 34.7% in level III neonatal unit. Culture positive sepsis constituted 7.3%, urinary tract infection 0.3%, meningitis 7 % and probable sepsis 26.4%. Neonatal factors like extreme preterm, extreme low birth weight, gestational age, birth weight, duration of stay in level III neonatal unit, number of handling, number of skin pricks, duration of intravenous line, duration of tube feeds, mechanical ventilation and maternal premature rupture of membrane were associated with neonatal sepsis significantly. Conclusion: Incidence of neonatal sepsis can be minimized by concentrating on modifiable risk factors and implementing the protocol of minimum handling and minimal skin pricks for the neonates.
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Affiliation(s)
- Lavanya Eswaran
- College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducehrry, India
| | - Vetriselvi Prabakaran
- Department of Paediatric Nursing, College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Adhisivam Bethou
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Oumer M, Abebaw D, Tazebew A. Time to recovery of neonatal sepsis and determinant factors among neonates admitted in Public Hospitals of Central Gondar Zone, Northwest Ethiopia, 2021. PLoS One 2022; 17:e0271997. [PMID: 35900981 PMCID: PMC9374017 DOI: 10.1371/journal.pone.0271997] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Neonatal sepsis is a leading cause of neonatal morbidity and mortality,
particularly in developing countries. Time to recovery is an indicator of
the severity of sepsis, and risk factors varied significantly according to
study population and settings. Moreover, published literature regarding the
time to recovery of neonatal sepsis is scarce. Objective The aim of this study was to assess the time to recovery of neonatal sepsis
and determinant factors among neonates admitted in the Public Hospitals of
Central Gondar Zone, Northwest Ethiopia. Methods An institution-based prospective follow-up study design was conducted among
631 neonates with sepsis. A structured, pre-tested, interviewer-administered
questionnaire was used. The median time to recovery, life-table, the Kaplan
Meier curve, and the log-rank test were computed. Both bi-variable and
multivariable Cox regression models were applied to analyze the data. Results Of all septic neonates, 511 successfully recovered. They were followed for a
total of 4,740-neonate day’s observation and the median time to recovery was
7 days (IQR = 5–10 days). After adjusting for covariates, intrapartum fever
(AHR = 0.69, 95%CI: 0.49, 0.99), induced onset of labor (AHR = 0.68, 95%CI:
0.49, 0.94), chest indrawing (AHR = 0.67, 95%CI: 0.46, 0.99), late onset
sepsis (AHR = 0.55, 95%CI: 0.40, 0.75), non-oral enteral feeding (AHR =
0.38, 95%CI: 0.29, 0.50), assisted with bag and mask (AHR = 0.72, 95%CI:
0.56, 0.93), normal birth weight (AHR = 1.42, 95%CI: 1.03, 1.94),
gestational age of 37–42 weeks (AHR = 1.93, 95%CI: 1.32, 2.84), septic shock
(AHR = 0.08, 95%CI: 0.02, 0.39), infectious complications (AHR = 0.42,
95%CI: 0.29, 0.61), being in critical conditions (AHR = 0.68, 95%CI: 0.52,
0.89), and early recognition of illness (AHR = 1.83, 95%CI: 1.27, 2.63) were
independently associated with the time to recovery of neonatal sepsis. Conclusions and recommendations The time to recovery of this study was moderately acceptable as compared to
the previous studies. The above-mentioned factors could be used for the
early identification of neonates with sepsis at risk for protracted illness
and it could guide prompt referral to higher centers in primary health
sectors. This also will provide prognostic information to clinicians and
families as longer recovery time has economic and social implications in our
country.
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Affiliation(s)
- Mohammed Oumer
- Department of Human Anatomy, School of Medicine, College of Medicine and
Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Dessie Abebaw
- Department of Epidemiology and Biostatistics, Institute of Public Health,
College of Medicine and Health Sciences, University of Gondar, Gondar,
Ethiopia
| | - Ashenafi Tazebew
- Department of Pediatrics and Child Health, School of Medicine, College of
Medicine and Health Sciences, University of Gondar, Gondar,
Ethiopia
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Akselsen AB, Sheth CC, Veses V. Efficacy of empiric antibiotic treatment of late-onset neonatal sepsis caused by Enterobacteriaceae: A Systematic Review. Lett Appl Microbiol 2021; 75:500-510. [PMID: 34951709 DOI: 10.1111/lam.13640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
Neonatal sepsis is a serious condition, where an adequate empiric antibiotic treatment is crucial. The objective of this systematic review is to assess whether the World Health Organisation's recommended treatment regime remains applicable for late-onset neonatal sepsis caused by Enterobacteriaceae, in the time of increased antimicrobial resistance. PubMed was searched for articles from 2009 to 2020. A total of 49 articles were eligible for inclusion. The review was carried out in accordance with PRISMA guidelines. For Klebsiella spp. 100%, 68%, and 63% of the studies found sensitivity to ampicillin, gentamicin, and third generation cephalosporin in <50% of the isolates. For Escherichia coli the corresponding values were 88%, 50%, and 42% respectively, whilst for Enterobacter spp. 100%, 70% and 94% of the studies found <50% sensitivity to these antibiotics. Overall, there is low sensitivity to all agents in the WHO's recommended empiric treatment regimes (WHO recommends ampicillin plus gentamicin as first line treatment and third generation cephalosporin as second line treatment). A revised guideline for empiric antibiotic treatment of neonatal sepsis is urgently needed due to increased threat of antimicrobial resistant Enterobacteriaceae causing neonatal sepsis.
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Affiliation(s)
- Alice B Akselsen
- Department of Medicine, Faculty of Health Sciences, Universidad CEU Cardenal Herrera, CEU Universities, Alfara del Patriarca 46115, Valencia, Spain
| | - Chirag C Sheth
- Department of Medicine, Faculty of Health Sciences, Universidad CEU Cardenal Herrera, CEU Universities, Alfara del Patriarca 46115, Valencia, Spain
| | - Veronica Veses
- Department of Biomedical Sciences, Faculty of Health Sciences, Universidad CEU Cardenal Herrera, CEU Universities, Alfara del Patriarca 46115, Valencia, Spain
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A Prospective Study on Neonatal Sepsis in a Tertiary Hospital, Nepal. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.4.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
About 20 % of neonates develop sepsis and among them approximately 1% die due to sepsis-related causes. Bacterial pathogens are the commonest cause of neonatal sepsis which is either early-onset (<72 hours of age) or late-onset (>72 hours). Little is known about the epidemiology and antimicrobial susceptibility pattern of sepsis causing bacterial pathogens in Nepal. A prospective study was carried out among neonates suspected to have sepsis and admitted to Tribhuwan University Teaching Hospital from January to December 2016. Clinical suspicion of sepsis was made based on clinical findings and laboratory parameters, later confirmed by isolation of organisms in blood culture. Drug resistance pattern of Gram-positive and Gram-negative bacteria were studied by standard methods. Meropenem resistant Gram-negative bacteria were processed for the detection of β-lactamases and resistant genes were detected by X-pert Carba-R (Cepheid) Assays. Of 372 neonates with clinically suspected sepsis, 132 (35.4%) had blood culture positivity, with 47% early-onset and 53% late-onset sepsis. Coagulase-negative Staphylococcus aureus (CONS) was the most common (37.9%) etiological agent followed by Klebsiella pneumoniae (12.9%). Of all 132 isolates, 81 (61.3%) were Gram-positive of which 22 (27.2%) were multi-drug resistant (MDR), three (3.7%) were methicillin-resistant S. aureus (MRSA), and 14 (17.2%) were methicillin-resistant CoNS; and 50 (37.8%) were Gram-negative of which 26 (52%) were MDR and 29 (58%) were resistant to β-lactamases. The blaKPC gene was detected in four isolates of K. pneumoniae, two of E. coli, one ABC (Acinetobacter baumanii complex), and one Enterobacter aerogenes whereas blaNDM gene was detected in one isolate of K. pneumoniae, two of E. coli, two Pseudomonas aeruginosa, one Acinetobacter baumanii complex, and one Enterobacter aerogenes. Overall mortality due to sepsis-related causes was 7.6% (10 of 132). One-third of clinically suspected neonatal sepsis cases were culture positive. Late-onset sepsis was more common than early onset. CoNS was the predominant bacterial isolate followed by Klebsiella pneumoniae, with high rates of multi-drug resistance.
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Kothari N, Dsouza V, Mishra U, Maheshwari R, Shah D, D’Cruz D, Baird J, Luig M, Jani P. Asymptomatic full-term infants born to women with chorioamnionitis may not need routine antibiotics. Acta Paediatr 2021; 110:3000-3005. [PMID: 34358357 DOI: 10.1111/apa.16059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
AIM While infants with early-onset sepsis require antibiotics, there is little evidence to support their routine use in asymptomatic infants exposed to maternal chorioamnionitis. We aimed to ascertain the incidence of culture-proven sepsis in full-term infants exposed to chorioamnionitis and to determine whether asymptomatic infants need routine antibiotic treatment. METHODS This study was retrospective. Included were all full-term infants admitted to our neonatal intensive care unit between 1 January 2017 and 31 May 2018 who were given intravenous antibiotics for maternal chorioamnionitis. After identifying eligible infants, relevant maternal and infant data were collected from our medical records and the Neonatal Intensive Care Units Database. RESULTS We selected 167 term infants from 7736 deliveries. The incidence of chorioamnionitis was 21 per 1000 deliveries. The mean gestational age was 39 weeks (range 37-41), and 57% infants were male. Asymptomatic infants (76%) received intravenous antibiotics for an average of 2 days compared to 4 days in the symptomatic group (24%), p < 0.001. No infant died or developed culture-positive sepsis. CONCLUSION The risk of early-onset sepsis in well-appearing term infants of mothers with chorioamnionitis is low. Further studies are mandatory to determine whether asymptomatic infants of mothers with clinical chorioamnionitis need antibiotic treatment.
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Affiliation(s)
- Nakul Kothari
- Department of Neonatology Westmead Hospital Westmead NSW Australia
| | - Vanessa Dsouza
- Department of Neonatology Westmead Hospital Westmead NSW Australia
| | - Umesh Mishra
- Department of Neonatology Westmead Hospital Westmead NSW Australia
| | - Rajesh Maheshwari
- Department of Neonatology Westmead Hospital Westmead NSW Australia
- The University of Sydney Sydney NSW Australia
| | - Dharmesh Shah
- Department of Neonatology Westmead Hospital Westmead NSW Australia
- The University of Sydney Sydney NSW Australia
| | - Daphne D’Cruz
- Department of Neonatology Westmead Hospital Westmead NSW Australia
| | - Jane Baird
- Department of Neonatology Westmead Hospital Westmead NSW Australia
| | - Melissa Luig
- Department of Neonatology Westmead Hospital Westmead NSW Australia
| | - Pranav Jani
- Department of Neonatology Westmead Hospital Westmead NSW Australia
- The University of Sydney Sydney NSW Australia
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12
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Rattani S, Farooqi J, Hussain AS, Jabeen K. Spectrum and Antifungal Resistance of Candidemia in Neonates With Early- and Late-Onset Sepsis in Pakistan. Pediatr Infect Dis J 2021; 40:814-820. [PMID: 33941745 DOI: 10.1097/inf.0000000000003161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal candidemia leads to high morbidity and mortality in developing countries. We studied the trends, spectrum and antifungal resistance in neonatal candidemia isolates from the year 2014 to 2019. METHODS This was a cross-sectional study conducted at the Aga Khan University, Pakistan. Neonates with positive blood cultures with Candida species were retrospectively identified from the laboratory database (2014-2018) and prospectively in 2019 where clinical information was also collected as part of routine laboratory reporting. RESULTS We identified 669 neonates with Candida species in blood cultures. Three hundred forty-six neonates had early-onset disease (EOD age ≤7 days) and 323 had late-onset disease (LOD age >7 days). Non-albicans Candida species (86.7%) were predominant versus C. albicans (13.3%; P-value 0.024) with Candida tropicalis being most common in both EOD and LOD. Candida pelliculosa and Candida guilliermondii were associated with EOD and C. albicans with LOD. Isolation of fluconazole nonsusceptible non-albicans Candida species was significantly higher in early-onset (5.9%) versus late-onset (2%) neonatal candidemia (P-value 0.005; crude odds ratio [COR] 2.73, 95% CI: 1.34-5.53). LOD in neonates was more likely associated with the use of vancomycin (COR 3.89, 95% CI: 1.39-10.89). EOD was more likely seen in patients with vaginal delivery (COR 4.16, 95% CI: 1.42-12.23) and in neonates with respiratory distress leading to intensive care unit admission (COR 3.31, 95% CI: 1.05-10.42). CONCLUSIONS Non-albicans Candida species were increasingly isolated from neonates with candidemia during recent years from Pakistan. Amphotericin remains first-line option for neonatal candidemia in our setting as fluconazole nonsusceptible Candida species are commonly isolated.
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Affiliation(s)
- Salima Rattani
- From the Department of Pathology & Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Joveria Farooqi
- From the Department of Pathology & Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Ali Shabbir Hussain
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Kauser Jabeen
- From the Department of Pathology & Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
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13
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Reddy K, Bekker A, Whitelaw AC, Esterhuizen TM, Dramowski A. A retrospective analysis of pathogen profile, antimicrobial resistance and mortality in neonatal hospital-acquired bloodstream infections from 2009-2018 at Tygerberg Hospital, South Africa. PLoS One 2021; 16:e0245089. [PMID: 33444334 PMCID: PMC7808607 DOI: 10.1371/journal.pone.0245089] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Analysis of hospital-acquired bloodstream infection (HA-BSI) trends is important to monitor emerging antimicrobial resistance (AMR) threats and guide empiric antibiotic choices. Methods A retrospective 10-year review of neonatal HA-BSI was performed at Tygerberg Hospital’s neonatal unit in Cape Town, South Africa. Neonatal clinical and laboratory data from 2014 to 2018 (Period 2) was compared with published data from 2009 to 2013 (Period 1). Results The neonatal unit’s HA-BSI rate declined between periods from 3.9/1000 inpatient-days in Period 1 to 3.3/1000 inpatient-days in Period 2 (p = 0.002). Pathogen yield and blood culture contamination rate were unchanged (11.0% to 10.4%, p = 0.233; 5.1% to 5.3%, p = 0.636 respectively). Gram-negative pathogens predominated (1047/1636; 64.0%); Klebsiella species, Staphylococcus aureus, Serratia marcescens, Enterococcus species and Acinetobacter baumannii were the most frequent pathogens. Extended spectrum beta-lactamase production was observed in 319/432 (73.8%) of Klebsiella species, methicillin resistance in 171/246 (69.5%) of Staphylococcus aureus and extensive drug resistance in 115/137 (83.9%) of Acinetobacter species (2009–2018). The crude mortality rate of neonatal HA-BSI episodes increased from Period 1 to Period 2 from 139/717 (19.4%) to 179/718 (24.9%) (p = 0.014), but HA-BSI attributable mortality remained unchanged (97/139 [69.8%] vs 118/179 [65.9%], p = 0.542). The in-vitro activity of piperacillin-tazobactam and amikacin declined during Period 2 (74.6% to 61.4%; p<0.001). Conclusion Although HA-BSI rates declined in the neonatal unit, antimicrobial resistance rates in BSI pathogens remained high. Continuous BSI surveillance is a valuable tool to detect changes in pathogen and AMR profiles and inform empiric antibiotic recommendations for neonatal units in resource-limited settings.
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Affiliation(s)
- Kessendri Reddy
- Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- * E-mail: ,
| | - Adrie Bekker
- Division of Neonatology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrew C. Whitelaw
- Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tonya M. Esterhuizen
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Angela Dramowski
- Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Singh MP, Balegar V KK, Angiti RR. The practice of blood volume submitted for culture in a neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2020; 105:600-604. [PMID: 32198199 DOI: 10.1136/archdischild-2019-318080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/09/2020] [Accepted: 02/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Neonatal sepsis is the leading cause of mortality and morbidity in neonatal intensive care units. The volume of blood taken for culture remains one of the most important factors in isolating microorganisms. OBJECTIVES To evaluate the impact of the intervention on the blood volume submitted for culture and to identify factors influencing the volume as determined by the phlebotomist. METHODS Blood culture volume was determined by weighing the culture bottle before and immediately after blood inoculation. A 3-month preintervention audit revealed that in 126/130 samples (96.9%), the volume of blood submitted was suboptimal. Multiple intervention measures were instituted, and volume was monitored over the next 9 months. RESULTS 637 blood culture samples were included in the study, 130 were in preintervention and 507 were in postintervention epochs. Following the intervention, suboptimal volume samples reduced from 96.9% (126/130 samples) to 25% (126/507 samples), p<0.0001 and the median (IQR) sample volume improved from 0.36 (0.23) ml to 0.9 (0.27) ml, p<0.0001. Poor blood flow was identified as the most common reason for an inadequate sample. CONCLUSION The study underscores the role of educational intervention in improving the blood culture volume in newborn infants. Poor backflow from the cannula is an important cause of inadequate volume collection.
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Affiliation(s)
- Moni Pankhuri Singh
- Neonatal Intensive Care Unit, Nepean Hospital, Penrith, New South Wales, Australia
| | - Kiran Kumar Balegar V
- Neonatal Intensive Care Unit, Nepean Hospital, Penrith, New South Wales, Australia .,The University of Sydney, Sydney Medical School Nepean, Sydney, New South Wales, Australia
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Aku FY, Akweongo P, Nyarko KM, Mensah LG, Amegan-Aho K, Kumi L, Afari EA, Ameme DK, Kenu E. Factors associated with culture proven neonatal sepsis in the Ho municipality 2016. Pan Afr Med J 2020; 36:281. [PMID: 33088410 PMCID: PMC7545969 DOI: 10.11604/pamj.2020.36.281.20408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/03/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Neonatal Sepsis (NNS) is a public health problem which causes death or disability unless appropriate antibiotic treatment is given promptly. Globally, sepsis is an important cause of morbidity and mortality in neonates despite recent progress in health care delivery. We assessed the factors associated with culture proven sepsis among neonates in the Ho Municipality, Ghana. Methods a cross-sectional study was conducted in two public hospitals in the Ho Municipality between January and May, 2016. All neonates who were clinically suspected with sepsis in the Neonatal Intensive Care Unit (NICU) and their mothers were recruited. A 2ml blood sample was taken aseptically and dispensed into a mixture of thioglycollate and tryptone soy broth in a 1: 10 dilution and microbiological procedures performed. Case notes of both neonates and their mothers were reviewed and interviews conducted to collect both clinical and socio-demographic data. We determined the factors associated with culture proven neonatal sepsis using logistic regression model and statistical significance was determined at 95% confidence intervals. Results out of 150 neonates, 26 (17%) had laboratory confirmed sepsis. The most common pathogen isolated was Staphylococcus epidermidis 14, (54%). Neonates whose mothers were primigravida (OR=2.74; 95% CI: 1.12-6.68), and those who attended antenatal clinics (ANC) fewer than three schedules (OR=2.90; 95% CI: 1.06-7.96) had higher odds of developing culture proven sepsis. Conclusion neonates who were the first babies of their mothers were more likely to develop laboratory confirmed sepsis. Also, neonates of mothers who attended ANC less than 3 times were more likely to develop laboratory confirmed sepsis. High index of suspicion is required to diagnose neonatal sepsis among neonates of primigravida mothers and mothers who attend fewer than three ANC schedules.
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Affiliation(s)
- Fortress Yayra Aku
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana.,School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Patricia Akweongo
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Kofi Mensah Nyarko
- Namibia Field Epidemiology Training Programme, Ministry of Health and Social Services, Wndhoek, Namibia
| | | | - Kokou Amegan-Aho
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Lawrence Kumi
- Regional Health Directorate, Ghana Health Service, Volta Region, Ho, Ghana
| | - Edwin Andrew Afari
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Donne Kofi Ameme
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
| | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Programme, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
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Prevalence of Neonatal Sepsis in Ethiopia: A Systematic Review and Meta-Analysis. Int J Pediatr 2020; 2020:6468492. [PMID: 32351579 PMCID: PMC7180396 DOI: 10.1155/2020/6468492] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/29/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Neonatal sepsis is a systemic infection occurring in infants during the first 4 weeks of life and is a major cause of mortality and morbidities of newborns due to their age-related weak and immature immune systems. In Ethiopia, despite many studies being conducted on neonatal sepsis, the reported findings are inconsistent. The aim of this study is to determine the prevalence of neonatal sepsis to enhance the utility and interpretation of the evidence. Methods An extensive systematic review and meta-analysis were performed to extract studies on the prevalence of neonatal sepsis in Ethiopia. The PubMed, Cochrane Library, ScienceDirect, Web of Science, and Google Scholar were systematically searched. Two independent authors selected and extracted the data from each included article. The heterogeneity of included studies was assessed using the Higgins I 2 test, and a random-effects model was performed in Stata/se Version 14. Results Eighteen studies with a sample size of 10,495 study subjects were included with a reported range of neonatal sepsis from 17% to 78%. The pooled prevalence of neonatal sepsis was 45% (95% CI: 35, 55; I 2 = 99.3%, p < 0.01). Early onset neonatal sepsis was found to have a prevalence of 75.4% (95% CI: 68.3, 82.6). Subgroup analysis in the study area (i.e., by region) was calculated revealing the highest neonatal sepsis in Amhara region at 64.4% (95% CI: 44.9, 84.0) and the lowest in Southern Nations, Nationality, and People at 28% (95% CI: 16, 40). Conclusion In this review, the prevalence of neonatal sepsis in Ethiopia was found to be high, especially in terms of early onset neonatal sepsis. As a result of the findings, it is important to consider the early and optimal points for interventions to better manage the prevalence and outcomes of neonatal sepsis. Further research is needed to investigate the neonatal sepsis status at different regions and associated factors for neonatal sepsis not yet studied.
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Olorukooba AA, Ifusemu WR, Ibrahim MS, Jibril MB, Amadu L, Lawal BB. Prevalence and Factors Associated with Neonatal Sepsis in a Tertiary Hospital, North West Nigeria. Niger Med J 2020; 61:60-66. [PMID: 32675896 PMCID: PMC7357807 DOI: 10.4103/nmj.nmj_31_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/03/2019] [Accepted: 02/09/2020] [Indexed: 12/24/2022] Open
Abstract
CONTEXT Neonatal sepsis is an important cause of morbidity and mortality of newborns, especially in developing countries. AIMS Our study determined the prevalence of neonatal sepsis and its predisposing factors among neonates admitted in Ahmadu Bello University Teaching Hospital (ABUTH). SETTINGS AND DESIGN This was a cross-sectional descriptive study conducted in ABUTH. SUBJECTS AND METHODS The data were abstracted from the case notes of neonates admitted from May 2017 to May 2018. A pretested pro forma was used to abstract the data. STATISTICAL ANALYSIS USED Odds ratios and multivariate logistic regression were used to determine the factors associated with neonatal sepsis among the study population. RESULTS The prevalence of neonatal sepsis was 37.6%. Escherichia coli was the most commonly isolated organism. Neonates 0-7 days of age were 2.8 times less likely to develop neonatal sepsis than older neonates. Babies born with an Apgar score of <6 within the 1st min were 2.4 times more likely to develop neonatal sepsis than those whose Apgar score was higher. Neonates of mothers who had urinary tract infection during pregnancy were 2.3 times more likely to have had sepsis and those whose mothers had premature rupture of membranes were 4.6 times more likely. CONCLUSIONS The prevalence of neonatal sepsis was high among the neonates studied. Neonatal and maternal factors were associated with sepsis in the neonates. These findings provide guidelines for the selection of empirical antimicrobial agents in the study site and suggest that a continued periodic evaluation is needed to anticipate the development of neonatal sepsis among neonates admitted.
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Affiliation(s)
| | | | | | | | - Lawal Amadu
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
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18
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Almohammady MN, Eltahlawy EM, Reda NM. Pattern of bacterial profile and antibiotic susceptibility among neonatal sepsis cases at Cairo University Children Hospital. J Taibah Univ Med Sci 2020; 15:39-47. [PMID: 32110181 PMCID: PMC7033391 DOI: 10.1016/j.jtumed.2019.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives Neonatal sepsis is the third leading contributor to mortality and morbidity. Emanating resistance to antibiotics in neonatal intensive care units (NICUs) is considered a major burden. In this study, we aimed to investigate the bacterial prevalence and antibiotic profile among patients admitted with sepsis in the NICU of Cairo University Children Hospital. Methods Neonates with suspected sepsis were evaluated for bacterial sepsis in their blood cultures. The neonates with positive bacterial blood culture were included in this study, whereas neonates with negative culture were excluded. Positive samples were sub-cultured on blood, MacConkey, and chocolate agar plates. Organisms were identified by Gram staining and biochemical reactions. Antibiotic susceptibility was assessed by the Kirby–Bauer disc diffusion method. Results Seventy blood cultures (31.7%) were bacteria-positive: 45.3% for Klebsiella, 22.7% for coagulase-negative staphylococci (CoNS), and for Acinetobacter (10.7%), methicillin-resistant Staphylococcus aureus (MRSA) (9.3%), Pseudomonas (5.3%), Enterobacter (4%), and streptococci (2.7%). High resistance to all cephalosporins, B-lactamase combinations, penicillin, carbapenems, and aminoglycosides was observed. All Gram-negative Enterobacteria showed the highest sensitivity to levofloxacin, whereas Pseudomonas and Acinetobacter were highly sensitive to polymyxin B. Gram-positive samples were sensitive to vancomycin and linezolid. Streptococci were slightly sensitive to vancomycin and highly sensitive to macrolides and cefotaxime. Conclusions In our study, Klebsiella and CoNS were the most common isolates in neonatal sepsis. The levels of multidrug-resistant strains were alarmingly high. This finding negatively affected the outcomes, prompting the need for a strict guideline for antibiotics use.
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Affiliation(s)
| | - Eman M Eltahlawy
- Department of Environmental Health and Occupational Medicine, National Research Centre, Cairo, Egypt
| | - Nashwa M Reda
- Department of Clinical and Chemical Pathology, Faculty of Medicine-Cairo University, Cairo, Egypt
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Amare D, Mela M, Dessie G. Unfinished agenda of the neonates in developing countries: magnitude of neonatal sepsis: systematic review and meta-analysis. Heliyon 2019; 5:e02519. [PMID: 31687604 PMCID: PMC6819861 DOI: 10.1016/j.heliyon.2019.e02519] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/12/2019] [Accepted: 09/23/2019] [Indexed: 01/11/2023] Open
Abstract
Purpose Neonatal sepsis is the major cause of mortality and morbidity globally, particularly in developing countries. Despite studies revealed the extent of neonatal sepsis in developing countries, the findings were inconclusive. Therefore, the main aim of this study was to determine the pooled prevalence of neonatal sepsis in developing countries. Methods We used a systematic review and Meta-analysis study method. The reviewed studies were accessed through an electronic web-based search strategy from the electronic database (PUBMED), advanced google scholar, different journal sites. The data extraction was done by two researchers using a data extraction table and the disparity between data extractors was resolved by the third researcher. The analysis was done using STATA version 11. The I2 test was used to assess heterogeneity across studies. The Funnel plot, Begg's test, and Egger's test were used to check for publication bias. The random-effect model was used to determine the pooled effect size. All studies related to neonatal sepsis which fulfill the inclusion criteria were considered into this study. The quality of each study was checked using the Newcastle-Ottawa Scale and studies graded low score were excluded from the study. Results At the end, 36 articles fit with our study objectives. Studies conducted in Ethiopia were significant the source of heterogeneity of the study with a coefficient = 90, P-value = 0.025. The overall pooled prevalence of the study was 29.92%. The limitations of this study would be the authors were only used articles reported in the English language, and publication bias. Conclusion The pooled prevalence of neonatal sepsis was found to be high which accounted for a third of the neonates. Despite countries have established possible prevention and treatment mechanisms, neonatal sepsis is the major public health problem in lower and middle-income countries till now.
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Affiliation(s)
- Desalegne Amare
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Bahir Dar University, 79, Bahir Dar, Ethiopia
| | | | - Getenet Dessie
- Department of Adult Health Nursing, College of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Abstract
Purpose of Review Neonatal sepsis is a diagnosis made in infants less than 28 days of life and consists of a clinical syndrome that may include systemic signs of infection, circulatory shock, and multisystem organ failure. Recent Findings Commonly involved bacteria include Staphylococcus aureus and Escherichia coli. Risk factors include central venous catheter use and prolonged hospitalization. Neonates are at significant risk of delayed recognition of sepsis until more ominous clinical findings and vital sign abnormalities develop. Blood culture remains the gold standard for diagnosis. Summary Neonatal sepsis remains an important diagnosis requiring a high index of suspicion. Immediate treatment with antibiotics is imperative.
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Pokhrel B, Koirala T, Shah G, Joshi S, Baral P. Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal. BMC Pediatr 2018; 18:208. [PMID: 29950162 PMCID: PMC6020420 DOI: 10.1186/s12887-018-1176-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/11/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Neonatal sepsis, one of the leading causes of mortality in neonatal intensive care units (NICU) of developing countries like Nepal, is often not extensively studied. In order to decrease the morbidity and mortality associated with neonatal sepsis, neonatologists should have a keen knowledge of the existing bacteriological flora and their antibiotic susceptibility pattern. In this study, we aim to determine the bacteriological profile and antibiotic susceptibility pattern of culture positive neonatal sepsis in the NICU of a tertiary teaching hospital in Nepal. METHODS This was a retrospective cross-sectional study of all blood culture positive sepsis cases among neonates admitted to the neonatal intensive care unit of Patan Hospital, Nepal between April 15, 2014 and April 15, 2017. All neonates with a clinical suspicion of sepsis with a positive blood culture were identified. Patient demographics, clinical details, maternal risk factors, and laboratory data including bacteriological profiles and antimicrobial susceptibilities were recorded and analyzed. RESULTS Of the 336 neonates admitted in the NICU, 69 (20.5%) had culture-positive sepsis. The majority were early-onset sepsis (n = 54, 78.3%) and were among the preterm babies (n = 47, 68.1%). Most bacterial isolates were gram-negative, predominantly the Klebsiella species (n = 23, 33.3%). Klebsiella showed high resistance to commonly used antibiotics such as; Cefotaxime (90.5%), Gentamicin (75%), Ciprofloxacin (76.2%), Ofloxacin (72.2%) and Chloramphenicol (65%). However, they showed good susceptibility to Carbapenems (100%), Colistin (88.8%) and Tigecycline (81.8%). Among cultures with gram-positive species, Coagulase-negative Staphylococci (CONS) (n = 14, 20.3%) predominated. CONS showed high resistance to Oxacillin (80%), Cefotaxime (66.7%) and Meropenem (80%) but good susceptibility (100%) to Vancomycin and Linezolid. Prevalence of multidrug-resistant strain was 73.9%. CONCLUSIONS Klebsiella species and CONS were the most common causes of neonatal sepsis in our study. A significant proportion of the isolates were multidrug resistant strains, which pose a great threat to neonatal survival, and thereby, warrant modification of existing empirical therapy. Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed. We recommend a combination of Piperacillin-Tazobactam and Ofloxacin as the first line therapy and combination of Vancomycin and Meropenem as the second line empirical therapy in our NICU.
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Affiliation(s)
- Bhishma Pokhrel
- Department of Pediatrics, Patan Academy of Health Sciences, Lagankhel, PO Box 26500, Lalitpur, Nepal
| | - Tapendra Koirala
- School of Medicine, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - Ganesh Shah
- Department of Pediatrics, Patan Academy of Health Sciences, Lagankhel, PO Box 26500, Lalitpur, Nepal
| | - Suchita Joshi
- Department of Pediatrics, Patan Academy of Health Sciences, Lagankhel, PO Box 26500, Lalitpur, Nepal
| | - Pinky Baral
- School of Health and Allied Sciences, Pokhara University, Lekhnath-12, Kaski, Nepal
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Kooshki P, Rezaei-Matehkolaei A, Mahmoudabadi AZ. The patterns of colonization and antifungal susceptibility of Candida, isolated from preterm neonates in Khorramabad, South West of Iran. J Mycol Med 2018. [PMID: 29530715 DOI: 10.1016/j.mycmed.2018.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Usually, 7-20% of preterm neonates colonized by Candida species present invasive candidiasis. Candida albicans, and several non-albicans species cause invasive infection with C. albicans being the most dominant agent. In the last two decades, infection due to non-albicans have been increased dramatically due to their low sensitivity to antifungal drugs such as fluconazole. The aim of present study was to evaluate Candida colonization pattern and antifungal susceptibility among preterm neonates from Khorramabad, South west of Iran. MATERIALS AND METHODS Samples were collected from 80 preterm neonates, cultured on CHROMagar Candida and incubated at 37°C. All recovered isolates were primarily screened based on classical methods and identified by PCR-RFLP targeting the ITS-rDNA regions. Antifungal susceptibility testing of all isolates was performed according to the CLSI method against amphotericin B, caspofungin, itraconazole, fluconazole and voriconazole. RESULTS Totally 23 isolates of Candida species were recovered from 20 patients (female: male, 50:50) including, C. albicans (18), C. parapsilosis (2) and C. glabrata (1). Furthermore, the blood cultures from two patients were yielded C. albicans and C. parapsilosis so that patient with C. albicans died after five days. Generally, in this study, 9 (39.1%) isolates were resistant to amphotericin B including; 7 (30.4%) C. albicans and 2 (8.7%) C. parapsilosis. In addition, 2 (8.7%) and 4 (17.4%) isolates were also resistant to itraconazole and caspofungin, respectively. CONCLUSION In conclusion, Candida colonization among preterm neonates is still an important issue in hospitals. In addition, in spite of a significant amphotericin B resistant Candida, voriconazole, fluconazole, and itraconazole are valuable antifungals, due to fully sensitivity to Candida.
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Affiliation(s)
- P Kooshki
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - A Rezaei-Matehkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - A Z Mahmoudabadi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Loh LN, McCarthy EMC, Narang P, Khan NA, Ward TH. Escherichia coli K1 utilizes host macropinocytic pathways for invasion of brain microvascular endothelial cells. Traffic 2017; 18:733-746. [PMID: 28799243 DOI: 10.1111/tra.12508] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 01/06/2023]
Abstract
Eukaryotic cells utilize multiple endocytic pathways for specific uptake of ligands or molecules, and these pathways are commonly hijacked by pathogens to enable host cell invasion. Escherichia coli K1, a pathogenic bacterium that causes neonatal meningitis, invades the endothelium of the blood-brain barrier, but the entry route remains unclear. Here, we demonstrate that the bacteria trigger an actin-mediated uptake route, stimulating fluid phase uptake, membrane ruffling and macropinocytosis. The route of uptake requires intact lipid rafts as shown by cholesterol depletion. Using a variety of perturbants we demonstrate that small Rho GTPases and their downstream effectors have a significant effect on bacterial invasion. Furthermore, clathrin-mediated endocytosis appears to play an indirect role in E. coli K1 uptake. The data suggest that the bacteria effect a complex interplay between the Rho GTPases to increase their chances of uptake by macropinocytosis into human brain microvascular endothelial cells.
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Affiliation(s)
- Lip Nam Loh
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth M C McCarthy
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Priyanka Narang
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Naveed A Khan
- Department of Biological Sciences, Faculty of Science and Technology, Sunway University, Selangor, Malaysia
| | - Theresa H Ward
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Nunes BM, Xavier TC, Martins RR. Antimicrobial drug-related problems in a neonatal intensive care unit. Rev Bras Ter Intensiva 2017; 29:331-336. [PMID: 28876403 PMCID: PMC5632976 DOI: 10.5935/0103-507x.20170040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/24/2017] [Indexed: 12/17/2022] Open
Abstract
Objective The goal was to determine the main drug-related problems in neonates who were
using antimicrobials. Method This was an observational, prospective and longitudinal study. Drug-related
problems were classified according to version 6.2 of the Pharmaceutical Care
Network Europe Foundation classification. A descriptive analysis was
performed, in which the clinical and therapeutic variables were presented as
absolute and relative frequencies or as the mean and standard deviation, as
appropriate. Results In total, 152 neonates with a predominance of males (58.5%), gestational age
of 32.7 ± 4.2 weeks and weight of 1,903.1 ± 846.9g were
included. The main diagnostic hypothesis of infection was early sepsis
(66.5%), and 71.7% of the neonates had some risk factor for infection. Among
the neonates, 33.6% had at least one drug-related problem. Of these, 84.8%
were related to treatment effectiveness and 15.2% to adverse reactions. The
main cause of drug-related problems was the selected dose, particularly for
aminoglycosides and cephalosporins. Conclusion The use of antimicrobials in the neonatal intensive care is mainly associated
with problems related to medication effectiveness, predominantly the
prescription of subdoses of antimicrobials, especially aminoglycosides.
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Affiliation(s)
- Bruna Meirelly Nunes
- Residência Multiprofissional em Saúde, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte - Natal (RN), Brasil
| | - Tatiana Costa Xavier
- Residência Multiprofissional em Saúde, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte - Natal (RN), Brasil
| | - Rand Randall Martins
- Departamento de Farmácia, Universidade Federal do Rio Grande do Norte - Natal (RN), Brasil
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Candidemia in the Neonatal Intensive Care Unit: A Retrospective, Observational Survey and Analysis of Literature Data. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7901763. [PMID: 28884129 PMCID: PMC5572580 DOI: 10.1155/2017/7901763] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/18/2017] [Indexed: 12/23/2022]
Abstract
We evaluated the epidemiology of Candida bloodstream infections in the neonatal intensive care unit (NICU) of an Italian university hospital during a 9-year period as a means of quantifying the burden of infection and identifying emerging trends. Clinical data were searched for in the microbiological laboratory database. For comparative purposes, we performed a review of NICU candidemia. Forty-one candidemia cases were reviewed (overall incidence, 3.0 per 100 admissions). Candida parapsilosis sensu stricto (58.5%) and C. albicans (34.1%) were the most common species recovered. A variable drift through years was observed; in 2015, 75% of the cases were caused by non-albicans species. The duration of NICU hospitalization of patients with non-albicans was significantly longer than in those with C. albicans (median days, 10 versus 12). Patients with non-albicans species were more likely to have parenteral nutrition than those with C. albicans (96.3% versus 71.4%). Candida albicans was the dominant species in Europe and America (median, 55% and 60%; resp.); non-albicans species predominate in Asia (75%). Significant geographic variation is evident among cases of candidemia in different parts of the world, recognizing the importance of epidemiological data to facilitate the treatment.
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Lee HY, Hsu SY, Hsu JF, Chen CL, Wang YH, Chiu CH. Risk factors and molecular epidemiology of Acinetobacter baumannii bacteremia in neonates. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:367-376. [PMID: 28830746 DOI: 10.1016/j.jmii.2017.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/10/2017] [Accepted: 07/27/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acinetobacter baumannii infections in neonates are not uncommon but rarely studied. METHODS Clinical and molecular epidemiology of 40 patients with A. baumannii bacteremia in the neonatal intensive care units (NICUs) of a medical center from 2004 to 2014 was analyzed. RESULTS Multi-drug resistance was found in only 3 isolates (7.5%). Sequence types (STs) of A. baumannii defined by multilocus sequencing typing were diverse, and 72.4% identified isolates belonged to novel STs. Majority of the isolates were susceptible to antibiotics tested. Among the 3 imipenem-resistant A. baumannii (IRAB) isolates, 2 (66.7%) belonged to ST684, a novel ST. All of the 3 isolates were susceptible to tigecycline and colistin. The predominant mechanism of imipenem resistance in these neonatal isolates is ISAba1-blaOXA-80, which has never been reported in Asia before. Most infected newborns were premature (95%), with very low birth weight (70% < 1500 g), prolonged intubation, usage of percutaneous central venous catheter (65%) and long-term usage of total parenteral nutrition or intravenous lipid (95%). IRAB infection, inappropriate initial therapy, 1-minute Apgar score and early onset infection within the first 10 days of life were found to correlate with mortality by log-rank test. Prior use of imipenem for at least 5 days and use of high frequency oscillation ventilation (HFOV) were statistically significant risk factors for acquiring IRAB infections. CONCLUSIONS To reduce mortality of IRAB infection, it is crucial to consider giving effective agents, such as colistin, in 2 days for high risk neonates who has been given imipenem or used HFOV.
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Affiliation(s)
- Hao-Yuan Lee
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Pediatrics, Wei-Gong Memorial Hospital, Miaoli, Taiwan
| | - Shih-Yun Hsu
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chyi-Liang Chen
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Hsin Wang
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Thatrimontrichai A, Chanvitan P, Janjindamai W, Dissaneevate S, Jefferies A, Shah V. Brief communication (Original). Trends in neonatal sepsis in a neonatal intensive care unit in Thailand before and after construction of a new facility. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0806.356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Neonatal sepsis is a cause of mortality and long-term morbidity worldwide.
Objectives: To describe longitudinal trends in the cumulative incidence of early- and late-onset sepsis (EOS and LOS), mortality, and causative organisms in a Thai Hospital before and after construction of a new neonatal intensive care unit (NICU).
Methods: Review of NICU admissions with blood cultures positive for bacteria or fungi for the periods 1995 to 2002 (preconstruction) and 2004 to 2010 (postconstruction). Sepsis was categorized into EOS (within first 3 days of life) and LOS (after first 3 days of life).
Results: Of 5,570 admissions, 241 (4.3%) neonates with 276 episodes of sepsis were identified. There was no difference in the rate of sepsis overall (P = 0.90), LOS (P = 0.30), or sepsis-related mortality (P = 0.61) over the two periods, but the rate of EOS increased significantly from 0.34% to 0.81% (P = 0.04). Rates of Klebsiella species and Escherichia coli sepsis increased from 13.6% to 25.6% (P = 0.01) and from 5.3% to 12.2% (P = 0.04), respectively, while rates of Staphylococcus aureus sepsis decreased from 12.9% to 4.3% (P < 0.007). Sepsisrelated mortality was 1.8%.
Conclusions: Although direct causality cannot be proven, the rate of EOS and the pattern of causative organisms changed following construction of the new NICU. Building a new unit does not necessarily result in a reduction in the rate of sepsis. This data may provide a baseline for implementing evidence-based infection control strategies to prevent/reduce sepsis and improve neonatal care.
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Affiliation(s)
- Anucha Thatrimontrichai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Prasin Chanvitan
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Waricha Janjindamai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Supaporn Dissaneevate
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Ann Jefferies
- Division of Neonatology, Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
| | - Vibhuti Shah
- Department of Paediatrics, Division of Neonatology, Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
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Boo NY, Cheah IGS. Factors associated with inter-institutional variations in sepsis rates of very-low-birth-weight infants in 34 Malaysian neonatal intensive care units. Singapore Med J 2017; 57:144-52. [PMID: 26996633 DOI: 10.11622/smedj.2016056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to determine whether patient loads, infant status on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis rates in very-low-birth-weight (VLBW) infants in the Malaysian National Neonatal Registry (MNNR). METHODS This was a retrospective study of 3,880 VLBW (≤ 1,500 g) infants admitted to 34 neonatal intensive care units (NICUs) in the MNNR. Sepsis was diagnosed in symptomatic infants with positive blood culture. RESULTS Sepsis developed in 623 (16.1%) infants; 61 (9.8%) had early-onset sepsis (EOS) and 562 (90.2%) had late-onset sepsis (LOS). The median EOS rate of all NICUs was 1.0% (interquartile range [IQR] 0%, 2.0%). Compared with NICUs reporting no EOS (n = 14), NICUs reporting EOS (n = 20) had significantly higher patient loads (total live births, admissions, VLBW infants, outborns); more mothers with a history of abortions, and antenatal steroids and intrapartum antibiotic use; more infants requiring resuscitation procedures at birth; higher rates of surfactant therapy, pneumonia and insertion of central venous catheters. The median LOS rate of all NICUs was 14.5% (IQR 7.8%, 19.2%). Compared with NICUs with LOS rates below the first quartile (n = 8), those above the third quartile (n = 8) used less intrapartum antibiotics, and had significantly bigger and more mature infants, more outborns, as well as a higher number of sick infants requiring ventilator support and total parenteral nutrition. CONCLUSION Patient loads, resuscitation at birth, status of infants on admission and treatment interventions were significantly associated with inter-institutional variations in sepsis.
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Affiliation(s)
- Nem-Yun Boo
- Department of Population Health, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Irene Guat-Sim Cheah
- Department of Paediatrics, Paediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Rohit A, Maiti B, Shenoy S, Karunasagar I. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for rapid diagnosis of neonatal sepsis. Indian J Med Res 2017; 143:72-8. [PMID: 26997017 PMCID: PMC4822372 DOI: 10.4103/0971-5916.178613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives: The difficulties in diagnosis of neonatal sepsis are due to varied clinical presentation, low sensitivity of blood culture which is considered the gold standard and empirical antibiotic usage affecting the outcome of results. Though polymerase chain reaction (PCR) based detection of bacterial 16S rRNA gene has been reported earlier, this does not provide identification of the causative agent. In this study, we used restriction fragment length polymorphism (RFLP) of amplified 16S rRNA gene to identify the organisms involved in neonatal sepsis and compared the findings with blood culture. Methods: Blood samples from 97 neonates were evaluated for diagnosis of neonatal sepsis using BacT/Alert (automated blood culture) and PCR-RFLP. Results: Bacterial DNA was detected by 16S rRNA gene PCR in 55 cases, while BacT/Alert culture was positive in 34 cases. Staphylococcus aureus was the most common organism detected with both methods. Klebsiella spp. was isolated from four samples by culture but was detected by PCR-RFLP in five cases while Acinetobacter spp. was isolated from one case but detected in eight cases by PCR-RFLP. The sensitivity of PCR was found to be 82.3 per cent with a negative predictive value of 85.7 per cent. Eighty of the 97 neonates had prior exposure to antibiotics. Interpretation & conclusions: The results of our study demonstrate that PCR-RFLP having a rapid turnaround time may be useful for the early diagnosis of culture negative neonatal sepsis.
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Affiliation(s)
| | | | | | - Indrani Karunasagar
- Department of Microbiology, College of Fisheries, Mangalore; Faculty of Biomedical Science, Nitte University Centre for Science Education & Research, India
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Assessing the Role of Clinical Manifestations and Laboratory Findings in Neonatal Sepsis. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2016. [DOI: 10.5812/pedinfect.29985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Resch B, B R, N H. Comparison Between Pathogen Associated Laboratory and Clinical Parameters in Early-Onset Sepsis of the Newborn. Open Microbiol J 2016; 10:133-9. [PMID: 27478518 PMCID: PMC4939603 DOI: 10.2174/1874285801610010133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 06/10/2016] [Accepted: 06/14/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To identify laboratory and clinical characteristics of different pathogens associated with early-onset sepsis (EOS) of the newborn. METHODS Newborns with EOS were retrospectively analyzed regarding laboratory and clinical parameters associated with the identified pathogen. RESULTS We identified 125 newborns having diagnosis of culture proven EOS between 1993 and 2011. One hundred cases had diagnosis of group B streptococci (GBS) infection (80%), 11 had Escherichia coli (8.8%), eight enterococci (6.4%), and six other pathogens (4.8%). White blood cell count (WBC), immature to total neutrophil (IT) ratio, and C-reactive protein (CRP) values did not differ between groups within the first 72 hours of life. Presence of high (>30000/µL) and low (<9000/µl) WBC was significantly less found compared with IT-ratio >0.2 in GBS and E.coli EOS. High WBC were more common found than low WBC in all groups. Gram positive pathogens were more common found in late preterm and term infants (84%), and gram negative pathogens more common in very low birth weight infants (64%). E. coli was significantly associated with lower gestational age and birth weight, respectively. CONCLUSION An abnormal IT-ratio was a more common finding than an abnormal WBC in GBS and E. coli EOS. E. coli was significantly associated with prematurity.
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Affiliation(s)
- Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria; Division of Neonatology, Department of Pediatrics, Medical University of Graz, Graz, Austria
| | - Renoldner B
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Hofer N
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
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Risk factors of late-onset neonatal sepsis in Taiwan: A matched case-control study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 49:430-5. [DOI: 10.1016/j.jmii.2013.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/11/2013] [Accepted: 08/05/2013] [Indexed: 11/23/2022]
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Tran HT, Doyle LW, Lee KJ, Dang NM, Graham SM. A high burden of late-onset sepsis among newborns admitted to the largest neonatal unit in central Vietnam. J Perinatol 2015; 35:846-51. [PMID: 26156065 DOI: 10.1038/jp.2015.78] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/16/2015] [Accepted: 05/29/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to determine the prevalence, causes and outcome of sepsis in hospitalized neonates in the largest neonatal unit in central Vietnam. STUDY DESIGN A 1-year prospective cohort study of newborns admitted to the neonatal unit in Da Nang. A sepsis work-up including blood culture was undertaken before commencing antibiotics for neonates with suspected sepsis. RESULT Of 2555 neonatal admissions, 616 neonates had 729 episodes of suspected invasive sepsis. A pathogen was isolated from blood in 115 (16%) episodes in 106 neonates. The prevalence of early-onset sepsis (EOS) was 8 (95% confidence interval (CI): 4 to 11) per 1000 admissions, and of late-onset sepsis (LOS) was 34 (95% CI: 27 to 41) per 1000 admissions. Of 86 neonates with LOS, 69 (80%) also fulfilled the criteria for nosocomial sepsis. The commonest bacterial causes of EOS were coagulase-negative Staphylococcus (CoNS) and Staphylococcus aureus, and of LOS were Acinetobacter, CoNS and Klebsiella pneumoniae. Fungal sepsis occurred in 35 neonates of which most were nosocomial sepsis. In vitro resistance to multiple antibiotics was common among Gram-negative bacteria. Antibiotics were prescribed and given to 68% of all admissions, and 14% of all admissions received four or more different antibiotics. The case fatality rate for confirmed sepsis was 46%. CONCLUSION Late-onset, nosocomial sepsis was common and associated with a high mortality in hospitalized newborns in the largest neonatal unit in central Vietnam. These findings highlighted the need for improved infection control measures and antibiotic stewardship, which have since been implemented.
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Affiliation(s)
- H T Tran
- Neonatal Unit, Department of Paediatrics, Da Nang Hospital for Women and Children, Da Nang, Vietnam.,Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - L W Doyle
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - K J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - N M Dang
- Neonatal Unit, Department of Paediatrics, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - S M Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
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Changing of bloodstream infections in a medical center neonatal intensive care unit. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 50:514-520. [PMID: 26440920 DOI: 10.1016/j.jmii.2015.08.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/22/2015] [Accepted: 08/31/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND/PURPOSE Bloodstream infections (BSIs) are associated with high mortality and morbidity in neonatal intensive care units (NICUs). The epidemiology of these infections may change after the application of new infection control policies. The aims of this study are to reveal the changing epidemiology of BSIs in our NICU and inspect the effects of infection control efforts. METHODS We reviewed and analyzed the clinical characteristics of culture-proven BSIs in our NICU from 2008 to 2013 and compared them with our two previously reported data (1992-2001 and 2002-2007). RESULTS The mortality rate decreased from 16.3% in 1992-2001 to 5.6% in 2008-2013. In the recent study period, Gram-positive infections became predominant (58.0%). Coagulase-negative staphylococci remained the most commonly isolated organisms (26.0%). Group B Streptococcus (GBS) BSIs had the highest mortality rate (30.0%). Most GBS-infected infants' mother did not perform prenatal GBS screening. There was a decrease in the total fungal infection rate after fluconazole prophylaxis for very-low-birth-weight (VLBW) neonates, but the infections of fluconazole-resistant Malassezia pachydermatis increased. The incidence of central line-associated BSI increased to 10.6% in 2011. After restricting the catheter duration to <21 days, the incidence decreased to 4.2% in 2013. CONCLUSION Through the years, the overall mortality rate of BSIs in our NICU decreased. Maternal GBS screening is an important issue for avoiding early onset GBS mortality. Fungal infection rate decreased after antifungal prophylaxis policy for VLBW infants, but we should be aware of resistant strains. Restriction of the catheter duration may decrease the incidence of catheter-related BSI.
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Epidemiology of Neonatal Sepsis and Implicated Pathogens: A Study from Egypt. BIOMED RESEARCH INTERNATIONAL 2015; 2015:509484. [PMID: 26146621 PMCID: PMC4471255 DOI: 10.1155/2015/509484] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/09/2015] [Accepted: 05/11/2015] [Indexed: 02/07/2023]
Abstract
Prospective analytic study was conducted in NICUs of three Egyptian Neonatal Network (EGNN) participants in Mansoura Hospitals in Egypt over a period of 18 months from March 2011 to August 2012. By using EGNN 28-day discharge form, all demographic, clinical, and laboratory data were recorded and studied. During the study period, 357 neonates were diagnosed as suspected sepsis with an incidence of 45.9% (357/778) among the admitted neonates at the three neonatal intensive care units. 344 neonates (sex ratio = 1.3:1) were enrolled in the study in which 152 (44.2%) were classified as early onset sepsis EOS (≤72 hr) and 192 (55.8%) as late onset sepsis LOS (>72 hr). Among the LOS cases, 33.9% (65/192) were caused by nosocomial infections. In 40.7% (140/344), sepsis was confirmed by positive blood culture. The total mortality rate for the proven neonatal sepsis was 51% (25/49) and 42.9% (39/91) for EOS and LOS, respectively. Coagulase negative staphylococci were predominant isolates in both EOS and LOS, followed by Klebsiella pneumoniae. Most of the bacterial isolates had low sensitivity to the commonly used empiric antibiotics. However, 70.1% (89/127) exhibited multidrug resistance. Best sensitivities among Gram-positive isolates were found against imipenem, ciprofloxacin, vancomycin, and amikacin.
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Effect of mupirocin decolonization on subsequent methicillin-resistant Staphylococcus aureus infection in infants in neonatal intensive care units. Pediatr Infect Dis J 2015; 34:241-5. [PMID: 25742074 DOI: 10.1097/inf.0000000000000540] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate whether topical mupirocin treatment can effectively decolonize methicillin-resistant Staphylococcus aureus (MRSA) carriage and reduce subsequent MRSA infection in neonates. METHODS During a 1-year period, the infants admitted to our neonatal intensive care units (NICUs)-1 and NICU-2 were included, and specimens from the nares and umbilicus were obtained within 24 hours, and specimen collection was repeated weekly for 2 weeks. Mupirocin was administered for 5 days to the infants with MRSA colonization in NICU-1 during the first half of the year and then switched to those in NICU-2 during the second half of the year. RESULTS A total of 525 infants were recruited: 257 infants in the treatment group and 268 in the control group. MRSA colonization was detected in 130 infants (25%) during NICU stay, which is a similar rate in both groups. Twenty-two (4.2%) episodes of MRSA infection were identified. The rate of MRSA infection was significantly higher in infants with prior colonization than in those without (10.2% vs. 2.3%, P<0.001). Among the infants with prior colonization, the rate of MRSA infection in the treatment group was significantly lower than that in the control group (3.2% vs. 16%, P=0.014), and the rate in the treatment group was comparable to that in those without colonization (P=0.7804). Of the 15 infants with both clinical and colonizing isolates, indistinguishable strains between the paired isolates from the same infant by molecular methods were identified in 14 infants (93%). CONCLUSION Administering mupirocin topical therapy to MRSA-colonized infants in NICUs might reduce subsequent MRSA infections during hospitalization in these infants. A large-scale study should be conducted.
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Limited diagnostic value of routine screening of neonates with the urinary group B streptococcal antigen tests. Pediatr Neonatol 2014; 55:480-6. [PMID: 25067807 DOI: 10.1016/j.pedneo.2014.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 02/07/2014] [Accepted: 03/13/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A urinary latex test for detection of antigens from group B Streptococcus (GBS) has been used for the diagnosis of invasive GBS disease. However, the value of routine screening of infants with this test has not been determined. METHODS All infants admitted to Linkou Chang-Gung Memorial Hospital (Taoyuan, Taiwan) from January 2005 to May 2013 were screened with a urinary GBS antigen test (Wellcogen Strep B). Medical records were retrospectively reviewed to determine the diagnostic value of this test. RESULTS A total of 14,277 infants were tested and 38 cases had confirmed diagnoses of invasive GBS disease (34 bacteremia, 18 meningitis, 14 both), corresponding to a prevalence of 0.27% among our admitted infants. A total of 106 infants had positive results, but only 26 had confirmed disease. Among infants with confirmed disease, 12 had negative antigen results. These data allowed calculation of the sensitivity (68.4%), specificity (99.4%), positive predictive value (24.5%), and negative predictive value (99.9%). Adjusting for prevalence, the disease probability of a positive test result was 23.6%, and the probability of a negative post-test result was 0.09%. The absolute risk reduction of a negative result was very small (0.18%). Analysis of demographic, clinical, and laboratory parameters indicated that late age of onset (≥7 days-old), presence of seizure, fever, respiratory distress, leukopenia, bandemia, thrombocytopenia, coagulopathy, metabolic acidosis, and elevated levels of C-reactive protein (CRP) were significantly related to the presence of a true positive test result. CONCLUSION In our study population, the positive predictive value of the GBS antigen test was poor and the risk reduction of a negative result was weak. These results indicate that routine screening with this test has a limited diagnostic value. However, GBS antigen testing appears to be useful for early detection of disease in infants with certain demographic, clinical, and laboratory risk factors.
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The Sex Differences of Morphology and Immunology of SIRS of Newborn Wistar Rats. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:190749. [PMID: 27350991 PMCID: PMC4897487 DOI: 10.1155/2014/190749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/13/2014] [Accepted: 10/13/2014] [Indexed: 12/20/2022]
Abstract
The sex differences of infection and inflammatory diseases particularly appear at reproductive age and depend on the sex hormone level, varied between male and female. There are a few sets of data about the sex differences of infection and inflammatory diseases course, including systemic inflammatory response syndrome (SIRS) and sepsis, of newborns. The aim of our research was the estimation of morphological and immunological manifestation of SIRS of the newborn Wistar rats. Investigations were carried out on male and female two-day-old Wistar rats (10–12 g). SIRS was modeled by intraperitoneal injection of LPS (E. coli, O26: B6 strain, Sigma) in high dose—15 mg/kg. We did not find out any sex differences of the liver lesions severity between newborn males and females after LPS injection. The levels of endotoxin and estradiol in the serum, as the number of neutrophils in the intra-alveolar septa of the lungs, were higher in males than females with SIRS. Production of IL-2 and TNF-α by the spleen cells of males was higher than that in control group that reflects polarization predominantly on the Th1-type immune response. The secretion of IL-2, TNF-α, and IFN-γ by ConA activated spleen cells of females decreased that reflects the suppression of Th1-type immune response. We suppose that the LPS administration in the high dose causes the multidirectional reaction of the immune system of neonatal males and females Wistar rats.
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Wójkowska-Mach J, Gulczyńska E, Nowiczewski M, Borszewska-Kornacka M, Domańska J, Merritt TA, Helwich E, Kordek A, Pawlik D, Gadzinowski J, Szczapa J, Adamski P, Sulik M, Klamka J, Brzychczy-Włoch M, Heczko PB. Late-onset bloodstream infections of Very-Low-Birth-Weight infants: data from the Polish Neonatology Surveillance Network in 2009-2011. BMC Infect Dis 2014; 14:339. [PMID: 24939563 PMCID: PMC4074408 DOI: 10.1186/1471-2334-14-339] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 06/09/2014] [Indexed: 12/02/2022] Open
Abstract
Background Late-Onset Bloodstream Infections (LO-BSI) continue to be one of the most important complications associated with hospitalization of infants born with very low birth weight (VLBW). The aims of this study were to assess the epidemiology of LO-BSI together with the risk factors and the distribution of causative pathogens at six Polish neonatal intensive care units that participated in the Polish Neonatology Surveillance Network from January 1, 2009 to December 31, 2011. Methods The surveillance covered 1,695 infants whose birth weights were <1501 grams (VLBW) in whom LO-BSI was diagnosed >72 hours after delivery. Case LO-BSI patients were defined according to NeoKISS. Results Four hundred twenty seven episodes of LO-BSI were diagnosed with a frequency of 25.3% and an incidence density of 6.7/1000 patient-days (pds). Results of our multivariate analysis demonstrated that surgical procedures and lower gestational age were significantly associated with the risk of LO-BSI. Intravascular catheters were used in infants with LO-BSI significantly more frequently and/or for longer duration: Central venous cathters (CVC) (OR 1.29) and Peripheral venous catheters (PVC) (OR 2.8), as well as, the total duration of total parenteral nutrition (13 vs. 29 days; OR 1.81). Occurrence of LO-BSI was significantly associated with increased the length of mechanical ventilation (MV) (OR 2.65) or the continuous positive airway pressure (CPAP) (OR 2.51), as well as, the duration of antibiotic use (OR 2.98). The occurrence of more than one infection was observed frequently (OR 9.2) with VLBW with LO-BSI. Microorganisms isolated in infants with LO-BSI were dominated by Gram-positive cocci, and predominantly by coagulase-negative staphylococci (62.5%). Conclusions Independent risk factor for LO-BSI in VLBV infants are: low gestational age and requirement for surgery. The incidence rates of LO-BSI especially CVC-BSI were higher in the Polish NICUs surveillance than those of other national networks, similar to the central- and peripheral utilization ratio.
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Affiliation(s)
- Jadwiga Wójkowska-Mach
- Microbiology, Jagiellonian University Medical College, 18 Czysta Street, Krakow 31-121, Poland.
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Isabel IG, Cynthia FL, Diana RG, Leticia BM, Sara GL, Susana MS, Marcela VA. Inborn Errors of Intermediary Metabolism in Critically Ill Mexican Newborns. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2014. [DOI: 10.1177/2326409814529649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ibarra-González Isabel
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Fernández-Lainez Cynthia
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, México
| | - Reyes-González Diana
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, México
| | - Belmont-Martínez Leticia
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, México
| | - Guillén-López Sara
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, México
| | - Monroy-Santoyo Susana
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, México
| | - Vela-Amieva Marcela
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, México
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Pereira CB, Czaplik M, Blanik N, Rossaint R, Blazek V, Leonhardt S. Contact-free monitoring of circulation and perfusion dynamics based on the analysis of thermal imagery. BIOMEDICAL OPTICS EXPRESS 2014; 5:1075-89. [PMID: 24761290 PMCID: PMC3986002 DOI: 10.1364/boe.5.001075] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/09/2014] [Accepted: 01/20/2014] [Indexed: 05/24/2023]
Abstract
Acute circulatory disorders are commonly associated with systemic inflammatory response (SIRS) and sepsis. During sepsis, microcirculatory perfusion is compromised leading to tissue hypoperfusion and potentially to multiple organ dysfunction. In the present study, acute lung injury (ALI), one of the major causes leading to SIRS and sepsis, was experimentally induced in six female pigs. To investigate the progress of body temperature distribution, measurements with a long-wave infrared camera were carried out. Temperature centralization was evidenced during ALI owing to impairments of peripheral perfusion. In addition, statistical analysis demonstrated strong correlations between (a) standard deviation of the skin temperature distribution (SD) and shock index (SI) (p<0.0005), (b) SD and mean arterial pressure (MAP) (p<0.0005), (c) ΔT/Δx and SI (p<0.0005), as well as between (d) ΔT/Δx and MAP (p<0.0005). For clarification purposes, ΔT/Δx is a parameter implemented to quantify the spatial temperature gradient. This pioneering study created promising results. It demonstrated the capacity of infrared thermography as well as of the indexes, SD and ΔT/Δx, to detect impairments in both circulation and tissue perfusion.
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Affiliation(s)
- Carina Barbosa Pereira
- Chair for Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrs. 20, D-52074 Aachen, Germany
| | - Michael Czaplik
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstrs. 30, D-52074 Aachen, Germany
| | - Nikolai Blanik
- Chair for Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrs. 20, D-52074 Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstrs. 30, D-52074 Aachen, Germany
| | - Vladimir Blazek
- Chair for Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrs. 20, D-52074 Aachen, Germany
| | - Steffen Leonhardt
- Chair for Medical Information Technology, Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrs. 20, D-52074 Aachen, Germany
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Kuo CY, Huang YC, Huang DTN, Chi H, Lu CY, Chang LY, Chi CY, Ho YH, Huang YC, Liu CC, Huang LM. Prevalence and molecular characterization of Staphylococcus aureus colonization among neonatal intensive care units in Taiwan. Neonatology 2014; 105:142-8. [PMID: 24356303 DOI: 10.1159/000356733] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 10/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Staphylococcus aureus, particularly methicillin-resistant (MRSA), is an important pathogen in neonatal intensive care units (NICUs). Carriage of S. aureus is a significant risk factor for subsequent infection. OBJECTIVES To determine the current status of MRSA prevalence among NICU-hospitalized infants in Taiwan, we conducted this pilot island-wide survey. METHODS On two designated dates in 2011, each patient who stayed in the NICUs of 7 participating hospitals was included. Nasal and umbilical swabs were obtained and sent for detection of S. aureus. The prevalence and risk factors for MRSA carriage were analyzed. MRSA strains were tested for antimicrobial susceptibility and underwent molecular characterization. RESULTS A total of 251 subjects were included. The overall prevalence of S. aureus and MRSA carriage was 13 and 4.4%, respectively. Previous skin and soft tissue infection was the only predictor in multivariate analysis (OR 40.36; 95% CI 2.32-702.64; p = 0.011). Among 11 MRSA isolates, 3 pulsotypes were identified, with one major type (73%). Nine isolates carried a type IV staphylococcal chromosomal cassette, and 2 carried the type VT. All but one MRSA isolate belonged to linage sequence type 59, the community clone in Taiwan. CONCLUSIONS On a designated date, 4.4% of the infants staying in NICUs in Taiwan carried almost genetically identical community strains of MRSA. MRSA colonization in these infants was significantly associated with previous skin and soft tissue infection.
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Affiliation(s)
- Chen-Yen Kuo
- Taiwan Pediatric Infectious Diseases Alliance, Chang Gung University, Taoyuan, Taiwan
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Folgori L, Bielicki J, Sharland M. A systematic review of strategies for reporting of neonatal hospital-acquired bloodstream infections. Arch Dis Child Fetal Neonatal Ed 2013; 98:F518-23. [PMID: 23645589 DOI: 10.1136/archdischild-2012-303149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the reporting of hospital-acquired bloodstream infection (HABSI) and central line-associated BSI (CLABSI) rates in neonatal intensive care units (NICUs). DESIGN Systematic review of evidence published after 2000 reporting HABSI cumulative incidence, crude HABSI and/or CLABSI rate and total patient-days and/or central line-days for single NICU. SETTING Inpatient. PATIENTS Neonates admitted to NICU. MAIN OUTCOME MEASURES To consider the reporting of and relationship between cumulative incidence of BSI and HABSI and/or CLABSI rates. RESULTS 18 studies fulfilled inclusion criteria. There was a wide variability in reporting of HABSI indicators and risk-adjustment strategies with reported crude HABSI and/or CLABSI rates showing an approximately sevenfold variation between centres. Information about NICU size and level of care was not always available. Many studies provided insufficient information about case mix, such as surgical care provision and prematurity. The proportion of total patient-days that were central venous catheters (CVC)-days ranged from 11.7% to 85.4%. Only six studies reported HABSI and CLABSI incidence. Comparing HABSI and CLABSI ranking, we found a relationship between rates. CONCLUSIONS We found significant variability in HABSI rate reporting. Although there appears to be an association between CLABSI and HABSI rates, non-CVC-related BSIs are likely to be highly relevant in some NICUs. If confirmed, and given CLABSI rates are more challenging to collect, it may be more appropriate to use HABSI rates for monitoring NICU healthcare-associated infection (HAI) in some settings. A European network of NICUs using a standardised methodology is required to determine the feasibility and reliability of different risk-adjusted measured of HAI rates.
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Affiliation(s)
- Laura Folgori
- Division of Clinical Sciences, Paediatric Infectious Disease Research Group, St George's University of London, , London, UK
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Risk factors and outcomes of carbapenem-resistant Acinetobacter baumannii bacteremia in neonatal intensive care unit: a case-case-control study. Pediatr Infect Dis J 2013; 32:140-5. [PMID: 22935872 DOI: 10.1097/inf.0b013e318270b108] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a serious threat among critically ill neonates. METHODS We performed a case-case-control study in a Thai neonatal intensive care unit to identify risk factors and outcomes for CRAB bacteremia. Case group (CG) I was defined as cases with CRAB (n = 14), and CG II was defined as cases with carbapenem-susceptible A. baumannii (n = 38) bacteremia. The control group (n = 44) was selected from all patients admitted before and after 3 days that CG I was identified, but had no infection. RESULTS The mean gestational age and birth weight of CG I, II and control were 33.5, 35.2 and 35.2 weeks and 1856.5, 2273.9 and 2309.5 g, respectively. By multivariate analysis, CG I was more likely to have had an umbilical artery catheter (adjusted odds ratio = 29.30; P = 0.019) whereas CG II was more likely exposed to ceftazidime (adjusted odds ratio = 5.19; P = 0.046) and aminoglycosides (adjusted odds ratio = 35.59; P = 0.002). There was a significant difference in history of cefoperazone/sulbactam (21.4% versus 0%; P = 0.01) and imipenem use (35.7% versus 0%; P < 0.001) among CG I compared with control. Crude mortality in CG I was higher than CG II (42.9% versus 13.2%; odds ratio = 5.0; P = 0.02). CONCLUSION Our cohort of neonatal CRAB bacteremia is characterized by a very high mortality. Infection-control interventions inclusive of strict adherence to infection-control process for central vascular line placement and maintenance as well as antimicrobial stewardship program are essential to help reduce CRAB bacteremia.
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Clinical and Bacteriological Characteristics of Neonatal Sepsis in an Intensive Care Unit in Kashan, Iran: A 2 Year Descriptive Study. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2013. [DOI: 10.5812/pedinfect.7875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lim WH, Lien R, Huang YC, Chiang MC, Fu RH, Chu SM, Hsu JF, Yang PH. Prevalence and pathogen distribution of neonatal sepsis among very-low-birth-weight infants. Pediatr Neonatol 2012; 53:228-34. [PMID: 22964280 DOI: 10.1016/j.pedneo.2012.06.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 11/02/2011] [Accepted: 12/01/2011] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Neonatal sepsis contributes to great mortality and morbidity among very-low-birth-weight (VLBW) infants. Prevalence and pathogen distribution of sepsis in the neonatal intensive care units (NICUs) vary with time and geographic location. Such information serves as a guide for selection of empirical antibiotics coverage. METHODS This is a case series study performed by retrospective chart review of VLBW infants (birth body weight, BBW, <1500 g) in a medical center during a 5-year period from January 2005 to December 2009. Episodes of positive blood cultures, pathogen distribution and related clinical manifestations were described. RESULTS A total of 158 episodes of sepsis were identified from 1042 VLBW infants. Sepsis rate was 152 per 1000 live births. The vast majority of infections (60.7%) were caused by Gram-positive organisms [G(+)], and overall Coagulase-negative staphylococci (CoNS) (52.5%) were the most common pathogen identified. Prevalence for early-onset sepsis (EOS) was 1% and for late-onset sepsis (LOS) was 14.2%. Infants with EOS had a much higher case fatality rate than LOS (40% vs. 4.7%). Escherichia coli (40%) were the leading pathogen of EOS while CoNS (54.7%) was the leading pathogens of LOS. Overall, apnea and/or bradycardia and/or cyanosis (65.8%), poor activity (48.7%), and increased respiratory effort (43.0%) were the most common presenting features of sepsis. CONCLUSION Unlike term infants, Gram-negative organism and E coli were the leading pathogen of EOS among VLBW infants. Judicious and timely use of antibiotic therapy is crucial in the care of VLBW infants.
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Affiliation(s)
- Wai Ho Lim
- Division of Neonatology, Chang Gung Children's Hospital, School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
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Lu CY, Tsao PN. Protect the unprotected: neonatal sepsis in very-low-birth-weight infants. Pediatr Neonatol 2012; 53:217-8. [PMID: 22964277 DOI: 10.1016/j.pedneo.2012.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 11/02/2011] [Accepted: 12/01/2011] [Indexed: 11/17/2022] Open
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Tran HT, Doyle LW, Lee KJ, Graham SM. A systematic review of the burden of neonatal mortality and morbidity in the ASEAN Region. WHO South East Asia J Public Health 2012; 1:239-248. [PMID: 28615550 DOI: 10.4103/2224-3151.207020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Neonatal morbidity and mortality are major global public health challenges representing an increasing proportion of overall under-5 child mortality, with the vast majority of neonatal deaths occurring in resource-limited settings. In the Association of Southeast Asian Nations (ASEAN) region, it is estimated that approximately 200 000 neonatal deaths occur annually with reported estimates of the neonatal mortality rate ranging from 1 to over 30 per 1000 live-births, depending on the setting. The aim of this study is to conduct a systematic review of published data on neonatal morbidity and mortality from the ASEAN region over the last 10 years. Very few published studies reporting neonatal morbidity and mortality in this region were found. Importantly, data are available from just a few countries, with an underrepresentation of the most resource-limited settings. The majority of the studies describing mortality and morbidity were retrospective surveys or focussed on a specific cause of neonatal morbidity. Studies included findings from a range of settings, from neonatal intensive care to community settings utilizing verbal autopsy. Therefore, comprehensive and prospective data are needed to inform priorities and potential interventions to improve neonatal care and reduce neonatal mortality in this region.
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Affiliation(s)
- Hoang T Tran
- Department of Paediatrics, Da Nang Hospital for Women and Children, Da Nang, Viet Nam; Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Lex W Doyle
- University of Melbourne Department of Obstetrics and Gynaecology, Royal Women's Hospital; Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katherine J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia
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Spasojević I, Obradović B, Spasić S. Bench-to-bedside review: Neonatal sepsis-redox processes in pathogenesis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:221. [PMID: 22574892 PMCID: PMC3580597 DOI: 10.1186/cc11183] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The present review is aimed at elucidating the neonatal 'sepsis redox cycle' - the cascade of inflammatory and redox events involved in the pathogenesis of sepsis in neonates. While adult and neonatal sepses share some common features, there are some substantial differences: higher mortality rates occur in adult sepsis and worse long-term effects are evident in neonatal sepsis survivors. Such epidemiological data may be explained by the lower ability of IL6 and IL8 to activate NF-κB-regulated transcription in neonatal sepsis in comparison to TNF-α, which is involved in the mechanisms of adult sepsis. The activation of NF-κB in neonatal sepsis is further promoted by hydrogen peroxide and results in mitochondrial dysfunction and energy failure as septic neonates experience decreased O2 consumption as well as lower heat production and body temperature in comparison to healthy peers. In neonates, specific organs that are still under development are vulnerable to sepsis-provoked stress, which may lead to brain, lung, and heart injury, as well as vision and hearing impairments. In the light of the processes integrated here, it is clear that therapeutic approaches should also target specific steps in the neonatal 'sepsis redox cycle' in addition to the current therapeutic approach that is mainly focused on pathogen eradication.
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Tu W, He J, Dai F, Wang X, Li Y. Impact of inborn errors of metabolism on admission in a neonatal intensive care unit--a prospective cohort study. Indian J Pediatr 2012; 79:494-500. [PMID: 21660401 DOI: 10.1007/s12098-011-0464-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To estimate the incidence of Inborn errors of metobolism (IEM) in Neonatal intensive care unit (NICU) using tandem mass spectrometry and to determine the impact that these disorders have on NICU resources. METHODS During the period of study, 724 (81% eligible cases) dried blood filter-paper samples were collected from a NICU. The samples were analysed using tandem mass spectrometry. The diagnosis was further confirmed through clinical symptoms and by gas chromatography-mass spectrometry. The results were also confirmed by clinical follow-up of all positive patients in an overall interval of 1 year. The mean observation period was 11 months per neonate. RESULTS In total, 22 cases were screen positive and 8 cases of inborn errors of metabolism were detected. The incidence of IEM in the population of patients admitted to the authors' NICU was 1.1%. The most common inborn error found was methylmalonic acidemia (3 cases, 37.5%), and all of the cases needed aggressive treatment and invasive mechanical ventilation. There were two cases of Tyrosinemia type 1, one case each of Maple Syrup Urine Disease, Propionic Acidemia, and Multiple Acyl-CoA dehydrogenase deficiency (MADD). Five of the eight patients required invasive mechanical ventilation. The median length of NICU stay was 3 days (1~7 days) and early therapeutic intervention was effective for four of them and other four patients (50%) died. CONCLUSIONS The incidence of IEM in NICU was 1.1%, indicating an underestimation of the incidence of metabolic disorders prior to implementing screening. Most patients with IEM in the NICU required invasive mechanical ventilation and the mortality was increased due to underlying IEM.
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Affiliation(s)
- Wenjun Tu
- Center for Clinical Laboratory Development, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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