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Singu BS, Verbeeck RK, Pieper CH, Ette EI. Confirming the Suitability of a Gentamicin Dosing Strategy in Neonates Using the Population Pharmacokinetic Approach with Truncated Sampling Duration. CHILDREN (BASEL, SWITZERLAND) 2024; 11:898. [PMID: 39201833 PMCID: PMC11352679 DOI: 10.3390/children11080898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 09/03/2024]
Abstract
(1) Background: Gentamicin is known to be nephrotoxic and ototoxic. Although gentamicin dosage guidelines have been established for preterm and term neonates, reports do show attainment of recommended peak concentrations but toxic gentamicin concentrations are common in this age group. (2) Methods: This was a prospective, observational study conducted in Namibia with 52 neonates. A dose of 5 mg/kg gentamicin was administered over 3-5 s every 24 h in combination with benzylpenicillin 100,000 IU/kg/12 h or ampicillin 50 mg/kg/8 h. Two blood samples were collected from each participant using a truncated pharmacokinetic sampling schedule. (3) Results: The one-compartment linear pharmacokinetic model best described the data. Birthweight, postnatal age, and white blood cell count were predictive of clearance (CL), while birthweight was predictive of volume (V). For the typical neonate (median weight 1.57 kg, median postnatal age 4 days (0.011 years), median log-transformed WBC of 2.39), predicted CL and V were 0.069 L/h and 0.417 L, respectively-similar to literature values. Simulated gentamicin concentrations varied with respect to postnatal age and bodyweight. (4) Conclusions: A 5 mg/kg/24 h dosage regimen yielded simulated gentamicin concentrations with respect to age and birthweight similar to those previously reported in the literature to be safe and efficacious, confirming its appropriateness.
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Affiliation(s)
- Bonifasius Siyuka Singu
- School of Pharmacy, Faculty of Health Sciences & Veterinary Medicine, University of Namibia, Windhoek Private Bag 13301, Namibia; (R.K.V.); (E.I.E.)
| | - Roger Karel Verbeeck
- School of Pharmacy, Faculty of Health Sciences & Veterinary Medicine, University of Namibia, Windhoek Private Bag 13301, Namibia; (R.K.V.); (E.I.E.)
| | | | - Ene I. Ette
- School of Pharmacy, Faculty of Health Sciences & Veterinary Medicine, University of Namibia, Windhoek Private Bag 13301, Namibia; (R.K.V.); (E.I.E.)
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Shittu O, Oniya MO, Olusi TA. Predictors of Comorbidity of Malaria and Septicemia in Children Living in Malaria-Endemic Communities in Nigeria. Acta Parasitol 2024; 69:514-525. [PMID: 38217641 DOI: 10.1007/s11686-023-00781-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/12/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE The study attempted to identify possible overlap between serum cell-reactive proteins (C-rp) and hematological indices as predictors of comorbidity of malaria and septicemia among children attending primary healthcare facilities in Ilorin, Nigeria. METHODS One hundred and ninety-three children (aged: ≤ 1-15 years) presenting with symptoms suggestive of malaria were enrolled. Blood specimens were collected and screened for: Romanowsky, culture, serum C-RP and hematological indices. RESULTS One hundred and fifteen (59.6%) children had Plasmodium falciparum infections (female 69.0% and male 34.1%). Septicemia was common among 52 (26.9%), but malaria and septicemia co-infection was 42 (36.5%). C-rp levels were low (< 10 mg/L) in 41 (35.7%, OR 4.594, CI 2.463-8.571) and high (> 10 mg/L) in 74 (64.3%, OR 2.519, CI 1.681-3.775) among the malaria positives (p < 0.05). Children with low C-rp, 8 (15.4%, OR 9.413, CI 4.116-21.531) were positive for septicemia and high C-RP 44 (84.6%, OR 1.694, CI 1.396-2.055), but without malaria, respectively. Similarly, increased C-rp levels were significantly associated with clinical malaria; > 10,000 parasites/μL (OR 1.486, CI 1.076-2.054, P < 0.001). Malaria-positive versus negative showed that PCV, C-rp, hemoglobin, platelet, WBC, and neutrophil were statistically significant (P < 0.05). Two bacteria species were identified, viz; Staphylococcus aureus 39 (54.9%) and Escherichia coli 32 (45.1%). The trade-off between sensitivity and specificity occurred at 16.475 cut-off using C-rp and degree of malaria severity as the standard for AUROC. CONCLUSION C-rp are inflammatory markers, though non-specificity may be associated with malaria prognosis and severity during malaria-septicemia co-infection.
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Affiliation(s)
- Olalere Shittu
- Parasitology Unit, Department of Zoology, University of Ilorin, Ilorin, Nigeria.
- Department of Biology, Federal University of Technology, Akure, Nigeria.
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Blumenröder S, Wilson D, Ndaboine E, Mirambo MM, Mushi MF, Bader O, Zimmermann O, Mshana SE, Groß U. Neonatal infection in Sub-Saharan Africa: a cross-sectional pilot study on bacterial pathogens and maternal risk factors. Front Microbiol 2023; 14:1171651. [PMID: 37180246 PMCID: PMC10167281 DOI: 10.3389/fmicb.2023.1171651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Although child morbidity and mortality could be reduced in Sub-Saharan Africa during the last years both remain high. Since neonatal infections play a major role, we conducted a cross-sectional pilot study in the lake region of Western Tanzania in order to analyze not only the prevalence of neonatal infection with its bacterial etiology including antimicrobial resistance pattern but also to detect potential maternal risk factors. Methods We screened 156 women for potential risk factors and examined their neonates for clinical signs of an infection including microbiological verification. All women were interviewed for medical history and their socio-economic background. High-vaginal swabs (HVS) of pregnant women and blood cultures of sick infants were investigated for bacterial pathogens using culture followed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) or polymerase-chain-reaction (PCR)-based assays. Antimicrobial resistances were determined using a disk diffusion test and verified by VITEK 2. Maternal malaria, blood glucose, and hemoglobin levels were determined by rapid tests and helminth infections by stool microscopy. Results and discussion Our results showed a prevalence of 22% for neonatal infections. In total, 57% of them had culture-positive bloodstream infections with Gram-negative bacteria being the most prevalent. All these expressed resistance against ampicillin. The prevalence of maternal infection with helminths or Plasmodium was low, indicating that anti-worming strategies and intermittent preventive treatment of malaria for pregnant women (IPTp) are effective. The study identified maternal urinary tract infection (UTI) and an elevated blood glucose level as potential maternal risk factors for early neonatal infection, an elevated blood glucose level, and maternal anemia for a late-onset infection. Conclusion Our study, therefore, indicates that monitoring maternal UTI in the last trimester as well as levels of maternal hemoglobin and blood glucose might be important to predict and eventually manage neonatal infections. As Gram-negative bacteria with resistance to ampicillin were most prevalent in culture-proven neonatal sepsis, WHO recommendations for calculated antibiosis in the sick young infant should be discussed.
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Affiliation(s)
- Simone Blumenröder
- Institute of Medical Microbiology and Virology, University Medical Centre Göttingen, Göttingen, Germany
| | - Damas Wilson
- Department of Obstetrics and Gynaecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Edgard Ndaboine
- Department of Obstetrics and Gynaecology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mariam M. Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Martha F. Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Oliver Bader
- Institute of Medical Microbiology and Virology, University Medical Centre Göttingen, Göttingen, Germany
| | - Ortrud Zimmermann
- Institute of Medical Microbiology and Virology, University Medical Centre Göttingen, Göttingen, Germany
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Uwe Groß
- Institute of Medical Microbiology and Virology, University Medical Centre Göttingen, Göttingen, Germany
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Role of systemic immune-inflammatory index in early diagnosis of sepsis in newborns with CHD. Cardiol Young 2022; 32:1826-1832. [PMID: 35550698 DOI: 10.1017/s1047951122001202] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Congenital heart diseases (CHD) are the most common causes of birth defects that have increased the risk of infections. Neonatal sepsis is a life-threatening condition and early diagnosis can be life-saving. We aimed to evaluate the potential role of the systemic immune-inflammatory index in the early diagnosis of neonatal sepsis. METHODS A retrospective cohort study was conducted on 166 newborns with a diagnosis of neonatal sepsis who were admitted to our hospital with CHD between January 2017 and June 2021. Haematological indices including neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune-inflammatory index were calculated for all patients at the time of diagnosis of neonatal sepsis (sepsis). The sepsis values of these indices were compared with the admission values (pre-sepsis) of the patients. RESULTS The mean gestational age and birth weight of the patients were 38.36 ± 1.42 weeks and 3057.75 ± 484.68 g. It was found that absolute neutrophil count, systemic immune-inflammatory index, neutrophil/lymphocyte ratio, but not platelet/lymphocyte ratio were significantly increased at the time of sepsis. The receiver operating characteristic curve showed that systemic immune-inflammatory index, neutrophil/lymphocyte ratio, and absolute neutrophil count have predictive ability to define neonatal sepsis among newborns with CHD. The systemic immune-inflammatory index produced an area under the curve receiver operating characteristic curve of 0.76 (70% sensitivity, 70.5% specificity). To discriminate neonatal sepsis, the cut-off values of systemic immune-inflammatory index, neutrophil/lymphocyte ratio, and absolute neutrophil count were 517.19, 2.62, and 9210/mm3, respectively. CONCLUSION As an easily accessible and reliable indicator, systemic immune-inflammatory index may be used in combination with the other parameters in the early diagnosis of neonatal sepsis.
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Gomathi V, Chitrasivasankari G, Uma T, Saravanan MP, Gurumoorthy K. Serial quantification of CRP and total leukocyte count as a complementary tool in neonatal sepsis. Bioinformation 2022; 18:920-924. [PMID: 37654832 PMCID: PMC10465766 DOI: 10.6026/97320630018920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 09/02/2023] Open
Abstract
Early detection and appropriate treatment of newborn sepsis reduce mortality and morbidity. A rapid, inexpensive laboratory approach is needed to assess newborn sepsis, even though blood culture is the gold standard for diagnosis. To compare serial CRP and Total Leukocyte Count (WBC) with blood culture, this study aimed to evaluate the role of newborn sepsis. A total 148 neonates with clinical symptoms of sepsis were included .CRP was measured by quantitative immuno turbidimetric method andotal leukocyte count (WBC) was measured by automated cell counter. CRP1 and WBC1 were measured within 6 hours of clinical symptoms. CRP2 and WBC2 were measured after 48 hours of clinical symptoms. Sensitivity, specificity, PPV, NPV of CRP1 and CRP2,WBC 1and WBC 2 were compared with culture positive and negative sepsis.CRP 2 showed high sensitivity 96% and high NPV95% with significant p value <0.0001. WBC2 has high sensitivity (90.57%) and NPV (91%) with significant p value <0.0001. CRP 1 has sensitivity 83%and NPV 82.3%, with p value < 0.001.WBC1 has lowest sensitivity (62.2%) and NPV (71.4%) compared to all other parameters. Serial CRP and WBC measurements are useful in the diagnosis of neonatal sepsis. Measurement of CRP and Total Leukocyte Count (WBC) after 48 hours of clinical symptoms were considered promptly for diagnose neonatal sepsis.
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Affiliation(s)
- V Gomathi
- Institute of Biochemistry, Madras Medical College, RGGGH, Chennai, India
| | | | - T Uma
- Institute of Biochemistry, Madras Medical College, RGGGH, Chennai, India
| | - MP Saravanan
- Institute of Biochemistry, Stanley Medical College, Chennai, India
| | - Kaarthikeyan Gurumoorthy
- Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai - 77, India
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Zamarano H, Musinguzi B, Kabajulizi I, Manirakiza G, Guti W, Muhwezi I, Hussein AA, Baweera A, Kabahinda B, Itabangi H, Bazira J, Kabanda T. Bacteriological profile, antibiotic susceptibility and factors associated with neonatal Septicaemia at Kilembe mines hospital, Kasese District Western Uganda. BMC Microbiol 2021; 21:303. [PMID: 34736415 PMCID: PMC8567569 DOI: 10.1186/s12866-021-02367-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Neonatal septicaemia is one of the most common leading causes of neonatal morbidity and mortality in developing countries. It is estimated to affect more than 30 million people worldwide annually, potentially leading to 6 million deaths. Objective(s) To determine the prevalence, bacteriological profile, antibiotic susceptibility and factors associated with neonatal septicaemia among neonates suspected to sepsis at Kilembe mines hospital. Methods We conducted a descriptive cross-sectional study, where purposive sampling technique was used and blood was drawn from 122 neonates suspected to sepsis attending Kilembe Mines Hospital during the period (July to November 2020). Specimens were inoculated in Brain heart infusion broth, transported to Fortportal Regional Referral Hospital, plated daily up to 7 days on blood, chocolate, MacConkey agar and incubated in aerobic and 5% carbondioxide. Pure colonies were identified by Gram stain, biochemical tests and antibiotic sensitivities obtained by Kirby Bauer disc diffusion method. Associations were tested using Chi square with Fisher’s exact or Yates correction tests where necessary and statistical significance was set at P < 0.05. Stata (version 14) used for statistical analysis. Results Blood cultures were positive in 59.0% cases with 55.5% male and 44.4% female. EOS was present in 56.9% and LOS 43.1% of the cases. Gram negative (56.9%) organisms were most implicated with neonatal septicaemia than Gram positives ones (43.1%). Gram positive organisms exhibited better susceptibility to amikacin, linezolid and vancomycin but more resistant to ampicillin and gentamicin. Of the aminoglycosides, amikacin exhibited a verge over netilmicin and gentamicin against Gram negative isolates. Risk factors of neonatal septicaemia were mother’s age of ≥25 years, employed mothers, tertiary-level of education, SVD, ANC attendance of ≥4 times, UTI during pregnancy, PROMS, foul Smelling liquor, urban residence, neonatal birth weight of ≥2500 g, Apgar score 1st and 5th min ≥6 and resuscitation. Conclusion Multi-drug resistant organisms were isolated. Therefore caution is required in selection of antibiotic therapy and avoid empirical treatment.
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Affiliation(s)
- Henry Zamarano
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
| | - Benson Musinguzi
- Department of Medical Laboratory Science, Faculty of Health Sciences, Muni University, P.O. Box 725, Arua, Uganda.,Department of Microbiology and Immunology, College of Health, Medicine and Life Sciences, King Ceasor University, P.O. Box 88, Kampala, Uganda
| | - Immaculate Kabajulizi
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Godfrey Manirakiza
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Walker Guti
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Ivan Muhwezi
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Ayan Ahmed Hussein
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Agnes Baweera
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Boaz Kabahinda
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Herbert Itabangi
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.,Department of Microbiology and Immunology, Faculty of Health Sciences, Busitema University, P.O Box 1460, Mbale, Uganda
| | - Joel Bazira
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Taseera Kabanda
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
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Sorsa A. Epidemiology of Neonatal Sepsis and Associated Factors Implicated: Observational Study at Neonatal Intensive Care Unit of Arsi University Teaching and Referral Hospital, South East Ethiopia. Ethiop J Health Sci 2020; 29:333-342. [PMID: 31447501 PMCID: PMC6689722 DOI: 10.4314/ejhs.v29i3.5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Globally, sepsis remains one of the major causes of morbidity and mortality in neonates, in spite of recent advances in health care units. The major burden of the problem occurs in the developing world while most evidence is derived from developed countries. The objective of this study was to evaluate the epidemiology of neonatal sepsis and associated factors among neonates admitted to Neonatal Intensive Care Unit (NICU). Methods Hospital based prospective cross-sectional study was conducted from April 2016 to May 2017. Neonates with clinical sepsis were included into the study. Data were analyzed using SPSS version 20. Frequencies, proportion and summary statistics were used to describe the study population in relation to relevant variables. Multivariate logistic regressions were used to assess factors associated with neonatal sepsis. p-values of < 0.05 were considered statistically significant. Results A total of 901neonates were admitted to NICU of which 303 neonates were admitted with diagnosis of clinical sepsis making the prevalence of neonatal sepsis to be 34%. Bacteremia were confirmed in 88/303(29.3%) of clinical sepsis, and gram-positive bacteria constituted 47/88(53.4%). Of all positive blood cultures, 52/88(59.1%) were reported from late onset sepsis. Coagulase negative staphylococcus (CoNS) accounted for 22/88(25%) followed by E. coli and S. aureus, each contributing 18/88(20.3%) and 16/88(18.2%) respectively. Prolonged PROM, low fifth Apgar score, prematurity and low birth weight were strongly associated with increased risk of neonatal sepsis. Neonates born to mothers who received antibiotics during labor and delivery were at significantly lower risk of acquiring neonatal sepsis. Conclusion The prevalence of neonatal sepsis was high, and most causes of neonatal sepsis were gram positive bacteria and most bacteria isolates were from late onset sepsis. Obstetric factors were strongly associated with development of neonatal sepsis. Intrapartal antibiotic administration significantly reduces neonatal sepsis.
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Affiliation(s)
- Abebe Sorsa
- Department of pediatrics and child health Arsi University College of Health Science, Asella, Ethiopia
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Mushi MF, Alex VG, Seugendo M, Silago V, Mshana SE. C - reactive protein and urinary tract infection due to Gram-negative bacteria in a pediatric population at a tertiary hospital, Mwanza, Tanzania. Afr Health Sci 2019; 19:3217-3224. [PMID: 32127899 PMCID: PMC7040338 DOI: 10.4314/ahs.v19i4.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Gram-negative bacteria are the major cause of urinary tract infections (UTI) in children. There is limited data on UTI systemic response as measured using C-reactive protein (CRP). Here, we report the association of CRP and UTI among children attending the Bugando Medical Centre, Mwanza, Tanzania. Methods A cross-sectional study was conducted between May and July 2017. Urine and blood were collected and processed within an hour of collection. Data were analyzed using STATA version 13. Results Of 250 enrolled children, 76(30.4%) had significant bacteriuria with 56(22.4%, 95%CI; 11.5–33.3) having gram-negative bacteria infection. There was dual growth of gram-negative bacteria in 3 patients. Escherichia coli (32.2%, 19/59) was the most frequently pathogen detected. A total of 88/250(35.2%) children had positive CRP on qualitative assay. By multinomial logistic regression, positive CRP (RRR=4.02, 95%CI: 2.1–7.7, P<0.001) and age ≤ 2years (RRR=2.4, 95%CI: 1.23–4.73, P<0.01) significantly predicted the presence of significant bacteriuria due to gram-negative enteric bacteria. Conclusion C-reactive protein was significantly positive among children with UTI due to gram-negative bacteria and those with fever. In children with age ≤ 2 years, positive CRP indicates UTI due to gram-negative enteric bacteria.
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Affiliation(s)
- Martha F Mushi
- Department of Microbiology/Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Science
| | - Vaileth G Alex
- Department of Microbiology/Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Science
| | - Mwanaisha Seugendo
- Department of Pediatric and Child Health, Weill Bugando School of Medicine, Catholic University of Health and child health
| | - Vitus Silago
- Department of Microbiology/Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Science
| | - Stephen E Mshana
- Department of Microbiology/Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Science
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Marando R, Seni J, Mirambo MM, Falgenhauer L, Moremi N, Mushi MF, Kayange N, Manyama F, Imirzalioglu C, Chakraborty T, Mshana SE. Predictors of the extended-spectrum-beta lactamases producing Enterobacteriaceae neonatal sepsis at a tertiary hospital, Tanzania. Int J Med Microbiol 2018; 308:803-811. [PMID: 29980372 PMCID: PMC6171784 DOI: 10.1016/j.ijmm.2018.06.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 11/27/2022] Open
Abstract
ESBL-PE sepsis was predicted by admission at ICU and ESBL-PE colonization. Neonates infected with ESBL-PE had significantly high mortality. ESBL-producing Klebsiella pneumoniae (ST45) carrying blaCTX-M-15 were predominant. Whole genome SNP analysis revealed clonal origin in 50% of ESBL-PE paired cases with similar sequence type.
The study was conducted to establish predictors of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) neonatal sepsis and mortality in a tertiary hospital, Tanzania. Between July and December 2016, blood culture was performed in neonates with clinical features of sepsis and neonates/mothers/guardians were screened for ESBL colonization. Selected isolates underwent whole genome sequencing to investigate relatedness. Logistic regression analysis was performed to determine predictors for ESBL-PE associated neonatal sepsis and mortality. Neonatal ESBL-PE sepsis was detected in 32(10.5%) of the 304 neonates investigated. Neonatal ESBL-PE sepsis was independently predicted by admission at the Intensive care Unit and positive mother and neonate ESBL-PE colonization. Deaths occurred in 55(18.1%) of neonates. Neonates infected with ESBL-PE, admitted at ICU, increased age and those transferred from other centres had significantly high mortality rates. Gram-negative bacteria formed the majority (76%) of the isolates, of which 77% were ESBL-PE. Virulent Klebsiella pneumoniae ST45 carrying blaCTX-M-15 were commonly isolated from neonates. Klebsiella pneumoniae (ST45) were the predominant cause of ESBL-PE neonatal sepsis and mortality. Improved infection control and antibiotic stewardship are crucial in controlling the spread of resistant strains. Rapid diagnostic tests to detect ESBL-PE in low-income countries are needed to guide treatment and reduce ESBL-PE-associated mortality.
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Affiliation(s)
- Rehema Marando
- Department of Pediatrics and Child Health, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Linda Falgenhauer
- Institute of Medical Microbiology, Justus-Liebig University, Schubertstrasse 81, 35392, Giessen, Germany; German Center for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Campus Giessen, Schubertstrasse 81, 35392, Giessen, Germany
| | - Nyambura Moremi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Martha F Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Neema Kayange
- Department of Pediatrics and Child Health, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Festo Manyama
- Department of Pediatrics and Child Health, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Can Imirzalioglu
- Institute of Medical Microbiology, Justus-Liebig University, Schubertstrasse 81, 35392, Giessen, Germany; German Center for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Campus Giessen, Schubertstrasse 81, 35392, Giessen, Germany
| | - Trinad Chakraborty
- Institute of Medical Microbiology, Justus-Liebig University, Schubertstrasse 81, 35392, Giessen, Germany; German Center for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Campus Giessen, Schubertstrasse 81, 35392, Giessen, Germany
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania.
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Sorsa A. Diagnostic Significance of White Blood Cell Count and C-Reactive Protein in Neonatal Sepsis; Asella Referral Hospital, South East Ethiopia. Open Microbiol J 2018; 12:209-217. [PMID: 30069260 PMCID: PMC6047197 DOI: 10.2174/1874285801812010209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Nowadays various biochemical markers, such as C-Reactive Protein (CRP), Procalcitonin and tumor necrosis factor alpha, have been proposed as a potential marker for screening neonatal sepsis. In the current study, we tried to see the diagnostic significance of White Blood Cell (WBC) count and CRP in diagnostic screening of neonatal sepsis. Methods A prospective cross-sectional study was conducted from May 2016 to April 2017 in Asella Teaching and Referral Hospital. Data were entered into EPI-INFO version 3.5.1 for cleanup and then exported to SPSS version 17 for further analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were used to assess the accuracy of CRP and WBC count taking blood culture as gold standard. Results Data of 303 neonates with clinical sepsis were analyzed. Positive CRP and abnormal WBC were reported in 136(45%) and 99(32.7%) of study subjects respectively. Blood culture turned to be positive in 88(29.4%) of study subjects. The Sensitivity, Specificity, PPV and NPV of WBC count were 59.5 %, 79.6%, 52%, 64.5% respectively while the sensitivity, specificity, PPV and NPV of CRP were 65.6%, 78%, 42% and 91% respectively. By combining both WBC and CRP, the sensitivity, specificity, PPV and NPV improve to 78.5%, 83%, 60% and 93% respectively. CRP positivity rate was comparable across gram positive and gram negative bacteria while high WBC count were more reported among gram positive sepsis than gram negative ( OR 4.8, (95% CI 1.45-15.87, P 0.01). Conclusion Based on this study's finding, it can be concluded that CRP alone or in combination with WBC count showed better diagnostic accuracy in neonatal sepsis.
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Affiliation(s)
- Abebe Sorsa
- Asella College of Health Science, Asella, Ethiopia
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Incidence of Fever and Positive Bacterial Cultures in Neonates Receiving Prostaglandin. Pediatr Cardiol 2018; 39:89-97. [PMID: 28980093 DOI: 10.1007/s00246-017-1731-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
Prostaglandin E (PGE1) is necessary to maintain ductus arteriosus patency in many newborns with congenital heart disease. Because PGE1 therapy commonly leads to fever, and given this population's fragile state, a complete sepsis workup is often performed in febrile, but otherwise asymptomatic, patients. This practice of liberal evaluation with bacterial cultures, empiric antibiotic treatment, and delays in essential surgical intervention may result in poor resource utilization and lead to increased iatrogenic morbidity. This study sought to determine the incidence of fever and culture-positive infection in patients receiving PGE1, and identify diagnostic variables that predict culture-positive infection. The study included a single-center retrospective review of all neonates receiving PGE1 between 2011 and 2014. Logistic regression and receiver operator characteristic analysis were used to identify significant predictors of positive bacterial cultures. Among 435 neonates, 175 (40%) had fevers (≥ 38.3 °C) while concurrently receiving PGE1, but only 9 (2%) had culture-positive infection and 1 (< 1%) had culture-positive bacteremia. Among 558 cultures collected, only 16 (3%) had bacterial growth. Multivariable analysis revealed age (p = 0.049, AUC 0.604), hospital length of stay (p = 0.002, AUC 0.764) and hypoxemia (p = 0.044, AUC 0.727) as the only significant predictors of positive cultures. Fever (p = 0.998, AUC 0.424) was not a significant predictor. In conclusion, given that fever occurs frequently in neonates receiving PGE1 and it is a very non-specific marker and not a predictor of positive cultures, the common practice of complete sepsis workup should be re-examined in febrile patients at low risk of bacterial illness.
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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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Xu L, Li Q, Mo Z, You P. Diagnostic value of C-reactive protein in neonatal sepsis: A meta-analysis. EUR J INFLAMM 2016. [DOI: 10.1177/1721727x16646787] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to determine the value of C-reactive protein (CRP) in the diagnosis of patients with neonatal sepsis by a meta-analysis. Potential relevant studies were searched through the PubMed, Embase, and Cochrane Library databases before February 2016. We combined estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) with their 95% confidence intervals (CIs) of CRP for neonatal sepsis diagnosis. Summary receiver operating characteristic (SROC) curve was applied to evaluate the diagnostic value of CRP. The meta-regression and subgroup analysis were performed when heterogeneity was significant. In total, 31 studies were included in our meta-analysis with 5698 participants. The overall estimates for CRP in the diagnosis of neonatal sepsis were: sensitivity 0.69 (95% CI, 0.66–0.71), specificity 0.77 (95% CI, 0.76–0.78), PLR 3.83 (95% CI, 3.03–4.84), NLR 0.38 (95% CI, 0.31–0.45), and DOR 12.65 (95% CI, 8.91–17.94). The area under the curve (AUC) and Q* index were 0.8458 and 0.7773. Meta-regression analysis showed that heterogeneity was irrelevant to test time, cutoff value, assay method of CRP, neonates, and sepsis type. Heterogeneity still existed but decreased after subgroup analysis. CRP might be a valuable approach for the diagnosis of neonatal sepsis.
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Affiliation(s)
- Liyun Xu
- Shandong Medical College, LinYi, Shandong, China
| | - Qiubo Li
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Zongju Mo
- Department of Pediatrics, The People’s Hospital of Junan, LinYi, Shandong, China
| | - Pengfei You
- Emergency Department, Women and Children’s Hospital of LinYi, LinYi, Shandong, China
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Lai MY, Tsai MH, Lee CW, Chiang MC, Lien R, Fu RH, Huang HR, Chu SM, Hsu JF. Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein (≦10 mg/L). BMC Infect Dis 2015; 15:320. [PMID: 26259626 PMCID: PMC4531520 DOI: 10.1186/s12879-015-1069-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 07/29/2015] [Indexed: 02/28/2024] Open
Abstract
Background Elevated C-reactive protein (CRP) level is widely used in clinical practice as a marker to distinguish between neonates with or without sepsis. However, some neonates with bacteremia have a CRP level within the normal range and they are not well characterized. Methods All episodes of neonatal culture-proven bloodstream infections (BSIs) between July 2004 and June 2012 were enrolled. Patients characteristics were compared for three CRP groups (low, ≤ 10 mg/L; intermediate, 11–100 mg/L; and high, > 100 mg/L) using the Chi-square test and one-way ANOVA. The sepsis-attributable mortality rates were compared using logistic regression analyses. Results Of 986 episodes of neonatal BSI, 247 (25.1 %) had CRP ≤10 mg/L at the onset of clinical sepsis. In the low CRP group, patients had lower gestational age and birth weight, and an earlier occurrence of BSI. Patients with underlying gastrointestinal pathology, renal disorders, cholestasis, and pulmonary hypertension had a non-significant elevated CRP level at the onset of sepsis. In the blood culture of the low CRP group, coagulase-negative staphylococci (CoNS) were relatively more common (55.9 %, p < 0.001) than the other two groups, although one-fourth were infected with gram-negative bacilli (19.0 %), fungi (2.8 %), or polymicrobial pathogens (3.6 %). Of the BSIs with initial low CRP, 29.1 % were treated with inadequate antibiotics, 13.0 % progressed to septic shock, and 5.3 % had infectious complications. The sepsis-attributable mortality rate was lower in the low CRP group (4.9 %) than in the high CRP group (13.6 %). Conclusions A considerable proportion of neonatal BSIs had a normal or low initial CRP level (≤10 mg/L), which was more likely to occur in low birth weight or extremely preterm infants, those with earlier onset of sepsis, and those infected with CoNS. Plasma CRP level should not be used to rule out severe culture-proven sepsis or guide the empirical choice of antibiotics.
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Affiliation(s)
- Mei-Yin Lai
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ming-Horng Tsai
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chiang-Wen Lee
- Department of Nursing, Division of Basic Medical Sciences, and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chia-Yi, Taiwan. .,Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| | - Ming-Chou Chiang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Reyin Lien
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ren-Huei Fu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hsuan-Rong Huang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Linkou Chang Gung Memorial Hospital, No. 5, Fu-Shin Rd., Kwei-Shan, Taoyuan, Taiwan.
| | - Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Linkou Chang Gung Memorial Hospital, No. 5, Fu-Shin Rd., Kwei-Shan, Taoyuan, Taiwan.
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