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Liang J, Su Y, Wang N, Wang X, Hao L, Ren C. A meta-analysis of the association between inflammatory cytokine polymorphism and neonatal sepsis. PLoS One 2024; 19:e0301859. [PMID: 38848433 PMCID: PMC11161124 DOI: 10.1371/journal.pone.0301859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/22/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE The purpose of this study is to investigate the relationship between single nucleotide polymorphisms of inflammatory cytokines and neonatal sepsis through meta-analysis. METHODS We collected research literature on the correlation between inflammatory cytokine polymorphisms and neonatal sepsis published before August 2023 through computer searches of databases such as PubMed, Embase, etc. The Stata 14.0 software was utilized for Meta-analysis. To assess heterogeneity, the chi-squared Q-test and I2 statistics were used. The Egger and Begg tests were conducted to determine the possibility of publication bias. RESULTS After reviewing 1129 articles, 29 relevant articles involving 3348 cases and 5183 controls were included in the study. The meta-analysis conducted on IL-1βrs1143643 polymorphism revealed significant findings: the T allele genotype has a lower risk of neonatal sepsis(P = 0.000, OR = 0.224, 95% CI: 0.168-0.299), while the TC and TT genotypes showed an increased risk(TC: P = 0.000,OR = 4.251, 95% CI: 2.226-8.119; TT: P = 0.019,OR = 2.020, 95% CI: 1.122-3.639). Similarly, newborns with the IL-6-174 CC genotype had a significantly higher risk of sepsis(P = 0.000,OR = 1.591, 95% CI: 1.154-2.194), while those with the IL-8-rs4073 TT (P = 0.003,OR = 0.467, 95% CI: 0.280-0.777)and TT + AA(P = 0.003,OR = 0.497, 95% CI: 0.315-0.785) genotypes had a significantly lower risk of sepsis. For the IL-10-1082 gene, newborns with the AA genotype(P = 0.002,OR = 1.702, 95% CI: 1.218-2.377), as well as those with the AA + GA genotype(P = 0.016,OR = 1.731, 95% CI: 1.108-2.705), had a significantly higher risk of sepsis. Lastly, newborns carrying the TNF-α-308 A allele (P = 0.016,OR = 1.257, 95% CI: 1.044-1.513)or the AA genotype(P = 0.009,OR = 1.913, 95% CI: 1.179-3.10) have a significantly increased risk of sepsis. Notwithstanding, additional studies must be included for validation. Applying these cytokines in clinical practice and integrating them into auxiliary examinations facilitates the early detection of susceptible populations for neonatal sepsis, thereby providing a new diagnostic and therapeutic approach for neonatal sepsis.
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Affiliation(s)
- Jiaojiao Liang
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yan Su
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Na Wang
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaoyan Wang
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ling Hao
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Changjun Ren
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Eker F, Akdaşçi E, Duman H, Yalçıntaş YM, Canbolat AA, Kalkan AE, Karav S, Šamec D. Antimicrobial Properties of Colostrum and Milk. Antibiotics (Basel) 2024; 13:251. [PMID: 38534686 DOI: 10.3390/antibiotics13030251] [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: 01/31/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
The growing number of antibiotic resistance genes is putting a strain on the ecosystem and harming human health. In addition, consumers have developed a cautious attitude towards chemical preservatives. Colostrum and milk are excellent sources of antibacterial components that help to strengthen the immunity of the offspring and accelerate the maturation of the immune system. It is possible to study these important defenses of milk and colostrum, such as lactoferrin, lysozyme, immunoglobulins, oligosaccharides, etc., as biotherapeutic agents for the prevention and treatment of numerous infections caused by microbes. Each of these components has different mechanisms and interactions in various places. The compound's mechanisms of action determine where the antibacterial activity appears. The activation of the antibacterial activity of milk and colostrum compounds can start in the infant's mouth during lactation and continue in the gastrointestinal regions. These antibacterial properties possess potential for therapeutic uses. In order to discover new perspectives and methods for the treatment of bacterial infections, additional investigations of the mechanisms of action and potential complexes are required.
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Affiliation(s)
- Furkan Eker
- Department of Molecular Biology and Genetics, Çanakkale Onsekiz Mart University, Çanakkale 17000, Turkey
| | - Emir Akdaşçi
- Department of Molecular Biology and Genetics, Çanakkale Onsekiz Mart University, Çanakkale 17000, Turkey
| | - Hatice Duman
- Department of Molecular Biology and Genetics, Çanakkale Onsekiz Mart University, Çanakkale 17000, Turkey
| | - Yalçın Mert Yalçıntaş
- Department of Molecular Biology and Genetics, Çanakkale Onsekiz Mart University, Çanakkale 17000, Turkey
| | - Ahmet Alperen Canbolat
- Department of Molecular Biology and Genetics, Çanakkale Onsekiz Mart University, Çanakkale 17000, Turkey
| | - Arda Erkan Kalkan
- Department of Molecular Biology and Genetics, Çanakkale Onsekiz Mart University, Çanakkale 17000, Turkey
| | - Sercan Karav
- Department of Molecular Biology and Genetics, Çanakkale Onsekiz Mart University, Çanakkale 17000, Turkey
| | - Dunja Šamec
- Department of Food Technology, University North, Trg Dr. Žarka Dolinara 1, 48000 Koprivnica, Croatia
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Mokhtar WA, Sherief LM, Kamal NM, ElSheikh AO, Omran FH, Abdulsaboor A, Sakr MM, El Gebally S, Shehab MMM, Alfaifi J, Turkistani R, Aljuaid F, Oshi MA, Elbekoushi FB, Mokhtar GA. Late onset neonatal sepsis: Can plasma gelsolin be a promising diagnostic marker? Medicine (Baltimore) 2024; 103:e37356. [PMID: 38457556 PMCID: PMC10919505 DOI: 10.1097/md.0000000000037356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/10/2024] Open
Abstract
Plasma gelsolin (pGSN) correlates with clinical improvement in septic patients. We aimed to investigate pGSN levels as a diagnostic and prognostic marker of neonatal late-onset-sepsis (LOS). A case-control study was done on 184 neonates (92 with LOS and 92 controls). All participants were subjected to detailed history taking, full clinical evaluation, sepsis workup, and pGSN enzyme-linked immunosorbent-assay measurement. We detected significantly lower pGSN level among cases compared to controls (90.63 ± 20.64 vs 451.83 ± 209.59). It was significantly related to the severity of sepsis and mortality, with significantly lower values among cases with septic shock and multiorgan failure and non-survivors. Follow-up pGSN significantly increased after sepsis improvement in survivors compared to admission values. pGSN might be a reliable diagnostic and prognostic marker for LOS.
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Affiliation(s)
- Wesam A. Mokhtar
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Laila M. Sherief
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Naglaa M. Kamal
- Pediatric Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Azza O. ElSheikh
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Farida H. Omran
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Abdulsaboor
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Maha M.H. Sakr
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shreif El Gebally
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Jaber Alfaifi
- Department of Child Health, Faculty of Medicine, University of Bisha, Bisha, Kingdom of Saudi Arabia
| | - Reem Turkistani
- Pediatric Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Futun Aljuaid
- Pediatric Department, Taif Children Hospital, Taif, Kingdom of Saudi Arabia
| | - Mohammed A.M. Oshi
- Neurology Division, Pediatric Department, Gaafar Ibnauf Children’s Emergency Hospital, Khartoum, Sudan
| | | | - Ghada A. Mokhtar
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Yoon Y, So H, Lee JK, Kim D, Jo KJ, Kim HH, Kim YJ, Lee J, Jo DS, Kim YK, Park SE, Chang YS, Kim YJ. Microbiologic Epidemiology of Early-onset Sepsis in Neonates Born at ≥35 0/7 Weeks' Gestation in Korea During 2009-2018. Pediatr Infect Dis J 2023:00006454-990000000-00414. [PMID: 37054389 DOI: 10.1097/inf.0000000000003931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND Sepsis within the first 3 days of life remains a leading cause of neonatal mortality and morbidity. However, few studies have addressed the epidemiology of sepsis in late preterm and term neonates, particularly in Asia. We aimed to estimate the epidemiology of early-onset sepsis (EOS) in neonates born at ≥35 0/7 weeks' gestation in Korea. METHODS A retrospective study was conducted in neonates with proven EOS born at ≥35 0/7 weeks' gestation from 2009 to 2018 at seven university hospitals. EOS was defined as identifying bacteria from a blood culture within 72 hours after birth. RESULTS A total of 51 neonates (0.36/1,000 live births) with EOS were identified. The median duration from birth to the first positive blood culture collection was 17 hours (range, 0.2-63.9). Among the 51 neonates, 32 (63%) patients were born by vaginal delivery. The median Apgar score was 8 (range, 2-9) at 1 minute and 9 (range, 4-10) at 5 minutes. The most common pathogen was group B Streptococcus (n = 21; 41.2%), followed by coagulase-negative staphylococci (n = 7; 13.7%) and Staphylococcus aureus (n = 5, 9.8%). Forty-six (90.2%) neonates were treated with antibiotics on the first day of symptom onset, and 34 (73.9%) neonates received susceptible antibiotics. The overall 14-day case-fatality rate was 11.8%. CONCLUSION This is the first multicenter study on the epidemiology of proven EOS in neonates born at ≥35 0/7 weeks' gestation and found that group B Streptococcus was the most common pathogen in Korea.
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Affiliation(s)
- Yoonsun Yoon
- From the Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyungwan University, Seoul, Korea
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea (current affiliation)
| | - Hyejin So
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea (current affiliation)
| | - Joon Kee Lee
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dongsub Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Kyo Jin Jo
- Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyun Ho Kim
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonbuk National University, Jeonju, Korea
| | - Yoo-Jin Kim
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jina Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Sun Jo
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonbuk National University, Jeonju, Korea
| | - Yun-Kyung Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Su Eun Park
- Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yun Sil Chang
- From the Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyungwan University, Seoul, Korea
| | - Yae-Jean Kim
- From the Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyungwan University, Seoul, Korea
- Samsung Advanced Institute for Health Sciences and Technology, Seoul, Korea
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Omenako KA, Enimil A, Marfo AFA, Timire C, Chinnakali P, Fenny AP, Jeyashree K, Buabeng KO. Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12968. [PMID: 36232262 PMCID: PMC9566692 DOI: 10.3390/ijerph191912968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Neonatal sepsis is a life-threatening emergency, and empirical antimicrobial prescription is common. In this cross-sectional study of neonates admitted with suspected sepsis in a teaching hospital in Ghana from January-December 2021, we described antimicrobial prescription patterns, compliance with national standard treatment guidelines (STG), blood culture testing, antimicrobial resistance patterns and treatment outcomes. Of the 549 neonates admitted with suspected sepsis, 283 (52%) were males. Overall, 529 (96%) received empirical antimicrobials. Most neonates (n = 407, 76.9%) were treated empirically with cefuroxime + gentamicin, while cefotaxime was started as a modified treatment in the majority of neonates (46/68, 67.6%). Only one prescription complied with national STGs. Samples of 257 (47%) neonates underwent blood culture testing, of which 70 (27%) were positive. Isolates were predominantly Gram-positive bacteria, with coagulase-negative Staphylococcus and Staphylococcus aureus accounting for 79% of the isolates. Isolates showed high resistance to most penicillins, while resistance to aminoglycosides and quinolones was relatively low. The majority of neonates (n = 497, 90.5%) were discharged after successfully completing treatment, while 50 (9%) neonates died during treatment. Strengthening of antimicrobial stewardship programmes, periodic review of STGs and increased uptake of culture and sensitivity testing are needed to improve management of sepsis.
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Affiliation(s)
- Kwaku Anim Omenako
- Eastern Regional Hospital, Ghana Health Service, Koforidua P.O. Box KF 201, Ghana
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| | - Anthony Enimil
- Komfo Anokye Teaching Hospital (KATH), Kumasi P.O. Box KS 1934, Ghana
- School of Medicine and Dentistry (SMD), Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| | - Afia Frimpomaa Asare Marfo
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
| | - Collins Timire
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry 605006, India
| | - Ama Pokuaa Fenny
- Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon, Accra P.O. Box LG 25, Ghana
| | - Kathiresan Jeyashree
- Department of Epidemiology and Biostatistics, National Institute of Epidemiology, Chennai 600077, India
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi 00233, Ghana
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Obiero CW, Williams P, Murunga S, Thitiri J, Omollo R, Walker AS, Egondi T, Nyaoke B, Correia E, Kane Z, Gastine S, Kipper K, Standing JF, Ellis S, Sharland M, Berkley JA. Randomised controlled trial of fosfomycin in neonatal sepsis: pharmacokinetics and safety in relation to sodium overload. Arch Dis Child 2022; 107:802-810. [PMID: 35078765 PMCID: PMC9411916 DOI: 10.1136/archdischild-2021-322483] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/24/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess pharmacokinetics and changes to sodium levels in addition to adverse events (AEs) associated with fosfomycin among neonates with clinical sepsis. DESIGN A single-centre open-label randomised controlled trial. SETTING Kilifi County Hospital, Kenya. PATIENTS 120 neonates aged ≤28 days admitted being treated with standard-of-care (SOC) antibiotics for sepsis: ampicillin and gentamicin between March 2018 and February 2019. INTERVENTION We randomly assigned half the participants to receive additional intravenous then oral fosfomycin at 100 mg/kg two times per day for up to 7 days (SOC-F) and followed up for 28 days. MAIN OUTCOMES AND MEASURES Serum sodium, AEs and fosfomycin pharmacokinetics. RESULTS 61 and 59 infants aged 0-23 days were assigned to SOC-F and SOC, respectively. There was no evidence of impact of fosfomycin on serum sodium or gastrointestinal side effects. We observed 35 AEs among 25 SOC-F participants and 50 AEs among 34 SOC participants during 1560 and 1565 infant-days observation, respectively (2.2 vs 3.2 events/100 infant-days; incidence rate difference -0.95 events/100 infant-days (95% CI -2.1 to 0.20)). Four SOC-F and 3 SOC participants died. From 238 pharmacokinetic samples, modelling suggests an intravenous dose of 150 mg/kg two times per day is required for pharmacodynamic target attainment in most children, reduced to 100 mg/kg two times per day in neonates aged <7 days or weighing <1500 g. CONCLUSION AND RELEVANCE Fosfomycin offers potential as an affordable regimen with a simple dosing schedule for neonatal sepsis. Further research on its safety is needed in larger cohorts of hospitalised neonates, including very preterm neonates or those critically ill. Resistance suppression would only be achieved for the most sensitive of organisms so fosfomycin is recommended to be used in combination with another antimicrobial. TRIAL REGISTRATION NUMBER NCT03453177.
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Affiliation(s)
- Christina W Obiero
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Phoebe Williams
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sheila Murunga
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnstone Thitiri
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Raymond Omollo
- Global Antibiotic Research and Development Partnership, Nairobi, Kenya
| | | | - Thaddaeus Egondi
- Global Antibiotic Research and Development Partnership, Nairobi, Kenya
| | - Borna Nyaoke
- Global Antibiotic Research and Development Partnership, Nairobi, Kenya
| | - Erika Correia
- Global Antibiotic Research and Development Partnership, Geneva, Switzerland
| | - Zoe Kane
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Silke Gastine
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Karin Kipper
- Institute of Chemistry, University of Tartu, Tartu, Estonia.,Analytical Services International (ASI) Ltd, St George's - University of London, London, UK
| | - Joseph F Standing
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sally Ellis
- Global Antibiotic Research and Development Partnership, Geneva, Switzerland
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, University of London, London, UK
| | - James Alexander Berkley
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya .,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
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7
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Turton JF, Perry C, Claxton A. Do plasmids containing heavy metal resistance genes play a role in neonatal sepsis and invasive disease caused by Klebsiella pneumoniae and Klebsiella variicola? J Med Microbiol 2022; 71. [PMID: 35972879 DOI: 10.1099/jmm.0.001486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Introduction. Klebsiella species are some of those most implicated in neonatal sepsis. However, many isolates from infections appear unremarkable; they are generally susceptible to antibiotics and often of sporadic types not associated with virulence.Hypothesis/Gap Statement. Investigation is needed to identify if such isolates have virulence characteristics.Aim. To sequence multiple isolates of a range of types from cases of neonatal invasive disease to identify elements that may explain their virulence, and to determine if such elements are more common among these isolates than generally.Methodology. In total, 14 isolates of K. pneumoniae/K. variicola belonging to 13 distinct types from blood or CSF from neonatal infections were sequenced using long-read nanopore technology. PCR assays were used to screen a general set of isolates for heavy metal resistance genes arsC, silS and merR.Results. Overall, 12/14 isolates carried one or more plasmids. Ten carried a large plasmid (186 to 310 kb) containing heavy metal resistance genes associated with hypervirulence plasmids, with most (nine) carrying genes for resistance to copper, silver and one other heavy metal (arsenic, tellurite or mercury), but lacking the genes encoding capsule-upregulation and siderophores. Most isolates (9/14) lacked any additional antibiotic resistance genes other than those intrinsic in the species. However, a representative of an outbreak strain carried a plasmid containing bla CTX-M-15, qnrS1, aac3_IIa, dfrA17, sul1, mph(A), tet(A), bla TEM1B and aadA5, but no heavy metal resistance genes. arsC, silS and merR were widely found among 100 further isolates screened, with most carbapenemase-gene-positive isolates (20/27) carrying at least one.Conclusion. Plasmids containing heavy metal resistance genes were a striking feature of isolates from neonatal sepsis but are widely found. They share elements in common with virulence and antibiotic resistance plasmids, perhaps providing a basis from which such plasmids evolve.
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Affiliation(s)
- Jane F Turton
- HCAI, Fungal, AMR, AMU & Sepsis Division, UK Health Security Agency, London, UK
| | - Claire Perry
- Reference Services Division, UK Health Security Agency, London, UK
| | - Alleyna Claxton
- Homerton University Hospital NHS Foundation Trust, London, UK
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8
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Admission Outcome and Antimicrobial Resistance Pattern of Bacterial Isolates among Neonates with Suspected Sepsis in Neonatal Intensive Care Unit at Dessie Comprehensive Specialized Hospital, Dessie, Northeastern Ethiopia. Interdiscip Perspect Infect Dis 2022; 2022:1318295. [PMID: 35845551 PMCID: PMC9286881 DOI: 10.1155/2022/1318295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Neonatal sepsis is a major cause of morbidity and mortality globally. The aim of this study was to assess admission outcome and antimicrobial susceptibility pattern of bacterial isolates among neonates with suspected sepsis at the Dessie Comprehensive specialized Hospital (DCSH), Northeastern Ethiopia. Method Cross-sectional study was conducted from August 2017 to March 2018. Two hundred forty-six neonates were recruited, and each patient's blood specimen was collected aseptically using bottle containing Brain Heart Infusion for blood culture. Both clinical and laboratory data such as bacterial culture growth and antimicrobial susceptibility pattern were collected from the neonate; clinical data from the mothers were also included. Antimicrobial susceptibility testing was performed using Kirby-Bauer disk diffusion method. The data were analyzed using SPSS version 20. Results Bacteria were identified from 67 (27.2%) blood cultures. The predominant pathogen was Escherichia coli (35.8%) followed by Staphylococcus aureus (26.8%), and Coagulase Negative Staphylococcus (CoNS) (19.4%). The isolated bacteria showed resistance to Ampicillin 55 (82%), third-generation Cephalosporins 21 (58.3%) and other tested antimicrobials. Overall, 68.6% bacterial isolates demonstrated Multidrug resistance (MDR) and total registered mortality rate was 12/246 (4.8%). Both neonatal factors such as neonatal temperature, septic umbilicus and utilization of indwelling medical device during delivery; and maternal factors such as age, antenatal urinary tract infection (UTI), mode of delivery and prolonged rupture of membrane (PROM) had shown statistically significant association with bacterial sepsis. Conclusion The rate of bacterial growth was found to be high; E. coli and S. aureus were the predominant organisms. Both maternal and neonatal related data were strong predictors for bacterial infection of the neonate. Therefore, improving infrastructures for screening of bacteremia as well as active surveillance in clinical setting needed to ensure proper empirical therapy.
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Sanidad KZ, Amir M, Ananthanarayanan A, Singaraju A, Shiland NB, Hong HS, Kamada N, Inohara N, Núñez G, Zeng MY. Maternal gut microbiome-induced IgG regulates neonatal gut microbiome and immunity. Sci Immunol 2022; 7:eabh3816. [PMID: 35687695 DOI: 10.1126/sciimmunol.abh3816] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The gut microbiome elicits antigen-specific immunoglobulin G (IgG) at steady state that cross-reacts to pathogens to confer protection against systemic infection. The role of gut microbiome-specific IgG antibodies in the development of the gut microbiome and immunity against enteric pathogens in early life, however, remains largely undefined. In this study, we show that gut microbiome-induced maternal IgG is transferred to the neonatal intestine through maternal milk via the neonatal Fc receptor and directly inhibits Citrobacter rodentium colonization and attachment to the mucosa. Enhanced neonatal immunity against oral C. rodentium infection was observed after maternal immunization with a gut microbiome-derived IgG antigen, outer membrane protein A, or induction of IgG-inducing gut bacteria. Furthermore, by generating a gene-targeted mouse model with complete IgG deficiency, we demonstrate that IgG knockout neonates are more susceptible to C. rodentium infection and exhibit alterations of the gut microbiome that promote differentiation of interleukin-17A-producing γδ T cells in the intestine, which persist into adulthood and contribute to increased disease severity in a dextran sulfate sodium-induced mouse model of colitis. Together, our studies have defined a critical role for maternal gut microbiome-specific IgG antibodies in promoting immunity against enteric pathogens and shaping the development of the gut microbiome and immune cells in early life.
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Affiliation(s)
- Katherine Z Sanidad
- Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY, USA.,Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Mohammed Amir
- Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY, USA.,Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Aparna Ananthanarayanan
- Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY, USA.,Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Anvita Singaraju
- Immunology and Microbial Pathogenesis Graduate Program, Weill Cornell Medicine, New York, NY, USA
| | - Nicholas B Shiland
- Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY, USA
| | - Hanna S Hong
- Department of Pathology and Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nobuhiko Kamada
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,WPI Immunology Frontier Research Center, Osaka University, Suita, Japan
| | - Naohiro Inohara
- Department of Pathology and Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Gabriel Núñez
- Department of Pathology and Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Melody Y Zeng
- Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY, USA.,Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.,Immunology and Microbial Pathogenesis Graduate Program, Weill Cornell Medicine, New York, NY, USA
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Inanimate Surfaces and Air Contamination with Multidrug Resistant Species of Staphylococcus in the Neonatal Intensive Care Unit Environment. Microorganisms 2022; 10:microorganisms10030567. [PMID: 35336141 PMCID: PMC8955995 DOI: 10.3390/microorganisms10030567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 01/30/2023] Open
Abstract
Background: Contamination of the hospital environment with multi-resistant (MDR) Staphylococcus increases the risk of infection. The aim of this study is to identify the MDR species of Staphylococcus on inanimate surfaces, in air, and in clinical samples, and analyze the risk factors that correlate with the occurrence of infections in a Neonatal Intensive Care Unit. Methods: Samples of inanimate surfaces and air were taken using a premoistened swab (0.9% sodium chloride) and spontaneous air sedimentation, respectively. The clinical isolates were recovered from infected neonates. The isolates (environmental and clinical) were identified by matrix-assisted laser desorption ionization-time of flight and the resistance profile was calculated using the disk diffusion agar technique. Results: In total, 181 isolates were obtained, 93 from (surfaces), 18 from the air, and 70 clinical samples. S. epidermidis was the most frequent species (66.8%), and the failure rate in air cleaning was 100%. More than 60% of the isolates were MDR, and the majority of clinical isolates (60.4%) had a resistance profile identical to that of the environmental isolates. Conclusion: Staphylococcus spp. were found in most of the analyzed samples, with a high frequency of MDR isolates, demonstrating the importance of the hospital environment as a reservoir, and the need for infection control measures, and rational use of antimicrobials.
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Sahib Abdul-Mohammed H, Kamal Mohammed A, Mohsen Ahmed Z. Imipenem Resistance in Gram-Negative Bacteria in the Central Pediatric Teaching Hospital in Baghdad, Iraq. ARCHIVES OF RAZI INSTITUTE 2022; 77:123-128. [PMID: 35891739 PMCID: PMC9288647 DOI: 10.22092/ari.2021.356678.1891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/04/2021] [Indexed: 02/23/2023]
Abstract
Antimicrobial resistance (AMR) is a serious challenge for infectious disease prevention and treatment, according to the World Health Organization. It is a worldwide problem caused primarily by inappropriate and insufficient therapy, misuse of antimicrobials without physician supervision, unnecessary hospital readmissions, and other factors. AMR has several consequences, including increased medical costs and mortality. The present study aimed to evaluate imipenem resistance in gram-negative bacteria in Central Pediatric Teaching Hospital in Baghdad, Iraq, and determine this bacteria resistance in different samples. Initially, a total of 100 different samples were collected from child patients from October 1, 2020, to August 31, 2021. Each isolate was identified using VITEK 2 automated microbiology system. The recorded data showed that the isolated organisms resistant to imipenem included Klebsiella pneumonia (n=21), Pseudomonas aeruginosa (n=19), and Acinetobacter baumannii (n=16). In the current study, Klebsiella pneumonia was the most common pathogen in males (n=57) compared to female (n=43), followed by Pseudomonas aeruginosa and Acinetobacter baumannii, particularly in the age range of 1 day- 3 years. Depending on the sample type, Klebsiella pneumonia, the most imipenem-resistant bacteria, was found more in the urine of patients with urinary tract infections. Pseudomonas aeruginosa was equally found in blood, urine, wound swab, and sputum samples. In comparison to other samples, Acinetobacter baumannii was found in greater numbers in the blood and in an equal number in urine and cerebrospinal.
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12
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Tosson AMS, Koptan D, Abdel Aal R, Abd Elhady M. Evaluation of serum and salivary C-reactive protein for diagnosis of late-onset neonatal sepsis: A single center cross-sectional study. J Pediatr (Rio J) 2021; 97:623-628. [PMID: 33582092 PMCID: PMC9432294 DOI: 10.1016/j.jped.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic utility of salivary C-reactive protein (CRP) and its potential correlation with serum CRP levels in full-term neonates with late-onset sepsis (LOS). METHODS This cross-sectional study included 90 neonates assigned to three equal groups: culture proven LOS, clinical LOS and a control group. Clinical findings and routine laboratory data including complete blood pictures and blood culture results were documented. Highly sensitive serum CRP was measured according to hospital protocol, while salivary CRP levels were measured using enzyme-linked immunosorbent assay. RESULTS The median serum CRP was significantly higher in septic neonates compared to controls (p < 0.001). For serum CRP, the optimum cut-off value for LOS diagnosis was found to be 7.2 mg/L with sensitivity, specificity, positive and negative predictive values of 91, 100, 100, and 85.7%, respectively. No significant difference was observed in levels of salivary CRP among the 3 study groups (p = 0.39). No correlation was found between the levels of salivary and serum CRP (r = 0.074, p = 0.49). CONCLUSION Serum CRP, at a cut-off value of 7.2 mg/L, exhibited a high specificity and positive predictive value in LOS diagnosis, whereas salivary CRP levels weren't significantly different between the 3 study groups nor did they predict abnormal serum CRP thresholds in newborns with sepsis.
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Affiliation(s)
- Angie M S Tosson
- Cairo University, Faculty of Medicine, Department of Pediatrics, Cairo, Egypt.
| | - Dina Koptan
- Cairo University, Faculty of Medicine, Clinical and Chemical Pathology Department, Cairo, Egypt
| | - Rabab Abdel Aal
- Cairo University, Faculty of Medicine, Department of Pediatrics, Cairo, Egypt
| | - Marwa Abd Elhady
- Cairo University, Faculty of Medicine, Department of Pediatrics, Cairo, Egypt
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13
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Berhane M, Gidi NW, Eshetu B, Gashaw M, Tesfaw G, Wieser A, Bårnes GK, Froeschl G, Ali S, Gudina EK. Clinical Profile of Neonates Admitted with Sepsis to Neonatal Intensive Care Unit of Jimma Medical Center, A Tertiary Hospital in Ethiopia. Ethiop J Health Sci 2021; 31:485-494. [PMID: 34483605 PMCID: PMC8365478 DOI: 10.4314/ejhs.v31i3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/19/2020] [Indexed: 11/20/2022] Open
Abstract
Background Globally, over 3 million newborn die each year, one million of these attributed to infections. The objective of this study was to determine the etiologies and clinical characteristics of sepsis in neonates admitted to intensive care unit of a tertiary hospital in Ethiopia. Methods A longitudinal hospital based cohort study was conducted from April 1 to October 31, 2018 at the neonatal intensive care unit of Jimma Medical Center, southwest Ethiopia. Diagnosis of sepsis was established using the World Health Organization's case definition. Structured questionnaires and case specific recording formats were used to capture the relevant data. Venous blood and cerebrospinal fluid from neonates suspected to have sepsis were collected. Results Out of 304 neonates enrolled in the study, 195 (64.1%) had clinical evidence for sepsis, majority (84.1%; 164/195) of them having early onset neonatal sepsis. The three most frequent presenting signs and symptoms were fast breathing (64.6%; 122/195), fever (48.1%; 91/195) and altered feeding (39.0%; 76/195). Etiologic agents were detected from the blood culture of 61.2% (115/195) neonates. Bacterial pathogens contributed for 94.8% (109/115); the rest being fungal etiologies. Coagulase negative staphylococci (25.7%; 28/109), Staphylococcus aureus (22.1%; 24/109) and Klebsiella species (16.5%; 18/109) were the most commonly isolated bacteria. Conclusion Majority of the neonates had early onset neonatal sepsis. The major etiologies isolated in our study markedly deviate from the usual organisms causing neonatal sepsis. Multicentre study and continuous surveillance are essential to tackle the current challenge to reduce neonatal mortality due to sepsis in Ethiopia.
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Affiliation(s)
| | | | - Beza Eshetu
- Department of Pediatrics and Child Health, Jimma University
| | - Mulatu Gashaw
- Department of Medical Laboratory Sciences, Jimma University
| | - Getnet Tesfaw
- Department of Medical Laboratory Sciences, Jimma University
| | - Andreas Wieser
- Max von Pettenkofer-Institute, Ludwig-Maximilians-Universität (LMU), Munich, Germany.,Division of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - Guro K Bårnes
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Innlandet Hospital Trust, Division Gjøvik-Lillehammer, Gjøvik, Norway
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Solomon Ali
- Department of Microbiology, St. Paul Hospital Millennium Medical College
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Atif M, Naseem M, Sarwar S, Mukhtar S, Malik I, Hassan MRU, Iqbal MN, Ahmad N. Spectrum of Microorganisms, Antibiotic Resistance Pattern, and Treatment Outcomes Among Patients With Empyema Thoracis: A Descriptive Cross-Sectional Study From the Bahawal Victoria Hospital Bahawalpur, Punjab, Pakistan. Front Med (Lausanne) 2021; 8:665963. [PMID: 34422850 PMCID: PMC8377472 DOI: 10.3389/fmed.2021.665963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study involves the analysis of spectrum of microorganisms, antibiotic resistance pattern, and treatment outcomes among empyema thoracis patients. This study also analyzes the factors associated with unsuccessful treatment outcome and duration of hospital stay among the patients. Methods: This was a descriptive, cross-sectional study carried out in the Pulmonology Ward of the Bahawal Victoria hospital, Bahawalpur, Pakistan. All patients with empyema thoracis registered at the study site during the period of 1 year were included in the study. Multivariate regression analysis was used to analyze the factors associated with duration of hospital stay and unsuccessful treatment outcome among the patients. Results: A total 110 patients were included in the study. Most of the patients (n = 73, 66.4%) were treated with piperacillin/tazobactam alone and in combination with either one or more than one antibiotics as an empiric therapy. Culture was positive in 58 (52.7%) patients and the most commonly identified organisms included, gram-negative Pseudomonas aeruginosa (n = 20; 18.8%) and Klebsiella sp. (n = 11, 10%) followed by same proportion of E. coli. The most commonly identified bacterial isolates showed high level of resistance against antibiotics used as an empiric therapy, while these showed low level of resistance against amoxicillin, clarithromycin, ertapenem, colistin, tigecycline, fosfomycin, rifampicin, and vancomycin. In this study, 82 (74.5%) patients successfully completed the treatment, while 12 (11%) showed no clinical improvement, 5 (4.5%) lost to follow up and 11 (10%) died. In multivariate binary logistic regression analysis, none of the patient attributes were significantly associated with unsuccessful treatment outcome, while in multivariate linear regression analysis, the factors which were significantly associated with duration of hospital stay included; duration of symptoms <2 weeks prior to admission (p = 0.008, beta = −0.247) and resistance to five antibiotic classes (p = 0.02, beta = 0.280). Conclusion: Close to 25% of the patients did not complete the treatment successfully. Most of the common bacterial isolates showed high level of resistance against the broad-spectrum antibiotics used as an empiric therapy. This is alarming. However, better sensitivity of common bacterial isolates against standardized first line treatment for empyema thoracis is promising.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Mehwish Naseem
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Sajjad Sarwar
- Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur, Pakistan
| | - Saba Mukhtar
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | | | | | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
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Liu J, Fang Z, Yu Y, Ding Y, Liu Z, Zhang C, He H, Geng H, Chen W, Zhao G, Liu Q, Wang B, Sun X, Wang S, Sun R, Fu D, Liu X, Huang L, Li J, Xing X, Wang X, Gao Y, Zhu R, Han M, Peng F, Geng M, Deng L. Pathogens distribution and antimicrobial resistance in bloodstream infections in twenty-five neonatal intensive care units in China, 2017-2019. Antimicrob Resist Infect Control 2021; 10:121. [PMID: 34399840 PMCID: PMC8365905 DOI: 10.1186/s13756-021-00989-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/01/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Overcrowding, abuse of antibiotics and increasing antimicrobial resistance negatively affect neonatal survival rates in developing countries. We aimed to define pathogens and their antimicrobial resistance (AMR) of early-onset sepsis (EOS), hospital-acquired late-onset sepsis (HALOS) and community-acquired late-onset sepsis (CALOS) in 25 neonatal intensive care units (NICUs) in China. STUDY DESIGN This retrospective descriptive study included pathogens and their AMR from all neonates with bloodstream infections (BSIs) admitted to 25 tertiary hospitals in China from January 1, 2017, and December 31, 2019. We defined EOS as the occurrence of BSI at or before 72 h of life and late-onset sepsis (LOS) if BSI occurred after 72 h of life. LOS were classified as CALOS if occurrence of BSI was ≤ 48 h after admission, and HALOS, if occurrence was > 48 h after admission. RESULTS We identified 1092 pathogens of BSIs in 1088 infants from 25 NICUs. Thirty-two percent of all pathogens were responsible for EOS, 64.3% HALOS, and 3.7% CALOS. Gram-negative (GN) bacteria accounted for a majority of pathogens in EOS (56.7%) and HALOS (62.2%). The most frequent pathogens causing EOS were Escherichia coli (27.2%) and group B streptococcus (GBS; 14.6%) whereas in CALOS they were GBS (46.3%) and Staphylococcus aureus (41.5%). Klebsiella pneumoniae (27.9%), Escherichia coli (15.7%) and Fungi (12.8%) were the top three isolates in HALOS. Third-generation cephalosporin resistance rates in GN bacteria ranged from 9.7 to 55.6% in EOS and 26% to 63.3% in HALOS. Carbapenem resistance rates in GN bacteria ranged from 2.7 to 31.3% in HALOS and only six isolates in EOS were carbapenem resistant. High rates of multidrug resistance were observed in Klebsiella pneumoniae (60.7%) in HALOS and in Escherichia coli (44.4%) in EOS. All gram-positive bacteria were susceptible to vancomycin except for three Enterococcus faecalis in HALOS. All-cause mortality was higher among neonates with EOS than HALOS (7.4% VS 4.4%, [OR] 0.577, 95% CI 0.337-0.989; P = 0.045). CONCLUSIONS Escherichia coli, Klebsiella pneumoniae and GBS were the leading pathogens in EOS, HALOS and CALOS, respectively. The high proportion of pathogens and high degree of antimicrobial resistance in HALOS underscore understanding of the pathogenesis and emphasise the need to devise effective interventions in developing countries.
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Affiliation(s)
- Jing Liu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Zengyu Fang
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Yonghui Yu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 234, Jingwu Road, Huai Yin District, Jinan, 250021, Shandong, China.
| | - Yanjie Ding
- Department of Pediatrics, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, China
| | - Zhijie Liu
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Chengyuan Zhang
- Department of Neonatology, Weifang Maternal and Child Health Hospital, Weifang, China
| | - Haiying He
- Department of Pediatrics, Baogang Third Hospital of Hongci Group, Baotou, China
| | - Hongli Geng
- Department of Neonatology, Zibo Maternal and Child Health Hospital, Zibo, China
| | - Weibing Chen
- Department of Pediatrics, People's Hospital of Rizhao, Rizhao, China
| | - Guoying Zhao
- Department of Pediatrics, Binzhou Medical University Hospital, Binzhou, China
| | - Qiang Liu
- Department of Pediatrics, Linyi People's Hospital, Linyi, China
| | - Baoying Wang
- Department of Pediatrics, Women and Children's Health Care Hospital of Linyi, Linyi, China
| | - Xueming Sun
- Department of Pediatrics, Weifang Yidu Central Hospital, Weifang, China
| | - Shaofeng Wang
- Department of Neonatology, Jinan Maternity and Child Health Care Hospital, Jinan, China
| | - Rongrong Sun
- Department of Pediatrics, Dongying People's Hospital, Dongying, China
| | - Delong Fu
- Department of Pediatrics, Tengzhou Central People's Hospital, Tengzhou, China
| | - Xinjian Liu
- Department of Pediatrics, Hebei Petro China Central Hospital, Langfang, China
| | - Lei Huang
- Department of Neonatology, Shandong Provincial Maternity and Child Health Care Hospital, Jinan, China
| | - Jing Li
- Department of Pediatrics, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Xuexue Xing
- Department of Pediatrics, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaokang Wang
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yanling Gao
- Department of Pediatrics, Dezhou People's Hospital, Dezhou, China
| | - Renxia Zhu
- Department of Pediatrics, Zibo Central Hospital, Zibo, China
| | - Meiying Han
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng, China
| | - Fudong Peng
- Department of Pediatrics, The Second People's Hospital of Liaocheng, Liaocheng, China
| | - Min Geng
- Department of Neonatology, The Second Children and Women's Healthcare of Jinan City, Jinan, China
| | - Liping Deng
- Department of Pediatrics, Heze Municipal Hospital, Heze, China
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Solomon S, Akeju O, Odumade OA, Ambachew R, Gebreyohannes Z, Van Wickle K, Abayneh M, Metaferia G, Carvalho MJ, Thomson K, Sands K, Walsh TR, Milton R, Goddard FGB, Bekele D, Chan GJ. Prevalence and risk factors for antimicrobial resistance among newborns with gram-negative sepsis. PLoS One 2021; 16:e0255410. [PMID: 34343185 PMCID: PMC8330902 DOI: 10.1371/journal.pone.0255410] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Newborn sepsis accounts for more than a third of neonatal deaths globally and one in five neonatal deaths in Ethiopia. The first-line treatment recommended by WHO is the combination of gentamicin with ampicillin or benzylpenicillin. Gram-negative bacteria (GNB) are increasingly resistant to previously effective antibiotics. OBJECTIVES Our goal was to estimate the prevalence of antibiotic-resistant gram-negative bacteremia and identify risk factors for antibiotic resistance, among newborns with GNB sepsis. METHODS At a tertiary hospital in Ethiopia, we enrolled a cohort pregnant women and their newborns, between March and December 2017. Newborns who were followed up until 60 days of life for clinical signs of sepsis. Among the newborns with clinical signs of sepsis, blood samples were cultured; bacterial species were identified and tested for antibiotic susceptibility. We described the prevalence of antibiotic resistance, identified newborn, maternal, and environmental factors associated with multidrug resistance (MDR), and combined resistance to ampicillin and gentamicin (AmpGen), using multivariable regression. RESULTS Of the 119 newborns with gram-negative bacteremia, 80 (67%) were born preterm and 82 (70%) had early-onset sepsis. The most prevalent gram-negative species were Klebsiella pneumoniae 94 (79%) followed by Escherichia coli 10 (8%). Ampicillin resistance was found in 113 cases (95%), cefotaxime 104 (87%), gentamicin 101 (85%), AmpGen 101 (85%), piperacillin-tazobactam 47 (39%), amikacin 10 (8.4%), and Imipenem 1 (0.8%). Prevalence of MDR was 88% (n = 105). Low birthweight and late-onset sepsis (LOS) were associated with higher risks of AmpGen-resistant infections. All-cause mortality was higher among newborns treated with ineffective antibiotics. CONCLUSION There was significant resistance to current first-line antibiotics and cephalosporins. Additional data are needed from primary care and community settings. Amikacin and piperacillin-tazobactam had lower rates of resistance; however, context-specific assessments of their potential adverse effects, their local availability, and cost-effectiveness would be necessary before selecting a new first-line regimen to help guide clinical decision-making.
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Affiliation(s)
- Semaria Solomon
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Oluwasefunmi Akeju
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Oludare A. Odumade
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rozina Ambachew
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Kimi Van Wickle
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mahlet Abayneh
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gesit Metaferia
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Maria J. Carvalho
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Department of Medical Sciences, Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Kathryn Thomson
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Kirsty Sands
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Timothy R. Walsh
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Department of Zoology, Ineos Oxford Institute of Antimicrobial Research, University of Oxford, Oxford, United Kingdom
| | - Rebecca Milton
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | | | - Delayehu Bekele
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Grace J. Chan
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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First Report of Multi-resistant Escherichia fergusonii Isolated from Children Under Two Months of Age in Intensive Care Unit. Jundishapur J Microbiol 2021. [DOI: 10.5812/jjm.116000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Gram-negative bacilli are primarily responsible for the most common pediatric infections. Frequently, Escherichia fergusonii is identified as E. coli because of its close genetic proximity. Objectives: We aimed at the isolation and identification of multi-resistant strains of E. fergusonii, affecting children under two months of age. Methods: Strains were isolated from infectious processes and were identified phenotypically and molecularly. The microdilution method (MicroScan, autoSCAN-4) and the disk diffusion method (modified Kirby Bauer) were used to analyze antibiotic susceptibility. Results: Strains isolated were multi-resistant. Molecular identification provided the correct taxonomic assignment. Escherichia fergusonii strains were wrongly identified as E. coli with the phenotypic identification method. In addition, Pseudomonas aeruginosa and Klebsiella pneumoniae were identified. The best sensitivity results were obtained with Ceftazidime/avibactam and ceftolozane/tazobactam. Conclusions: We provided the first report of isolation and identification of multi-resistant E. fergusonii strains affecting children under two months of age in a neonatal intensive care unit.
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Lima-Rogel V, Olguín-Mexquitic L, Kühn-Córdova I, Correa-López T, Romano-Aguilar M, Romero-Méndez MDC, Medellín-Garibay SE, Romano-Moreno S. Optimizing Meropenem Therapy for Severe Nosocomial Infections in Neonates. J Pharm Sci 2021; 110:3520-3526. [PMID: 34089712 DOI: 10.1016/j.xphs.2021.05.019] [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: 03/06/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
Meropenem pharmacokinetics in neonates exhibits large interindividual variability due to developmental changes occurring during the first month of life. The objective was to characterize meropenem pharmacokinetics through a population approach to determine effective dosing recommendations in neonates with severe nosocomial infections. Three blood samples from forty neonates were obtained once steady-state blood levels were achieved and plasma concentrations were determined with a validated chromatographic method. Data were used to develop and validate the one-compartment with first-order elimination population pharmacokinetic model obtained by non-linear mixed effect modeling. The final model was Clearance (L/h) = 2.23 × Creatinine Clearance (L/h) and Volume of distribution(L) = 6.06 × Body Surface Area(m2) × (1 + 0.60 if Fluticasone comedication). Doses should be adjusted based on said covariates to increase the likelihood of achieving therapeutic targets. This model explains 12.9% of the interindividual variability for meropenem clearance and 19.1% for volume of distribution. Stochastic simulations to establish initial dosing regimens to maximize the time above the MIC showed that the mean probabilities to achieve the PK/PD target (PTA) for microorganisms with a MIC of 2 and 8 µg/mL were 0.8 and 0.7 following i.v. bolus of 250 and 500 mg/m2/dose q8h, respectively. Meropenem extended 4h infusion would improve PTA in neonates with augmented creatinine clearance.
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Affiliation(s)
- Victoria Lima-Rogel
- Hospital Central "Dr. Ignacio Morones Prieto", Manuel Nava Martínez Ave. #6, University area, C.P, 78210 San Luis Potosi, Mexico
| | - Leticia Olguín-Mexquitic
- Hospital Central "Dr. Ignacio Morones Prieto", Manuel Nava Martínez Ave. #6, University area, C.P, 78210 San Luis Potosi, Mexico
| | - Ingrid Kühn-Córdova
- Hospital Central "Dr. Ignacio Morones Prieto", Manuel Nava Martínez Ave. #6, University area, C.P, 78210 San Luis Potosi, Mexico
| | - Tania Correa-López
- Pharmacy Laboratory, Faculty of Chemical Sciences, Autonomous University of San Luis Potosi, Mexico
| | - Melissa Romano-Aguilar
- Pharmacy Laboratory, Faculty of Chemical Sciences, Autonomous University of San Luis Potosi, Mexico
| | | | | | - Silvia Romano-Moreno
- Pharmacy Laboratory, Faculty of Chemical Sciences, Autonomous University of San Luis Potosi, Mexico.
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19
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Wang J, Li P, Zhang P, Du Q. Detailed nursing intervention on neonatal septicemia can improve the clinical symptoms of children and reduce the inflammatory reaction. Am J Transl Res 2021; 13:3443-3450. [PMID: 34017520 PMCID: PMC8129398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the application effect of detailed nursing intervention in neonatal septicemia. METHODS Altogether 60 neonates of neonatal septicemia admitted to our hospital from November 2019 to October 2020 were selected as the research participants, and all the children have received routine treatment, among which 30 neonates received routine nursing intervention as the regular group, and the remaining 30 received detailed nursing intervention as the detail group. The clinical effects, improvement of clinical symptoms, length of stay, and guardian satisfaction were compared, and the levels of serum inflammatory factors (TNF-α, IL-6 and IL-17) and immune function indicators (CD4+, CD8+) before and after nursing intervention were detected. RESULTS The total effective rate in the detail group was higher than that in the regular group (P < 0.05). Compared with the regular group, the temperature stabilization time, blood culture turning negative time, improvement time of milk rejection and hospital stay in the detail group were significantly shortened (P < 0.05). The guardian satisfaction score in the detail group was higher than that in the regular group (P < 0.05). After nursing, the levels of TNF-α, IL-6 and IL-17 decreased in both groups, and the levels of these three in the detail group were lower than those in the regular group (P < 0.05). After nursing, CD4+/CD8+ of children in both groups increased, and CD4+/CD8+ in the detail group and regular group were higher than those in the regular group (P < 0.05). CONCLUSION The adoption of detailed nursing modes in the treatment of neonatal septicemia can further improve the treatment effect, shorten the hospital stay and the improvement time of clinical symptoms, reduce the incidence of complications, improve the nursing satisfaction of guardians, reduce the inflammation of the body and improve the immune function of the body.
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Affiliation(s)
- Jing Wang
- Department of Paediatrics, Ningbo Yinzhou District Second HospitalNingbo 315100, Zhejiang Province, China
| | - Peifen Li
- Department of Paediatrics, Ningbo Yinzhou District Second HospitalNingbo 315100, Zhejiang Province, China
| | - Peijie Zhang
- Wound Ostomy Clinic, Ningbo Yinzhou District Second HospitalNingbo 315100, Zhejiang Province, China
| | - Qing Du
- Department of Paediatrics, Ningbo Yinzhou District Second HospitalNingbo 315100, Zhejiang Province, China
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Salama K, Gad A, El Tatawy S. Sepsis profile and outcome of preterm neonates admitted to neonatal intensive care unit of Cairo University Hospital. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2021. [PMCID: PMC7916998 DOI: 10.1186/s43054-021-00055-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background This study demonstrates the experience of the neonatal intensive care unit (NICU) of a tertiary referral center in Egypt in management of prematures with neonatal sepsis. This retrospective study included preterm neonates admitted to NICU with clinical and/or laboratory diagnosis of sepsis. Blood culture was done followed by antimicrobial susceptibility testing for positive cases. Neonates with sepsis were classified into early onset sepsis (EOS) and late onset sepsis (LOS). Hematological scoring system (HSS) for detection of sepsis was calculated. Results The study included 153 cases of neonatal sepsis; 63 (41.2%) EOS and 90 (58.8%) LOS. The majority of the neonates had very low or moderately low birth weight (90.9%). All neonates received first-line antibiotics in the form of ampicillin-sulbactam, and gentamicin. Second-line antibiotics were administered to 133 neonates (86.9%) as vancomycin and imipenem-cilastatin. Mortalities were more common among EOS group (p < 0.017). Positive blood cultures were detected in 61 neonates (39.8%) with a total number of 66 cultures. The most commonly encountered organisms were Klebsiella MDR and CoNS (31.8% each). Klebsiella MDR was the most predominant organism in EOS (28.9%), while CoNS was the most predominant in LOS (39.2%) The detected organisms were divided into 3 families; Enterobacteriaceae, non-fermenters, and Gram-positive family. There 3 families were 100% resistant to ampicillin. The highest sensitivity in Enterobacteriaceae and Non-fermenters was for colistin and polymyxin-B. An HSS of 3–8 had a sensitivity and specificity of 62.3% and 57.6%, respectively for diagnosis of culture-proven sepsis. Conclusion Neonatal sepsis was encountered in 21.5% of admitted preterm neonates; LOS was more common (58.8%). Mortality was 51.6%. Klebsiella MDR and CoNS were the most commonly encountered organisms in both EOS and LOS. The isolated families were 100% resistant to ampicillin. The hematological scoring system (HSS) showed limited sensitivity for detection of sepsis.
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Annamalai A, Gupta V, Jain S, Datta P. Increasing Resistance to Reserve Antibiotics: The Experience of a Tertiary Level Neonatal Intensive Care Unit. J Trop Pediatr 2021; 67:6024863. [PMID: 33280018 DOI: 10.1093/tropej/fmaa086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Blood stream infections are considered as a major cause of morbidity and mortality in neonates. Recent trend shows increasing resistance to commonly used antibiotics. AIMS AND OBJECTIVES The aim of this study is to find the antibiotic susceptibility pattern of various bacteria from blood samples in neonates and associated risk factors. METHODS All consecutive cases of intramural neonatal sepsis were enrolled for >12 months. Before starting or changing antibiotic, blood sample under all aseptic precautions was taken for culture. Clinical and demographic details were recorded to analyze risk factors for sepsis. Antibiotic sensitivity tests were done as per CLSI 2019 guidelines. RESULTS Of the 898 participants, 107 showed culture positivity. Klebsiella pneumoniae (25.2%) and Coagulase-negative Staphylococcus (23.3%). The blood culture positivity rate was 11.9%. Approximately 79% of isolates were multidrug-resistant: extended-spectrum beta-lactamase 90%, carbapenemase-resistant Enterobacteriaceae 27.7% and MRSA 43%. The risk factors found to be associated with sepsis were period of gestation ≤37 weeks, meconium-stained liquor, birth weight <1500 g, mechanical ventilation, partial exchange transfusion, duration of antibiotics for >10 days and duration of both NICU stay and hospital stay for >10 days. The case fatality rate (CFR) was more due to K. pneumoniae (19.2%) and the relative risk of death was 2.53 in culture-positive cases with an attributable risk of 60% and the population attributable risk of 15.4%. CONCLUSION Increase in antibiotic resistance organisms can lead to an increase in the neonatal CFR, so regular surveillance is needed.
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Affiliation(s)
- Anushya Annamalai
- Department of Microbiology, Government Medical College and Hospital, Chandigarh 160031, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh 160031, India
| | - Suksham Jain
- Department of Neonatology, Government Medical College and Hospital, Chandigarh 160031, India
| | - Priya Datta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh 160031, India
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Atif M, Zia R, Malik I, Ahmad N, Sarwar S. Treatment outcomes, antibiotic use and its resistance pattern among neonatal sepsis patients attending Bahawal Victoria Hospital, Pakistan. PLoS One 2021; 16:e0244866. [PMID: 33439876 PMCID: PMC7806133 DOI: 10.1371/journal.pone.0244866] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sepsis is one of the major causes of neonatal mortality in Pakistan. This study aimed to investigate the treatment outcomes, antibiotic use and its resistance pattern among neonatal sepsis patients attending a tertiary care hospital in Pakistan. We also aimed to identify the factors affecting mortality in neonatal sepsis patients. METHODS A descriptive, cross-sectional study was conducted in the pediatric wards of the Bahawal Victoria Hospital, Bahawalpur, Pakistan. All eligible neonatal sepsis patients who were registered at the study site from January 1, 2019 to June 30, 2019 were included in the study. The data collection form included information on patient's characteristics, antibiotic use and its sensitivity pattern, laboratory and microbiological data, and final treatment outcomes. Treatment outcomes included, discharged (with treatment success), leave against medical advice (LAMA), discharged on request (DOR) and death. Multivariable binary logistic regression analysis was used to find the independent factors associated with death. A p-value of less than 0.05 was considered statistically significant. RESULTS Among the total 586 patients, 398 (67.9%) were male, 328 (56%) were preterm, 415 (70.8%) were diagnosed with early onset sepsis, 299 (51%) were born with low birth weight. Most of the patients (n = 484, 82.6%) were treated with amikacin+cefotaxime at the start of treatment. Culture was positive in 52 (8.9%) patients and the most commonly identified bacteria included, Klebsiella species (n = 19, 36.5%) followed by E. coli (n = 15, 28.5%) and Staphylococcus aureus (n = 8, 15.4%). The identified bacterial isolates showed high level of resistance against the antibiotics initiated at the start of the treatment, while resistance against piperacillin+tazobactam, imipenem, vancomycin and linezolid was very low. Just under half of the patients (n = 280, 47.8%) successfully completed the treatment (i.e., discharged with treatment success), while 123 (21%) patients died during treatment. In multivariable binary logistic regression, the factors which still remained significantly associated with neonatal death included, preterm delivery (AOR 9.59; 95% CI 4.41, 20.84), sub-optimal birth weight (AOR 5.13; 95% CI 2.19, 12.04), early onset sepsis (AOR 2.99; 95% CI 1.39, 6.41) and length of hospital stay (AOR 0.76; 95% CI 0.67, 0.88). CONCLUSION The mortality rate associated with sepsis was high in our study cohort. The bacterial isolates showed high level of resistance against the antibiotics started as the empiric therapy. Rational use of antibiotics can decrease the adverse outcomes in neonatal sepsis patients.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Rabia Zia
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Balochistan, Pakistan
| | - Sajjad Sarwar
- Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur, Punjab, Pakistan
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Braima OA, Ali MA, Abdulla EM. Bacteriological profile and antibiotic resistance in newborn infants with possible community-acquired neonatal sepsis in Khartoum State, Sudan. Sudan J Paediatr 2021; 21:13-22. [PMID: 33879938 DOI: 10.24911/sjp.106-1601909519] [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] [Indexed: 01/08/2023]
Abstract
Neonatal sepsis is a leading cause of morbidity and mortality, and knowledge of bacterial patterns and susceptibility to antibiotics is essential to design therapeutic guidelines. To determine the bacterial aetiology and antibiotic resistance patterns in neonatal sepsis, a prospective, cross-sectional, hospital-based study was conducted in a large paediatric emergency hospital in Khartoum State, Sudan, over a 6-month period. All newborn infants with a clinical diagnosis of sepsis were included in the study and had a blood sample collected for culture and sensitivity. The World Health Organization case definition of neonatal sepsis in conjunction with the Integrated Management of Childhood Illnesses criteria was used to select patients. A total of 170 newborn infants fulfilled the study inclusion criteria. The median age at presentation was 4-7 days and blood culture was positive in 31%. Early-onset neonatal sepsis was present in 30% of cases, while 70% were late-onset. Gram-positive organisms accounted for 58% of the total isolates, and 38% were Gram-negative organisms. Staphylococcus aureus was the most prevalent organism (55% of all isolates) and 72% of these were methicillin-resistant which showed 100% sensitivity to vancomycin and 90% to gentamycin. Pseudomonas aeruginosa was the commonest Gram-negative organism in both early and late-onset sepsis and the second commonest isolated organism, accounting for 19% of cases. All Gram-negative organisms were 100% sensitive to imipenem, meropenem and ciprofloxacin. Both Gram-positive and Gram-negative organisms were highly resistant to benzylpenicillin and cefotaxime, the commonly used empiric antibiotics in neonatal sepsis.
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Affiliation(s)
- Osama Ahmed Braima
- Department of Paediatrics, University Hospitals of Morecambe, NHS Foundation Trust, United Kingdom
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Chaudhary BR, Malla KK, Poudel S, Jha BK. Study of Antibiotic Susceptibility among Bacterial Isolates in Neonatal Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:893-899. [PMID: 34506425 PMCID: PMC7775007 DOI: 10.31729/jnma.5216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction: Neonatal sepsis is a major cause of neonatal morbidity and mortality worldwide, especially in developing countries like Nepal. Antibiotic resistance among microorganisms poses new challenges in the treatment of neonatal sepsis. The present study is conducted with the objectives of determining clinico-bacteriological profile and antibiotic susceptibility among isolated bacteria in a neonatal intensive care unit. Methods: A descriptive cross-sectional study was conducted from January 1, 2017, to December 31, 2019, in the neonatal intensive care unit of a tertiary care hospital after obtaining ethical clearance from Institutional Review Committee (Ref: 2020-064). The sample size was calculated and 77 neonates with culture-proven sepsis were included in the study. The antibiotic susceptibility tests of the isolates were done by Kirby-Bauer disc diffusion method. Data entry was done in Statistical Packages for the Social Sciences version 20. Results: Of the 841 specimens (blood, cerebrospinal fluid, urine, tracheal aspirate and pus) processed for culture, bacteria were isolated in 84 (10.0%) specimens. Among the 84, gram-negative bacilli were the predominant isolates 76 (90.5%); of which Acinetobacter baumannii was the most common 27 (32.1%). Both the Gram-negative and the Gram-positive bacteria showed high resistance to Penicillin and Cephalosporins. Gram-negative bacteria showed maximum sensitivity to Colistin, Carbapenems, Tigecycline and Fluoroquinolones. Gram-positive bacteria showed maximum susceptibility to Amikacin, Vancomycin and Carbapenems. Conclusions: Judicious use of antibiotics based on the updated knowledge of prevalent organisms in the local hospital setting and their antibiotic sensitivity pattern is of utmost importance for the effective treatment of neonatal sepsis.
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Affiliation(s)
- Brajesh Raj Chaudhary
- Department of Pediatrics, College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal
| | | | - Sajan Poudel
- Department of Pediatrics, College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal
| | - Brajesh Kumar Jha
- Department of Microbiology, College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal
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Ameya G, Weldemedhin T, Tsalla T, Gebremeskel F. Antimicrobial Susceptibility Pattern and Associated Factors of Pediatric Septicemia in Southern Ethiopia. Infect Drug Resist 2020; 13:3895-3905. [PMID: 33154655 PMCID: PMC7608546 DOI: 10.2147/idr.s278293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Septicemia is one of the major causes of morbidity and mortality in pediatric patients throughout the world. Drug-resistant pathogens are one of the major challenges to control. The study aimed to identify the major etiological agents, antimicrobial susceptibility pattern and associated factors of septicemia among pediatric patients in southern Ethiopia. Methods A cross-sectional study was conducted on pediatric patients. Blood samples were cultured and antimicrobial susceptibility testing was conducted by Kirby-Bauer disc diffusion techniques. Data were collected by pre-tested questionnaire to identify potential associated factors of septicemia. A bivariate logistic regression analysis was used and adjusted odds ratio with 95% CI at ≤0.05 level of significance was computed to determine the presence and strength of the association. Results Of 238 participants, 27 (11.3%) of them had a positive blood culture. Staphylococcus aureus (32.2%), coagulase negative Staphylococci (25%), and Klebsiella pneumoniae (14.3%) were the predominant isolates. The isolated bacteria showed high rates of resistance to amoxicillin, ceftriaxone, streptomycin and ampicillin. Multi-drug resistance (MDR) was observed in 82.1% of the isolates. Being infant [AOR=4.18, 95% CI, (1.3–13.0)], admission >10 days [AOR=5.54, 95% CI, (1.51–20.41)], burn [AOR=3.55, 95% CI, (1.02–12.38)] and wound cases [AOR=5.52, 95% CI, (1.50–20.34)] were associated with pediatric septicemia. Conclusion Gram positive bacteria were the predominant isolates and majority of isolates were MDR pathogens. Very young age, prolonged hospital stays, burn and wound cases were associated with pediatric septicemia. Establishing antibiotic stewardship is mandatory to minimize the high prevalence of drug resistance.
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Affiliation(s)
- Gemechu Ameya
- Department of Medical Laboratory Sciences, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | | | - Tsegaye Tsalla
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Feleke Gebremeskel
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Abd El-Aziz NK, Gharib AA, Mohamed EAA, Hussein AH. Real-time PCR versus MALDI-TOF MS and culture-based techniques for diagnosis of bloodstream and pyogenic infections in humans and animals. J Appl Microbiol 2020; 130:1630-1644. [PMID: 33073430 DOI: 10.1111/jam.14862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 12/18/2022]
Abstract
AIMS This study was applied to evaluate the usefulness of a high-throughput sample preparation protocol prior to the application of quantitative real-time PCR (qPCR) for the early diagnosis of bloodstream and pyogenic infections in humans and animals compared to matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and classical culture. METHODS AND RESULTS Saponin-mediated selective host cell lysis combined with DNase-1 was applied for processing of whole blood and pus clinical samples collected from suspected cases of septicaemia and pyogenic infections in humans and animals. The pre-PCR processing strategy enabled the recovery of microbial cells with no changes in their colony forming units immediately after the addition of saponin. DNase-1 was efficient for removing the DNAs from the host cells as well as dead cells with damaged cell membranes. The metagenomic qPCR and MALDI-TOF MS could identify the bacterial community of sepsis at species level with a concordance of 97·37% unlike the conventional culture. According to qPCR results, Staphylococcus aureus (24·24%) was predominated in animal pyogenic infections, whereas Klebsiella pneumonia (31·81%) was commonly detected in neonatal sepsis. CONCLUSIONS Saponin combined with DNase-1 allowed the efficient recovery of microbial DNA from blood and pus samples in sepsis using qPCR assay. SIGNIFICANCE AND IMPACT OF THE STUDY Metagenomic qPCR could identify a broad range of bacteria directly from blood and pus with more sensitivity, higher discriminatory power and shorter turnaround time than those using MALDI-TOF MS and conventional culture. This might allow a timely administration of a prompt treatment.
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Affiliation(s)
- N K Abd El-Aziz
- Microbiology Department, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - A A Gharib
- Microbiology Department, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - E A A Mohamed
- Microbiology Department, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - A H Hussein
- Avian and Rabbit Medicine Department, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
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Wahby AA, Elwassif M, Magdy M, Hamid TAA, Ibrahim AA. Association between DNA Damage and Serum Levels of Copper, Zinc, and Selenium in Full-Term Neonates with Late-Onset Sepsis. J PEDIAT INF DIS-GER 2020. [DOI: 10.1055/s-0040-1717126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Objective The alteration in certain trace elements is usually associated with impaired immune function and higher oxidative stress. Therefore, these elements are suggested to play an important role in the pathogenesis of neonatal sepsis. We aimed to evaluate copper (Cu), zinc (Zn), and selenium (Se) serum levels in full-term neonates with late-onset sepsis (LOS) and correlate these levels with DNA damage and other risk factors of sepsis.
Methods The study included a group of 100 neonates diagnosed with sepsis serving as the case group and another one of 60 neonates serving as the control group. DNA damage was assessed using the comet assay method and trace elements were measured using inductively coupled plasma mass spectrometry.
Results Compared with controls, the percentage of DNA damage was significantly elevated in patients with sepsis, while serum levels of Cu, Zn, and Se were markedly decreased (p = 0.001). A strong negative correlation was revealed between Se and DNA damage (r = −0.6, p = 0.001). However, no correlations were found between Cu or Zn and DNA damage. Univariate logistic regression analysis revealed that DNA damage as well as Cu, Zn, and Se serum levels can be considered as relevant risk factors for neonatal sepsis (p = 0.008, 0.004, 0.004, and 0.003, respectively). Receiver-operating characteristic curve analysis showed that the strongest indicator for neonatal sepsis was Se (area under the curve [AUC] = 0.94, confidence interval [CI] = 0.9–0.98, p = 0.001), followed by Cu (AUC = 0.9, CI = 0.85–0.96, p = 0.001), and then Zn (AUC = 0.87, CI = 0.8–0.93, p = 0.001).
Conclusion The percentage of DNA damage may help in the assessment of neonatal sepsis severity. Altered levels of Cu, Zn, and Se may play significant role in the pathogenesis of neonatal sepsis. Se serum level is strongly correlated with percentage of DNA damage. Therefore, Se can predict the severity of LOS.
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Affiliation(s)
- Aliaa Ahmed Wahby
- Department of Clinical and Chemical Pathology, National Research Centre, Cairo, Egypt
| | - Maha Elwassif
- Department of Medical Biochemistry, National Research Centre, Cairo, Egypt
| | - Mai Magdy
- Department of Clinical and Chemical Pathology, National Research Centre, Cairo, Egypt
| | | | - Alshaymaa A. Ibrahim
- Department of Clinical and Chemical Pathology, National Research Centre, Cairo, Egypt
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Khaled BM, Noha ASM, Manal AAM, Engy SM. Role of Toll-Like Receptors 2 and 4 Genes Polymorphisms in Neonatal Sepsis in a Developing Country: A Pilot Study. J PEDIAT INF DIS-GER 2020. [DOI: 10.1055/s-0040-1714710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Objective Toll-like receptors (TLR) are one of the key molecules that alert the immune system to the presence of microbial infections. This study attempts to elucidate the role of TLR2 and TLR4 polymorphisms in neonatal sepsis.
Methods A case–control study including 30 neonates with confirmed sepsis compared with 20 neonates in a control group. TLR2 and TLR24 gene polymorphisms were confirmed by polymerase chain reaction.
Results The majority of infections were attributed to gram-negative organisms (72.5%) namely Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. Results also revealed that incidence of TLR polymorphism was significantly different between the sepsis and control groups (p = 0.016). The most common polymorphism was TLR2; Arg 753 Gln (16.7%). Presence of TLR polymorphism was also associated with a longer duration of therapy (a median of 10 days for cases with positive polymorphism compared with 6.5 days for negative cases; p = 0.001).
Conclusion This pilot study suggests that any polymorphisms in TLR2 and TLR4 might have a role that interferes with the innate immune response of newborn.
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Affiliation(s)
- Bedewy M. Khaled
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Abou Seada M. Noha
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Antonios A. M. Manal
- Division of Pediatric and Critical Care Medicine, Department of Pediatrics, Alexandria University, El-Shatby Hospital, Alexandria, Egypt
| | - Saleh M. Engy
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Fenske L, Concato AC, Vanin AP, Tamagno WA, de Oliveira Sofiatti JR, Treichel H, da Rosa JGS, Barcellos LJG, Kaizer RR. 17-α-Ethinylestradiol modulates endocrine and behavioral responses to stress in zebrafish. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:29341-29351. [PMID: 32440876 DOI: 10.1007/s11356-020-09318-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
The synthetic estrogen, 17-α-ethinylestradiol (EE2), present in contraceptive pills, is an endocrine-disrupting chemical (EDC) that can be found in the aquatic environment. We examined the impacts of EE2 on zebrafish behavioral and physiological responses through the novel tank test (NTT), which measures anxiety-like behavior; the mirror-induced aggression (MIA) test, which measures aggressiveness; and the social preference test (SPT), which measures social cohesion. The steroid hormone levels were also measured. Here, we show that exposure to EE2 impairs stress responses by regulating the levels of specific hormones and eliciting an anxiolytic response, increasing aggression, and reducing social preference in zebrafish. In nature, these changes in behavior compromise reproduction and anti-predator behaviors, which, in turn, affects species survival. The maintenance of an intact behavioral repertoire in zebrafish is essential for their survival. Thus, our results point to the danger of environmental contamination with EE2 as it may alter the dynamics of the prey-predator relationship.
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Affiliation(s)
- Lurian Fenske
- Programa de Pós-Graduação em Ciência e Tecnologia Ambiental, Universidade Federal da Fronteira Sul, Rodovia RS 135, Km 72, Erechim, RS, 99700-970, Brazil
| | - Ani Carla Concato
- Programa de Pós-Graduação em Ciência e Tecnologia Ambiental, Universidade Federal da Fronteira Sul, Rodovia RS 135, Km 72, Erechim, RS, 99700-970, Brazil
- Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Campus Sertão, Rodovia RS 135, Km 25, Sertão, RS, 99170-000, Brazil
| | - Ana Paula Vanin
- Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Campus Sertão, Rodovia RS 135, Km 25, Sertão, RS, 99170-000, Brazil
| | - Wagner Antonio Tamagno
- Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Campus Sertão, Rodovia RS 135, Km 25, Sertão, RS, 99170-000, Brazil
| | - Jéssica Reis de Oliveira Sofiatti
- Programa de Pós-Graduação em Ciência e Tecnologia Ambiental, Universidade Federal da Fronteira Sul, Rodovia RS 135, Km 72, Erechim, RS, 99700-970, Brazil
| | - Helen Treichel
- Programa de Pós-Graduação em Ciência e Tecnologia Ambiental, Universidade Federal da Fronteira Sul, Rodovia RS 135, Km 72, Erechim, RS, 99700-970, Brazil
| | | | - Leonardo José Gil Barcellos
- Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Maria (UFSM), Av. Roraima, 1000, Cidade Universitária, Camobi, Santa Maria, RS, 97105-900, Brazil
- Curso de Medicina Veterinária, Universidade de Passo Fundo (UPF), BR 285, São José, Passo Fundo, RS, 99052-900, Brazil
- Programa de Pós-Graduação em Bioexperimentação, Universidade de Passo Fundo (UPF), BR 285, São José, Passo Fundo, RS, 99052-900, Brazil
- Programa de Pós-Graduação em Ciências Ambientais, Universidade de Passo Fundo (UPF), BR 285, São José, Passo Fundo, RS, 99052-900, Brazil
| | - Rosilene R Kaizer
- Programa de Pós-Graduação em Ciência e Tecnologia Ambiental, Universidade Federal da Fronteira Sul, Rodovia RS 135, Km 72, Erechim, RS, 99700-970, Brazil.
- Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Campus Sertão, Rodovia RS 135, Km 25, Sertão, RS, 99170-000, Brazil.
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Fahmey SS, Mostafa N. Pentraxin 3 as a novel diagnostic marker in neonatal sepsis. J Neonatal Perinatal Med 2020; 12:437-442. [PMID: 31381534 DOI: 10.3233/npm-190261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neonatal sepsis is an important cause of morbidity and mortality especially in developing countries. As clinical manifestations of neonatal sepsis are nonspecific, early diagnosis and treatment remain a challenge. Pentraxin 3 (PTX3) is an acute-phase protein secreted by various cells in response to the proinflammatory signals. Our aim was to investigate the diagnostic value of PTX3 in neonatal sepsis. METHODS We studied 90 neonates; 60 with culture-proven sepsis and 30 healthy neonates as a control group. Serum levels of PTX 3 were measured by ELISA. RESULTS Neonates with sepsis had significantly higher levels of PTX 3 as compared to controls (p < 0.001). Diagnostic cutoff value of PTX 3 was 5.6 μg/L with a sensitivity of 98.3% and a specificity of 96.7%. PTX 3 was significantly increased in nonsurvivors when compared to survivors (p < 0.001). PTX3 had better sensitivity when compared with CRP. CONCLUSION PTX 3 could be used as a new biomarker of neonatal sepsis with high sensitivity and specificity.
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Affiliation(s)
- S S Fahmey
- Department of Pediatrics, Beni-Suef University, Beni-Suef, Egypt
| | - N Mostafa
- Department of Clinical and Chemical Pathology, Beni-Suef University, Beni-Suef, Egypt
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Khalil N, Blunt HB, Li Z, Hartman T. Neonatal early onset sepsis in Middle Eastern countries: a systematic review. Arch Dis Child 2020; 105:639-647. [PMID: 31969351 DOI: 10.1136/archdischild-2019-317110] [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: 02/24/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Early onset neonatal sepsis (EOS) accounts for a significant portion of neonatal mortality, which accounts for 46% of global under five child mortality. OBJECTIVE This systematic review studies the bacterial aetiology of EOS in the Middle East, susceptibility patterns to recommended empirical antibiotic therapy and whether this differs between high-income and middle-income countries in the region. METHODS Articles were collected from Medline, Web of Science, the Cochrane Library and Index Medicus for the Eastern Mediterranean Region. The articles included in our systematic review met the following criteria: published after January 2000, data relevant to the Middle East, data specific for early onset sepsis, no language restriction. Data on aetiology and susceptibility were extracted from prospective and retrospective studies. Risk of bias was assessed using the Newcastle-Ottawa Scale. This study focused on EOS but does include data regarding neonatal late-onset sepsis antibiotic susceptibility. The data regarding coagulase-negative Staphylococcus species were excluded from final analysis, as possible contaminants. The protocol for this systematic review was registered on PROSPERO: CRD42017060662. RESULTS 33 articles from 10 countries were included in the analysis. There were 2215 cases of culture-positive EOS, excluding coagulase-negative Staphylococcus. In middle-income countries, Klebsiella species (26%), Staphylococcus aureus (17%) and Escherichia coli (16%) were the most common pathogens, in contrast to group B Streptococcus (26%), E. coli (24%) and Klebsiella (9%) in high-income countries. Overall susceptibility to ampicillin/gentamicin and third-generation cephalosporin were 40% and 37%, respectively, in middle-income countries versus 93% and 91%, respectively, in high-income countries. CONCLUSIONS EOS in middle-income countries was more likely to be due to Gram-negative pathogens and less likely to be susceptible to empirical antibiotic therapy. This has important public health implications regarding neonatal mortality in the Middle East region.
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Affiliation(s)
- Nadim Khalil
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA .,Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Heather B Blunt
- Biomedical Libraries, Dartmouth College, Hanover, New Hampshire, USA
| | - Zhongze Li
- Biostatistics Shared Resource, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Tyler Hartman
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Hassuna NA, AbdelAziz RA, Zakaria A, Abdelhakeem M. Extensively-Drug Resistant Klebsiella pneumoniae Recovered From Neonatal Sepsis Cases From a Major NICU in Egypt. Front Microbiol 2020; 11:1375. [PMID: 32636828 PMCID: PMC7317144 DOI: 10.3389/fmicb.2020.01375] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background Neonatal sepsis is a nuisance to clinicians and medical microbiologists, particularly those cases caused by Klebsiella pneumoniae. Thus, we aimed at investigating the profile and mechanisms of antibiotic resistance and the clonal relationships between K. pneumoniae isolated from neonates at the largest tertiary care hospital’s neonatal intensive care units (NICUs) in Minia, Egypt. Methods This study comprised 156 neonates diagnosed with culture-proven sepsis from February 2019 to September 2019, at a major NICU of Minia City. All K. pneumoniae isolates were collected and characterized by antimicrobial profile, resistance genotype, and pulsed-field gel electrophoresis typing. Results Twenty-four K. pneumoniae isolates (15.3%) were collected out of the 156 sepsis diagnosed neonates. These samples showed extensive drug resistance (XDR) to most of the tested antimicrobials, except fluoroquinolones. All the K. pneumoniae isolates possessed blaVIM and blaNDM carbapenemase genes, while blaKPC gene was detected in 95.8%. Considering extended-spectrum β-lactamases genes, blaCTX–M was found in all the isolates and blaOXA–1 gene in 75% of them. The plasmid-mediated quinolone resistance gene qnrS, was predominantly found among our isolates in comparison to qnrB or qnrA. A moderate degree of clonal relatedness was observed between the isolates. Conclusion To the best of our knowledge, this the first report of an alarming occurrence of XDR among K. penumoniae isolates recovered from neonatal sepsis in Egypt. Our data necessitate proper antimicrobial stewardship as the choices will be very limited.
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Affiliation(s)
- Noha A Hassuna
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Reem A AbdelAziz
- Department of Pediatrics, Faculty of Medicine, Minia University, Minia, Egypt
| | - Amira Zakaria
- Biotechnology Institute, Suez Canal University, Ismaïlia, Egypt
| | - Mohammed Abdelhakeem
- Department of Clinical Pathology, Faculty of Medicine, Minia University, Minia, Egypt
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CLINICAL AND MICROBIOLOGICAL FEATURES OF EARLY-ONSET NEONATAL SEPSIS IN PRETERM INFANTS. EUREKA: HEALTH SCIENCES 2020. [DOI: 10.21303/2504-5679.2020.001284] [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
Early-onset neonatal sepsis (EONS) remains the leading cause of morbidity and mortality, especially among premature infants. Conducting high-quality epidemiological monitoring is an important condition for effective tactics treatment neonatal infections and improving the quality of medical care for this category of newborn.
The aim. Determination of the value of microbiological triggers in the blood in various clinical options for EONS in preterm infants.
Materials and methods. Clinical and microbiological data on 50 prematurely born newborns with EONS were selected. The analysis of the frequency of detected bacteremia, the distribution of pathogenic microorganisms and the clinical characteristics of neonatal sepsis.
Results. In the study, sources of infection were detected in 94 % of cases. Positive blood cultures were obtained in 17 (34 %) newborns with EONS. 61.5 % of all cases of bacteremia were caused by coagulase-negative staphylococcus (CoNS). Gram-negative pathogens were detected in 23.5 % of positive blood cultures, representatives of this group were Escherichia coli and Klebsiella pneumonia. The overall mortality rate from EONS was 30 %.
Conclusions. The incidence of sepsis confirmed by a positive blood culture was 34 %. The most common cause of EONS is CoNS, low incidence of group B Streptococcus sepsis has been established. The most frequent septicopymic sources of infection were the lungs, which is expressed in the high incidence (94 %) of X-ray pneumonia in the structure of the EONS.
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Chu SM, Hsu JF, Lai MY, Huang HR, Chiang MC, Fu RH, Tsai MH. Risk Factors of Initial Inappropriate Antibiotic Therapy and the Impacts on Outcomes of Neonates with Gram-Negative Bacteremia. Antibiotics (Basel) 2020; 9:antibiotics9040203. [PMID: 32340241 PMCID: PMC7235779 DOI: 10.3390/antibiotics9040203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Timely appropriate empirical antibiotic plays an important role in critically ill patients with gram-negative bacteremia. However, the relevant data and significant impacts have not been well studied in the neonatal intensive care unit (NICU). METHODS An 8-year (1 January 2007-31 December 2014) cohort study of all NICU patients with gram-negative bacteremia (GNB) in a tertiary-care medical center was performed. Inadequate empirical antibiotic therapy was defined when a patient did not receive any antimicrobial agent to which the causative microorganisms were susceptible within 24 h of blood culture sampling. Neonates with GNB treated with inadequate antibiotics were compared with those who received initial adequate antibiotics. RESULTS Among 376 episodes of Gram-negative bacteremia, 75 (19.9%) received inadequate empirical antibiotic therapy. The cause of inadequate treatment was mostly due to the pathogen resistance to prescribed antibiotics (88.0%). Bacteremia caused by Pseudomonas aeruginosa (Odds ratio [OR]: 20.8, P < 0.001) and extended spectrum β-lactamase (ESBL)-producing bacteria (OR: 18.4, P < 0.001) had the highest risk of inadequate treatment. Previous exposure with third generation cephalosporin was identified as the only independent risk factor (OR: 2.52, 95% CI: 1.18-5.37, P = 0.018). Empirically inadequately treated bacteremias were significantly more likely to have worse outcomes than those with adequate therapy, including a higher risk of major organ damage (20.0% versus 6.6%, P < 0.001) and infectious complications (25.3% versus 9.3%, P < 0.001), and overall mortality (22.7% versus 11.0%, P = 0.013). Conclusions: Inadequate empirical antibiotic therapy occurs in one-fifth of Gram-negative bacteremias in the NICU, and is associated with worse outcomes. Additional prospective studies are needed to elucidate the optimal timing and aggressive antibiotic regimen for neonates who are at risk of antibiotic-resistant Gram-negative bacteremia.
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Affiliation(s)
- Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-M.C.); (J.-F.H.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (R.-H.F.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
| | - Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-M.C.); (J.-F.H.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (R.-H.F.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
| | - Mei-Yin Lai
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-M.C.); (J.-F.H.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (R.-H.F.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
| | - Hsuan-Rong Huang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-M.C.); (J.-F.H.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (R.-H.F.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
| | - Ming-Chou Chiang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-M.C.); (J.-F.H.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (R.-H.F.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
| | - Ren-Huei Fu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (S.-M.C.); (J.-F.H.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (R.-H.F.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
| | - Ming-Horng Tsai
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 613, Taiwan
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Yunlin Chang Gung Memorial Hospital, 707, Gongye Rd, Sansheng, Mailiao Township, Yunlin 638, Taiwan
- Correspondence: ; Tel.: +886-5-691-5151 (ext. 2879); Fax: +886-5-691-3222
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Understanding the Elements of Maternal Protection from Systemic Bacterial Infections during Early Life. Nutrients 2020; 12:nu12041045. [PMID: 32290170 PMCID: PMC7230816 DOI: 10.3390/nu12041045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
Late-onset sepsis (LOS) and other systemic bloodstream infections are notable causes of neonatal mortality, particularly in prematurely born very low birth weight infants. Breastfeeding in early life has numerous health benefits, impacting the health of the newborn in both the short-term and in the long-term. Though the known benefits of an exclusive mother's own milk diet in early life have been well recognized and described, it is less understood how breastfed infants enjoy a potential reduction in risk of LOS and other systemic infections. Here we review how gut residing pathogens within the intestinal microbiota of infants can cause a subset of sepsis cases and the components of breastmilk that may prevent the dissemination of pathogens from the intestine.
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You T, Zhang H, Guo L, Ling KR, Hu XY, Li LQ. Differences in clinical characteristics of early- and late-onset neonatal sepsis caused by Klebsiella pneumoniae. Int J Immunopathol Pharmacol 2020; 34:2058738420950586. [PMID: 32816593 PMCID: PMC7444108 DOI: 10.1177/2058738420950586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 07/27/2020] [Indexed: 01/09/2023] Open
Abstract
To identify differences in the clinical characteristics of early- and late-onset sepsis (EOS and LOS) caused by Klebsiella pneumoniae (K. pneumoniae) and to describe the risk factors for multidrug-resistant K. pneumoniae (MDR-KP) infection. Infants with K. pneumoniae-induced sepsis who were admitted to a children's Hospital between Jan 2000 and Dec 2019 were included. All infants were divided into EOS and LOS groups, as well as MDR-KP and non-MDR-KP groups. Demographics, clinical characteristics, and risk factors were compared between the two groups. One hundred eighty infants (66 with EOS and 114 with LOS) were further analyzed, accounting for 36.8% of sepsis cases caused by MDR-KP. The frequency of respiratory failure, bronchopulmonary dysplasia, and intraventricular hemorrhage were more common in the LOS group and a higher rate of acute respiratory distress syndrome was more common in infants in the EOS group (P < 0.05). K. pneumoniae showed a low sensitivity to penicillin, beta-lactams and cephalosporins, and it showed a high sensitivity to levofloxacin, ciprofloxacin, and amikacin. Prematurity, low birth weight, longer antibiotic exposure time, long duration of peripheral catheter insertion, long mechanical ventilation time, and long parenteral nutrition time were associated with an increased rate of MDR-KP infection by univariate analysis (P < 0.05). The regression analysis identified a long antibiotic exposure time (OR = 1.37, 95% CI: 1.01-1.89) and long parenteral nutrition time (OR = 1.39, 95% CI: 1.01-1.89) as independent risk factors for a MDR-KP infection, and a greater gestational age and birth weight were associated with a lower risk of MDR-KP infection (OR = 0.57, 95% CI: 0.40-0.79). LOS caused by K. pneumoniae may lead to a higher frequency of complications. The risk factors for MDR-KP infection were longer duration of antibiotic exposure and parenteral nutrition. A greater gestational age and larger birth weight may decrease the risk of MDR-KP infection.
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Affiliation(s)
- Ting You
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Han Zhang
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Lu Guo
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Ke-Ran Ling
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Xiao-Yu Hu
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
| | - Lu-Quan Li
- Neonatal Diagnosis and Treatment Center, Children’s Hospital of Chongqing Medical University, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, P.R. China
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Genetic diversity of carbapenem-resistant Klebsiella Pneumoniae causing neonatal sepsis in intensive care unit, Cairo, Egypt. Eur J Clin Microbiol Infect Dis 2019; 39:583-591. [PMID: 31773363 DOI: 10.1007/s10096-019-03761-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/30/2019] [Indexed: 12/26/2022]
Abstract
Neonatal sepsis is a great challenge for clinicians and infection control practitioners, especially in facilities with limited resources. Carbapenem-resistant Klebsiella pneumoniae (CRKP) is rapidly increasing and carriages a major threat to neonates. We aimed to examine phenotypes causing neonatal late onset sepsis (NLOS) in comparison with neonatal early onset sepsis (NEOS) with further investigations of genotypes, and genetic relatedness of CRKP in neonatal late-onset sepsis. Our study included 88 neonates diagnosed with sepsis: 58 with (NLOS) and 30 with (NEOS) from November 2015 to April 2016, at neonatal intensive care unit (NICU) of Cairo University Hospital. K. pneumoniae was the most common encountered pathogen in the NLOS group (37.9%) with a mean sepsis score of 6.39 when compared to the NEOS group (p < 0.05). In Klebsiella group, C-reactive protein and interleukin-6 levels were significantly high (p ˂ 0.001) and 56.5% of the isolates were meropenem resistant. The most prevalent carbapenemase gene was OXA-48 which was identified in 14/23 (60.8%) followed by NDM-1 which was identified in 12/23 (52.2%) as detected by multiplex PCR. Coexistence of both carbapenemases was found in 52.2% (12/23). The blaKPC, blaIMP, and blaVIM genes were not harbored in the isolates. By investigating the genetic relatedness of CRKP by pulsed-field gel electrophoresis, 23 isolates of K. pneumoniae revealed various pulsed-field gel electrophoresis (PFGE) patterns, demonstrating that the isolates were non-clonal. Awareness of the existing phenotypes and genotypes is important for proper treatment and infection control practices.
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Ji H, Bridges M, Pesek E, Graham K, Tan L, Chabra S. Acute Funisitis Correlates With the Risk of Early-Onset Sepsis in Term Newborns Assessed Using the Kaiser Sepsis Calculator. Pediatr Dev Pathol 2019; 22:523-531. [PMID: 31166881 DOI: 10.1177/1093526619855467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The risk of neonatal early-onset sepsis (EOS) is traditionally assessed on maternal signs of clinical chorioamnionitis. Recently, an online EOS risk calculator was developed by Kaiser Permanente using maternal and neonatal clinical parameters. We were interested in whether an increased Kaiser sepsis risk score correlates with histologic acute chorioamnionitis or acute funisitis. DESIGN Included in this retrospective review are 119 chorioamnionitis-exposed term neonates from January 1, 2015 and December 31, 2016. Clinical charts from mother-baby pairs were reviewed. An EOS risk score was obtained using the online Kaiser Sepsis Calculator. The presence and severity of acute chorioamnionitis and acute funisitis were recorded. A SPSS software was used for statistical analysis (IBM, New Jersey, USA). RESULTS The Kaiser Sepsis Calculator could identify 97 of 119 (81.5%) neonates without increased risk for sepsis. Histologic acute chorioamnionitis was present in 100 of 119 cases (84%), in which 44 cases (44%) show severe acute chorioamnionitis. Acute funisitis was recognized in 87 of 119 (73.1%) cases, all of which had concurrent acute chorioamnionitis. Severe funisitis was seen in 38 of the 87 cases (43.7%). The Kaiser Sepsis risk score correlates with the presence and severity of acute funisitis (P = .037 and P = .044, respectively) but not with the presence or the severity of acute chorioamnionitis (P = .105 and P = .672, respectively). CONCLUSION Our study provides histological evidence to support that the Kaiser Sepsis Calculator may help to effectively reduce unwarranted blood culture, antibiotics exposure, and neonatal intensive care unit admission in term neonates.
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Affiliation(s)
- Hongxiu Ji
- Department of Pathology, Overlake Hospital Medical Center, Bellevue, Washington.,Incyte Diagnostics, Bellevue, Washington
| | - Margie Bridges
- Department of Obstetrics and Gynecology, Overlake Hospital Medical Center, Bellevue, Washington
| | - Elizabeth Pesek
- Department of Obstetrics and Gynecology, Overlake Hospital Medical Center, Bellevue, Washington
| | - Kristin Graham
- Department of Obstetrics and Gynecology, Overlake Hospital Medical Center, Bellevue, Washington
| | - Lennart Tan
- Department of Pathology, Overlake Hospital Medical Center, Bellevue, Washington.,Incyte Diagnostics, Bellevue, Washington
| | - Shilpi Chabra
- Neonatal Intensive Care Unit, Overlake Hospital Medical Center, Bellevue, Washington.,Department of Pediatrics and Neonatology, University of Washington, Seattle, Washington
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Shakiba T, Sadeghnia A, Karbasizade V. Detection of bla CTX-M15 and bla OXA-48 genes in Gram-negative isolates from neonatal sepsis in central of Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2019; 11:280-287. [PMID: 31719958 PMCID: PMC6829106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to determine the prevalence of neonatal sepsis with a focus on antibiotic resistance and the frequency of the bla CTX-M-15 and bla OXA-48 genes in Gram-negative isolates. MATERIALS AND METHODS A total of 108 Umbilical Cord Blood (UCB) and 153 peripheral blood samples were cultured via BACTEC from May 2017 to June 2018. The bacterial isolates were identified using phenotypic and genotypic analyses. The antibiotic susceptibility profile of the isolates was determined by disk diffusion. PCR was used to determine the frequency of β-lactamase genes. RESULTS Among the 153 infants, 21 (13.7%) proved positive for sepsis. Escherichia coli, Staphylococcus epidermidis and Klebsiella pneumoniae were the most frequent isolates in the peripheral blood cultures. E. coli and Stenotrophomonas maltophilia were isolated from two UCB cultures. The highest resistance among the Gram-positive strains was to cefixime, ceftriaxone, cefotaxime and clindamycin. In the Gram-negative bacteria the highest rates of resistance were to ampicillin (91.7%). The frequency of bla OXA-48 and bla CTX-M-15 genes was 25% and 50%, respectively. CONCLUSION The high antibiotic resistance among the isolates reveals the importance of monitoring antibiotic consumption and improving control standards in the health care system, especially in neonatal wards.
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Affiliation(s)
- Taiebeh Shakiba
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Sadeghnia
- Department of Paediatrics, School of Medicine, Imam Hossein Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vajihe Karbasizade
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Corresponding author: Vajihe Karbasizade, Ph.D, Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Tel: +98 3137929069, Fax: +983136265606,
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Bunduki GK, Adu-Sarkodie Y. Clinical outcome and isolated pathogens among neonates with sepsis in Democratic Republic of the Congo: a cross-sectional study. BMC Res Notes 2019; 12:303. [PMID: 31138330 PMCID: PMC6540359 DOI: 10.1186/s13104-019-4346-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/24/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Neonatal sepsis still remains a significant cause of morbidity and mortality in developing countries. The prediction of the neonatal sepsis outcome depends on the anticipation from the clinical history, suspicion from clinical findings and confirmation by laboratory tests. This study aimed to determine the clinical outcome and isolated pathogens among neonates with sepsis in Butembo, Democratic Republic of the Congo. RESULTS The most frequent bacteria related to a poor outcome were Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Klebsiella spp. Most of isolated bacteria were found to be hospital-acquired infections. Therefore, adherence to infection prevention and control measures would reduce reduced rate of neonatal sepsis in our setting. The empiric antibiotic treatment should cover the spectrum of bacteria responsible of neonatal sepsis in Butembo, DRC.
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Affiliation(s)
- Gabriel Kambale Bunduki
- Department of Infectious Diseases, Faculty of Medicine, Université Catholique du Graben, PO.Box 29, Butembo, North-Kivu Democratic Republic of the Congo
- Department of Clinical Microbiology, School of Medical Sciences, College of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- Department of Clinical Microbiology, School of Medical Sciences, College of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Mutlu M, Aslan Y, Aktürk Acar F, Kader Ş, Bayramoğlu G, Yılmaz G. Changing trend of microbiologic profile and antibiotic susceptibility of the microorganisms isolated in the neonatal nosocomial sepsis: a 14 years analysis. J Matern Fetal Neonatal Med 2019; 33:3658-3665. [PMID: 30760078 DOI: 10.1080/14767058.2019.1582633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: Neonatal sepsis, especially nosocomial sepsis (NS) is one of the main causes of mortality and morbidity in neonates. Our aim was to investigate microorganisms responsible for NS and antimicrobial susceptibility patterns and to compare them in a different period.Methods: Blood culture registers from the Microbiology Laboratory were reviewed for the study population. The neonates with proven NS were enrolled in the study. Microorganisms responsible for NS and antimicrobial susceptibility patterns were recordedResults: The incidence of Gram-positive, Gram-negative, and fungal microorganisms were 61.6% (n = 570), 27.1% (n = 251) and 11.3% (n = 104), respectively. The most common isolated Gram-positive, Gram-negative pathogens and fungi were Coagulase-negative staphylococci (CoNS), Klebsiella pneumoniae, and C. guilliermondii. There was an increasing resistance rate among common nosocomial pathogens especially oxacillin resistant CoNS strains and increasing rate for extended-spectrum beta-lactamase (ESBL) positive microorganisms. Low susceptibility was detected to commonly used antibiotics for empirical treatment in neonatal sepsis.Conclusions: Our result showed that multiresistant microorganisms, especially oxacillin-resistant staphylococci and gram-negative bacilli resistant to cephalosporin have an increasing rate. Every unit should evaluate the causative agents and antimicrobial susceptibilities in order to select an appropriate regime for nosocomial sepsis. Periodic surveillance of organisms and their antibiotic resistance patterns in every unit might help physicians for proper selection of antibiotics for treatment of neonatal NS.
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Affiliation(s)
- Mehmet Mutlu
- Department of Neonatology Karadeniz Technical University, Trabzon, Turkey
| | - Yakup Aslan
- Department of Neonatology Karadeniz Technical University, Trabzon, Turkey
| | - Filiz Aktürk Acar
- Department of Neonatology Karadeniz Technical University, Trabzon, Turkey
| | - Şebnem Kader
- Department of Neonatology Karadeniz Technical University, Trabzon, Turkey
| | - Gülçin Bayramoğlu
- Department of Clinical Microbiology, Karadeniz Technical University, Trabzon, Turkey
| | - Gürdal Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University, Trabzon, Turkey
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Tosson AMS, Glaser K, Weinhage T, Foell D, Aboualam MS, Edris AA, El Ansary M, Lotfy S, Speer CP. Evaluation of the S100 protein A12 as a biomarker of neonatal sepsis. J Matern Fetal Neonatal Med 2019; 33:2768-2774. [PMID: 30563403 DOI: 10.1080/14767058.2018.1560411] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Sepsis has a grave impact on neonatal morbidity and mortality. Proper timely diagnosis and a subsequently tailored management are crucial to improving neonatal outcome and survival. New diagnostic methods are needed and much effort is directed to this objective. In this work, we aimed to evaluate S100A12 protein as a biomarker of neonatal sepsis.Materials and methods: In this prospective single-center study, 118 preterm and term neonates were enrolled and assigned to four groups: controls, infants with no infection, infants with probable infection and infants with proven infection. Clinical and routine laboratory data, the serum levels of S100A12 and additional cytokines (interleukin (IL)-1β, IL-2, IL-6, IL-17A, IL-18, IL-22, IL-10, and interferon (IFN)-γ) were assessed. Using stepwise multivariate logistic regression analysis, S100A12 protein was evaluated as a biomarker of neonatal infection.Results: Significant differences of the parameters of complete blood count and level of C-reactive protein were documented between the study/the four groups. The studied marker S100A12, as well as IL-6 and IL-10, were highly significant (p < .001) between infected and control groups. S100A12 had a sensitivity of 96.8% and a specificity of 93.3%. Even after adjusting for the confounding factors sex, body weight, gestational age, mode of delivery, number of pregnancies, premature rupture of membranes, and preeclampsia S100A12 remained significant between the infected and control groups.Conclusions: S100A12 may be considered as a new biomarker of neonatal sepsis.
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Affiliation(s)
| | - Kirsten Glaser
- University Children's Hospital, University of Würzburg, Würzburg, Germany
| | - Toni Weinhage
- Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | | | - Amira A Edris
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Mervat El Ansary
- Clinical and Chemical Pathology Department, Cairo University, Cairo, Egypt
| | - Sohilla Lotfy
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Christian P Speer
- University Children's Hospital, University of Würzburg, Würzburg, Germany
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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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Tayel SI, Soliman SE, Elsayed HM. Vitamin D deficiency and vitamin D receptor variants in mothers and their neonates are risk factors for neonatal sepsis. Steroids 2018. [PMID: 29530503 DOI: 10.1016/j.steroids.2018.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Increasing prevalence of neonatal sepsis in recent years catch attention to early prevention and management. Vitamin D receptor (VDR) polymorphism can modulate VDR expression level that greatly influences immunity and susceptibility to microbial infections. We aimed to investigate the association of VDR polymorphism at FokI, rs2228570 T/C, and TaqI, rs731236 C/T gene with serum 25-hydroxyvitamin D level and risk of neonatal sepsis. METHODS This work carried on 160 subjects classified into 80 cases (40 mothers and their 40 septic neonates) and 80 healthy controls (40 volunteer mothers and their 40 healthy neonates). Genotyping of VDR polymorphisms were assayed by real-time PCR and serum 25-hydroxyvitamin D level and hs-CRP were measured by ELISA. RESULTS Vitamin D deficiency was observed in mothers of cases compared with healthy ones (p = <0.001) and in septic neonates versus healthy ones (p = <0.001). Septic neonates had much higher VDR FokI TT genotype (p = 0.014) and T allele (p = 0.003) versus healthy ones. TT genotype and T allele could increase the risk of sepsis with OR 95% CI [4.804 (1.4-16.4)] and [2.786 (1.4-5.7)] respectively while VDR TaqI showed no association with sepsis. There was a strong LD between FokI and TaqI in sepsis cases. In sepsis, T/T genotype at FokI had significantly lower vitamin D (p = <0.001). CONCLUSION Vitamin D deficiency in mothers/neonates is a risk factor for neonatal sepsis. VDR FokI T allele had lower 25-hydroxyvitamin D level that may predispose to sepsis hazards.
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Affiliation(s)
- Safaa I Tayel
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University, Egypt.
| | - Shimaa E Soliman
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Menoufia University, Egypt
| | - Hanan M Elsayed
- Pediatric Department, Faculty of Medicine, Menoufia University, Egypt
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Helmy OM, Kashef MT. Different phenotypic and molecular mechanisms associated with multidrug resistance in Gram-negative clinical isolates from Egypt. Infect Drug Resist 2017; 10:479-498. [PMID: 29263684 PMCID: PMC5726372 DOI: 10.2147/idr.s147192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We set out to investigate the prevalence, different mechanisms, and clonal relatedness of multidrug resistance (MDR) among third-generation cephalosporin-resistant Gram-negative clinical isolates from Egypt. MATERIALS AND METHODS A total of 118 third-generation cephalosporin-resistant Gram-negative clinical isolates were included in this study. Their antimicrobial susceptibility pattern was determined using Kirby-Bauer disk diffusion method. Efflux pump-mediated resistance was tested by the efflux-pump inhibitor-based microplate assay using chlorpromazine. Detection of different aminoglycoside-, β-lactam-, and quinolone-resistance genes was done using polymerase chain reaction. The genetic diversity of MDR isolates was investigated using random amplification of polymorphic DNA. RESULTS Most of the tested isolates exhibited MDR phenotypes (84.75%). The occurrence of efflux pump-mediated resistance in the different MDR species tested was 40%-66%. Acinetobacter baumannii isolates showed resistance to most of the tested antibiotics, including imipenem. The blaOXA-23-like gene was detected in 69% of the MDR A. baumannii isolates. The MDR phenotype was detected in 65% of Pseudomonas aeruginosa isolates, of which only 23% exhibited efflux pump-mediated resistance. On the contrary, efflux-mediated resistance to piperacillin and gentamicin was recorded in 47.5% of piperacillin-resistant and 25% of gentamicin-resistant MDR Enterobacteriaceae. Moreover, the plasmid-mediated quinolone-resistance genes (aac(6')-Ib-cr, qnrB, and qnrS) were detected in 57.6% and 83.33% of quinolone-resistant MDR Escherichia coli and Klebsiella pneumoniae isolates, respectively. The β-lactamase-resistance gene blaSHV-31 was detected for the first time in one MDR K. pneumoniae isolate from an endotracheal tube specimen in Egypt, accompanied by blaTEM-1, blaCTX-M-15, blaCTX-M-14, aac(6')-Ib-cr, qnrS, and multidrug efflux-mediated resistance. CONCLUSION MDR phenotypes are predominant among third-generation cephalosporin-resistant Gram-negative bacteria in Egypt and mediated by different mechanisms, with an increased role of efflux pumps in Enterobacteriaceae.
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Affiliation(s)
- Omneya M Helmy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Mona T Kashef
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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