Treatment outcomes, antibiotic use and its resistance pattern among neonatal sepsis patients attending Bahawal Victoria Hospital, Pakistan

Magnitude of neonatal sepsis and its associated factors among neonates admitted to the neonatal intensive care unit in Hawassa Comprehensive Specialized Hospital, Sidama Regional State, Ethiopia, 2020

BACKGROUND

Neonatal sepsis is one of the most common causes of disease and death among neonates globally. And it made a great contribution to neonatal admission to intensive care units. To mitigate the ongoing neonatal crisis and accomplish the goal of sustainable development through a decrease in neonatal mortality, information from various regions is needed. Despite the considerable burden of neonatal sepsis in our setting, no prior studies were conducted in the study area. So, this study aimed to assess the magnitude and associated factors of neonatal sepsis among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama Regional State, Ethiopia.

METHODS

A hospital-based cross-sectional study was carried out among 287 neonates from March 1, 2020, to April 25, 2020. An interviewer-administered structured questionnaire was used to collect the data. The data were cleaned, coded, and entered into Epi Data 3.1 software and exported to Statistical Package for Social Science (SPSS) software version 23.0 for analysis. Binary logistic regression analyses were performed to identify variables having a significant association with neonatal sepsis. A p-value of ≤ 0.05 was considered statistically significant during multivariable logistic regression.

RESULTS

The study found that the magnitude of neonatal sepsis was 56%. The mean age of neonates was 3.2(SD±2.2) days. Around two-fifths (39%) of neonates were in the gestational age of <37 completed weeks. A quarter of mothers(25.8%) were delivered through cesarean section. During labor, 251 (87.5%) mothers had ≤4 digital vaginal examinations. Moreover, the finding revealed that mothers who delivered by cesarean section [AOR = 2.13, 95% CI (1.090-4.163)]. neonates who had been resuscitated at birth [AOR = 4.5, 95% CI (2.083-9.707)], and neonates who had NG tube inserted [AOR = 4.29, 95% CI (2.302-8.004)] were found to be significantly associated with neonatal sepsis.

CONCLUSIONS

The current study shows that neonatal sepsis was prevalent among more than half of the neonates admitted to the NICU. Therefore, designing strategies to enhance the aseptic techniques of professionals in the provision of care and actively and collaboratively working with cluster health facilities is highly recommended.

Time to death and its predictors among neonates admitted with sepsis in neonatal intensive care unit at comprehensive specialized hospitals in Northeast Ethiopia

Background

In impoverished nations like Ethiopia, neonatal sepsis contributes significantly to neonatal mortality. Despite variations in the specific timing of death and predictors of neonatal mortality associated with sepsis across different settings, there's limited documented information in the Neonatal Intensive Care Units of northeastern Ethiopia. Consequently, the aim of this study was to determine time to death and its predictors among neonates with sepsis admitted to Neonatal Intensive Care Units in comprehensive specialized hospitals in northeastern Ethiopia.

Methods

A prospective cohort study conducted at the institution level involved 306 neonates diagnosed with sepsis. Data collection utilized face-to-face interviews and chart reviews. Subsequently, the data were inputted into Epi-data version 4.6 and later analyzed using STATA version 17. The median time to death was determined, and both the Kaplan-Meier curve and log-rank test were applied. Furthermore, a Cox proportional hazard regression model was utilized to identify predictors of neonatal mortality associated with sepsis.

Result

The cumulative incidence of mortality among neonates admitted with sepsis was 34% (95% CI: 28.9%-39.5%). The neonatal mortality rate stood at 51 (95% CI: 42.1, 62) per 1,000 neonates admitted to the intensive care units with sepsis over a total of 1,854 person-days of observation. Additionally, the median time to death was 13 days (IQR = 5-23 days). Tachypnea [AHR 6.2 (95% CI: 1.5-9.7)], respiratory distress syndrome [AHR 2.1 (95% CI: 1.3-3.5)], lethargy [AHR 1.8 (95% CI: 1.2-2.6)], preterm birth [AHR 1.8 (95% CI: 1.2-2.7)], continuous positive airway pressure use [AHR 2.1 (95% CI: 1.3-3.4)], home delivery [AHR 2.63 (95% CI: 1.1-6.4)], Subgalea hemorrhage [AHR 1.8 (95% CI: 1.1-3.9)], and low platelet count [AHR 5.9 (95% CI: 2.3-8.6)] were found to be predictors of time to death in neonates with sepsis.

Conclusion

The study revealed an alarmingly high neonatal mortality rate among septic neonates, underscoring the urgency for intervention. Enhancing the quality of care in neonatal intensive care units, bolstering infection prevention during procedures such as continuous positive airway pressure, exercising caution with locally made accessories, and reinforcing a culture of institutional delivery are critical in curbing neonatal sepsis-related mortalities.

An Overview of Antibiotic Therapy for Early- and Late-Onset Neonatal Sepsis: Current Strategies and Future Prospects

Neonatal sepsis is a clinical syndrome mainly associated with a bacterial infection leading to severe clinical manifestations that could be associated with fatal sequalae. According to the time of onset, neonatal sepsis is categorized as early- (EOS) or late-onset sepsis (LOS). Despite blood culture being the gold standard for diagnosis, it has several limitations, and early diagnosis is not immediate. Consequently, most infants who start empirical antimicrobial therapy do not have an underlying infection. Despite stewardship programs partially reduced this negative trend, in neonatology, antibiotic overuse still persists, and it is associated with several relevant problems, the first of which is the increase in antimicrobial resistance (AMR). Starting with these considerations, we performed a narrative review to summarize the main findings and the future prospects regarding antibiotics use to treat neonatal sepsis. Because of the impact on morbidity and mortality that EOS and LOS entail, it is essential to start an effective and prompt treatment as soon as possible. The use of targeted antibiotics is peremptory as soon as the pathogen in the culture is detected. Although prompt therapy is essential, it should be better assessed whether, when and how to treat neonates with antibiotics, even those at higher risk. Considering that we are certainly in the worrying era defined as the "post-antibiotic era", it is still essential and urgent to define novel strategies for the development of antibacterial compounds with new targets or mechanisms of action. A future strategy could also be to perform well-designed studies to develop innovative algorithms for improving the etiological diagnosis of infection, allowing for more personalized use of the antibiotics to treat EOS and LOS.

Regional and National Trends in Consumption of Antimicrobials in Pakistan; Pre and Post-COVID (2019-2021)

BACKGROUND

Efforts to combat antimicrobial resistance, a growing public health problem in Pakistan, have been hampered by the lack of high-quality national and provincial-level antimicrobial consumption data. The singular objective of this retrospective study was to measure antimicrobial consumption over 3 years between 2019 and 2021.

METHODS

The study was designed to estimate antimicrobial consumption at National and Regional levels. Antimicrobial consumption data was collected by IQVIA covering 110 districts of Pakistan in which 88% of sales are census (accurate sales collected directly from distributors), whereas 12% of sales (sales of 300 pharmacies) are projected on the national level. To determine the usage for 3 consecutive years, the consumption of antibiotics was calculated as defined daily doses (DDD) of antibiotics per 1000 inhabitants per day (DID).

RESULTS

The results of our study demonstrated a steep increase in the consumption of antimicrobials from 2019 to 2021. An increase in consumption of most classes of antibiotics was observed both nationally and Regionally. Quinolones, penicillins (co-amoxiclav), macrolides, and third-generation cephalosporins remained the most frequently used antibiotics nationally. A 40% increase in intravenous use of antimicrobials was observed between 2019 and 2021 at the national level. Moxifloxacin, Levofloxacin, Ciprofloxacin, and linezolid were the most commonly used intravenous antibiotics. Region 7 (Peshawar) demonstrated the highest consumption, followed by Region 1 (Karachi) and Region 6 (Faisalabad). Among the most commonly used antibiotics, the use of third-generation cephalosporin (cefixime), quinolones, penicillins (amoxicillin + clavulanic acid), and macrolides (azithromycin) was most noticeable in all regions, particularly in those with the higher consumption of antibiotics.

CONCLUSIONS

Although the increase in consumption of all antibiotics is concerning, the steep increase in the use of watch and reserve category antibiotics during the study period calls for immediate actions to limit and regulate their usage.

Antibiotic Susceptibility Surveillance in the Punjab Province of Pakistan: Findings and Implications

Background and Objectives: The increase in antimicrobial resistance (AMR) across countries has seriously impacted the effective management of infectious diseases, with subsequent impact on morbidity, mortality and costs. This includes Pakistan. Antimicrobial surveillance activities should be mandatory to continually assess the extent of multidrug-resistant bacteria and the implications for future empiric prescribing. The objective of this retrospective observational study was to monitor the susceptibility pattern of microbes in Pakistan. Materials and Methods: Clinical samples from seven laboratories in Punjab, Pakistan were collected between January 2018 and April 2019, with Punjab being the most populous province in Pakistan. The isolates were identified and their antimicrobial susceptibility was tested using the Kirby-Bauer disc diffusion assay and micro broth dilution methods. The antibiotics assessed were those typically prescribed in Pakistan. Results: In total, 2523 bacterial cultural reports were studied. The most frequently isolated pathogens were Staphylococcus aureus (866, 34.3%), followed by Escherichia coli (814, 32.2%), Pseudomonas aeruginosa (454, 18.0%) and Klebsiella pneumoniae (269, 10.7%). Most pathogens were isolated from pus (1464, 58.0%), followed by urine (718, 28.5%), blood (164, 6.5%) and sputum (81, 3.2%). Conclusions: The findings suggest that current antimicrobial options are severally restricted in Pakistan due to the emergence of multidrug-resistant pathogens. This calls for urgent actions including initiating antimicrobial stewardship programs to enhance prudent prescribing of antibiotics. This includes agreeing on appropriate empiric therapy as part of agreed guidelines, in line with the WHO EML and AWaRe book, whilst awaiting culture reports. This is alongside other measures to reduce inappropriate antimicrobial prescribing and reverse the threat of rising AMR.

High prevalence of Panton-Valentine Leucocidin (PVL) toxin carrying MRSA and multidrug resistant gram negative bacteria in late onset neonatal sepsis indicate nosocomial spread in a Pakistani tertiary care hospital

BACKGROUND

Neonatal sepsis has high incidence with significant mortality and morbidity rates in Pakistan. We investigated common etiological patterns of neonatal sepsis at a tertiary care setup.

METHODS

90 pus and blood, gram negative and gram positive bacterial isolates were analyzed for virulence and antibiotic resistance gene profiling using PCR and disc diffusion methods.

RESULTS

Staphylococcus aureus showed strong association with neonatal sepsis (43 %) followed by Citrobacter freundii (21 %), Pseudomonas aeruginosa (13 %), Escherichia coli (15 %) and Salmonella enterica (8 %). Molecular typing of E. coli isolates depicted high prevalence of the virulent F and B2 phylogroups, with 4 hypervirulent phylogroup G isolates. 76.9 % S. aureus isolates showed presence of Luk-PV, encoding for Panton-valentine leucocidin (PVL) toxin with majority also carrying MecA gene and classified as methicillin resistant S. aureus (MRSA). ecpA, papC, fimH and traT virulence genes were detected in E. coli and Salmonella isolates. 47 % Citrobacter freundii isolates carried the shiga like toxin SltII B. Antimicrobial resistance profiling depicted common resistance to cephalosporins, beta lactams and fluoroquinolones.

CONCLUSION

Presence of PVL carrying MRSA and multidrug resistant gram negative bacteria, all isolated from late onset sepsis neonates indicate a predominant nosocomial transmission pattern which may complicate management of the disease in NICU setups.

Incidence of death and its predictors among neonates admitted with sepsis in referral hospitals, northwest Ethiopia, a prospective cohort study

Background

Each year, approximately 2.7 million neonates die in their first month of life worldwide, and the majority of these deaths occur in low-income countries. According to the Global Burden of Disease estimation, 1.3 million annual incident cases of neonatal sepsis were reported worldwide, resulting in 203,000 sepsis-attributable deaths. Little is known about the time to death of neonates and predictors after admission with a diagnosis of sepsis. This study aimed to assess the incidence and predictors of death among neonates admitted to the neonatal intensive care unit with a diagnosis of sepsis in referral hospitals in Northwest Ethiopia.

Methods

A multicenter prospective follow-up study was conducted from November 11 to December 7, 2021. A stratified random sampling technique was employed to select 412 neonates. Neonates admitted with sepsis were followed until they develop event for a maximum of 28 days of age. A face-to-face interview was conducted with the mother of the neonate using a pretested and structured questionnaire, and neonatal charts were reviewed to collect baseline factors. Data were entered into Epi-data version 4.6 and exported to STATA version 14 for analysis. A bivariable and multivariable exponential Cox regression model was fitted to identify predictors of death. The adjusted hazard ratio (AHR) with 95% CI was calculated, and statistical significance was declared at a P-value of 0.05 in the multivariable analysis.

Results

A total of 75 (18.47%) neonates died during the study period, with a 95% CI of 14.82-22.60. The incidence rate of death was 28 (95% CI, 22, 35) per 1,000 person-days of observation, with a total follow-up time of 2,677 person-days of observation. Birth weight (<2,500 g) (AHR = 2.12, 95% CI: 1.01, 4.43), prematurity (AHR = 2.06, 95% CI: 1.02, 4.15), duration of labor >24 h (AHR = 3.89, 95% CI: 1.38, 11.01), breast feeding (AHR = 0.43, 95% CI: 0.23, 0.80), having respiratory distress syndrome (AHR = 1.77, 95% CI: 1.02, 306), oxygen saturation less than 90% (AHR = 2.23, 95% CI: 1.02, 306) were significant predictors of death among neonates admitted with sepsis.

Conclusion and recommendation

The incidence of neonatal mortality in this study was high. Early detection and appropriate management of patients' presentations like respiratory distress syndrome and low oxygen saturation are necessary to reduce neonatal sepsis-related mortality. Special attention should be given to low birth weight and premature neonates and mothers should be encouraged to breastfeed their newborns after delivery.

Length of Hospital Stay and Its Predictors Among Neonatal Sepsis Patients: A Retrospective Follow-Up Study

INTRODUCTION

Sepsis is common among neonates, and is often fatal. Hospitalization results in severe nosocomial infections which could be resistant to antibiotics. It also incurs higher fees for medical care.

METHODS

A retrospective follow-up study, which includes 206 neonates, was conducted to assess the length of hospital stay among neonatal sepsis patients from September 2018 to September 2020 at TASH Hospital, Addis Ababa, Ethiopia. Data were collected from medical charts. Mean length of hospital stay was compared using independent sample t-tests. Risk factors for length of stay were identified using binary logistic regression analysis.

RESULTS

All neonates stayed a total of 325 days, which gives 75,512 neonate-days. Neonates who stayed more than 7 days had low mean birth weight and higher mean age at admission. Mean length of stay was higher among neonates with comorbid illness, neonates with drug therapy problems and male neonates. Even though the mean length of stay is shorter among neonates with maternal PROM and CS delivery, these maternal factors were found to be insignificant in the multivariate logistic regression.

DISCUSSION

Similar to other studies, neonates with low birth weight and comorbidity had a longer hospital stay. Neonates with maternal PROM and CS delivery had a shorter stay. But these maternal factors, identified by prior studies as risk factors for neonatal sepsis and its mortality, are not found to be predictors of prolonged hospitalization. Having neurologic features and drug therapy problems among neonates with sepsis prolonged hospital stay.

CONCLUSION

The mean length of stay varies with respect to maternal and neonatal factors. Lower birth weight, presence of neurologic features, presence of comorbidity, presence of drug therapy problems and being male are found to be predictors of a longer hospital stay among neonates with sepsis.

Pattern of Antimicrobial Susceptibility and Antimicrobial Treatment of Neonates Admitted with Suspected Sepsis in a Teaching Hospital in Ghana, 2021

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.

Antimicrobial Utilization among Neonates and Children: A Multicenter Point Prevalence Study from Leading Children’s Hospitals in Punjab, Pakistan

Antimicrobial resistance (AMR) compromises global health due to the associated morbidity, mortality, and costs. The inappropriate use of antimicrobial agents is a prime driver of AMR. Consequently, it is imperative to gain a greater understanding of current utilization patterns especially in high-risk groups including neonates and children. A point prevalence survey (PPS) was conducted among three tertiary care children’s hospitals in the Punjab province using the World Health Organization (WHO) methodology. Antibiotic use was documented according to the WHO AWaRe classification. Out of a total of 1576 neonates and children, 1506 were prescribed antibiotics on the day of the survey (prevalence = 95.5%), with an average of 1.9 antibiotics per patient. The majority of antibiotics were prescribed in the medical ward (75%), followed by surgical ward (12.8%). Furthermore, 56% of antibiotics were prescribed prophylactically, with most of the antibiotics (92.3%) administered via the parenteral route. The top three indications for antibiotics were respiratory tract infections (34.8%), gastrointestinal infections (15.8%), and prophylaxis for medical problems (14.3%). The three most common antibiotics prescribed were ceftriaxone (25.8%), amikacin (9.2%), and vancomycin (7.9%). Overall, 76.6% of the prescribed antibiotics were from Watch category followed by 21.6% from the Access group. There was a very high prevalence of antibiotic use among hospitalized neonates and children in this study. Urgent measures are needed to engage all the stakeholders to formulate effective ASPs in Pakistan, especially surrounding Watch antibiotics.

Understanding of Future Prescribers About Antimicrobial Resistance and Their Preparedness Towards Antimicrobial Stewardship Activities in Pakistan: Findings and Implications

Background: Insufficient antimicrobial-related training for physicians during their undergraduate education could have a negative impact on their prescribing. Unlike previous studies, this study not only explored the understanding and perception of Pakistani medical students about antibiotics and resistance, but also their preparedness towards antimicrobial stewardship programs.

Methods: An online cross-sectional study was undertaken with final-year medical students using a validated questionnaire from January 2021 to May 2021. Descriptive and inference statistics were applied for data analysis.

Results: Of 411 students, only 6.3% had undergone antimicrobial resistance (AMR) training. 16.1% of students believed that antibiotics are effective for viral ailments. More than half of the students agreed that AMR is a major healthcare problem in Pakistan (65.9%). Most students viewed poor infection control practices (66.9%), the use of too many broad-spectrum antibiotics (68.4%) for a longer duration (62.8%) with inadequate doses (67.9%) as the causes of AMR. The student’s preparation was insufficient in interpreting microbiological and pathological results (26.3%), selecting the correct antibiotics (22.1%), and awareness of the antibiotic spectrum (20.9%). The median preparedness score showed significant differences with sex (p = 0.049), age (p < 0.001), institute type (p = 0.014), and family income (p = 0.006).

Conclusion: Pakistani medical students showed adequate understanding of antibiotics, but lacked preparedness for several components of ASPs, including interpretation of microbiological results and spectrum of antibiotics. More steps need to be taken to prepare medical students for AMR and stewardship initiatives adequately.

Frequency and Factors Associated With Adverse Events Among Multi-Drug Resistant Tuberculosis Patients in Pakistan: A Retrospective Study

Background

Treatment of multi-drug resistant tuberculosis (MDR-TB) for a prolonged period with comparatively less effective and more toxic second-line anti-TB drugs is associated with greater incidence of adverse events.

Study aim

This study aimed to evaluate the frequency and factors associated with occurrence of adverse events among patients with MDR-TB attending the Bahawal Victoria Hospital, Bahawalpur, Pakistan.

Study design

This retrospective study included all patients with MDR-TB who were registered and treated at the study site between June 2014 and December 2016 and had their treatment outcomes available at the time of data collection (i.e., November 2018).

Measures and outcomes

The Electronic Nominal Record System (ERNS) records, medical charts of patients, and laboratory reports were reviewed to obtain the data. Adverse events were reported as per the standard criteria recommended by the WHO. Multivariate binary logistic regression was used to find the independent factors associated with the occurrence of adverse events.

Results

A total of 179 patients with MDR-TB were included in the final analysis. Out of these, 114 (63.7%) patients experienced at least one adverse event during the course of their treatment. Depression was the most common adverse events (33%), followed by nausea and vomiting (27.4%) and arthralgia (27.4%). The factors associated with the occurrence of adverse events included presence of comorbidity (adjusted odds ratio [AOR] 2.951; 95% CI 1.423, 6.118) and being employed (AOR 3.445; 95% CI 1.188, 9.993).

Conclusion

Adverse events were prevalent in this cohort, however, resolved with the effective management approaches. Patients with identified factors for occurrence of adverse events need special attention and enhanced clinical management.

Common Bacterial Isolates Associated With Neonatal Sepsis and Their Antimicrobial Profile: A Retrospective Study at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Background

Neonatal sepsis is a major contributor to morbidity and mortality among neonates. There has been considerable geographic variation in causative pathogens and antimicrobial sensitivity profiles over time. This makes the continuous monitoring of patterns of emergence crucial for the effective implementation of antimicrobial therapy guidelines in an attempt to control antimicrobial resistance.

Methods

A retrospective study was conducted among neonates with sepsis admitted to King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between May 2011 and October 2018. The data were collected from medical records in the neonatal intensive care unit and analyzed using SPSS version 20 (IBM Corp., Armonk, NY).

Results

There were 246 neonates clinically diagnosed with sepsis, of whom 40 (16.26%) had positive blood cultures. In the blood cultures, coagulase-negative Staphylococcus was the most prevalent microorganism (57.5%), followed by Klebsiella spp. (10%). Streptococcus agalactiae, Enterobacter cloacae, Escherichia coli, Acinetobacter baumanii, and Candida spp. each accounted for 5% of all isolates. Only single isolates of methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Bacillus spp. (2.5% each) were detected in this study. Most of the isolated microorganisms exhibited high sensitivity to ampicillin and gentamicin.

Conclusions

This study points to a likely emergence of coagulase-negative Staphylococci as the main cause of sepsis among neonates. Ampicillin and gentamicin are highly effective against the commonly isolated bacterial pathogens that cause neonatal sepsis.

Pattern of hospital antibiotic use in term neonates using WHO Access, Watch and Reserve Classification (AWaRe)

BACKGROUND AND OBJECTIVE

Pakistan has high neonatal mortality rate and antibiotic utilization data in hospitalized term neonates from Pakistan is lacking. The study aimed to determine the pattern of hospital antibiotic use in term neonates using World Health Organization (WHO) Access, Watch, and Reserve classification (AWaRe).

METHODS

This cross-sectional chart review study was conducted at the neonatal unit of Pediatric Medicine Department of University Hospital over a period of one year from 1^st January 2020 to 31^st December 2020. Hospitalized full term newborns up to 28-days of life, of either gender were consecutively included in the study. Data on demographic characteristics, admission diagnoses and antibiotic prescribed (class, agent and duration) were extracted from clinical charts. Descriptive statistics in the form of mean ± SD and frequency and percentages were calculated.

RESULTS

A total of 2276 term neonates consisting of 69% (n=1570) males were included in the study. Antibiotic prescription rate was 92.8%. Most common reason for admission was birth asphyxia (36.1%) followed by sepsis (33%). Most commonly prescribed antibiotic Ampicillin (84%) belonged to Access group of WHO - AWaRe classification. More than 97% of prescriptions were two or more antimicrobial combinations belonging to Watch group. Ampicillin and Cefoperazone was the most commonly prescribed (42.8%) two drug combination. Meropenem and vancomycin was prescribed to 20% of the neonates - mostly for sepsis and pneumonia. Mortality rate was 7.7% in current study.

CONCLUSION

High antibiotic prescription rate particularly from Watch-group is demonstrated in this study. There is high need of antimicrobial stewardship program in neonatal units.

Analysis of pathogens, drug resistance, sensitive antibiotic treatment and risk factors of early-onset sepsis in very low birth weight infants

The clinical manifestations, types of infectious pathogens, and drug-resistant strains of sepsis in infants with very low birth weight (VLBWIs) vary greatly in different regions and hospitals. In order to improve the level of diagnosis and treatment, this study analyzed the distribution and drug resistance of the pathogenic bacteria of sepsis in VLBWIs in our hospital. A total of 69 cases of VLBWIs in Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University from January 01, 2014 to December 31, 2020 were included. Among them, 34 VLBWIs with early-onset sepsis (EOS) were assigned to the EOS group, and 14 VLBWIs with late-onset sepsis (LOS) were included in the LOS group. The distribution of pathogens and the drug resistance of antibiotics were analyzed. The results showed that fluorescent nanoparticles detected pathogenic bacteria in 48 cases, and the blood cultures were all positive. A total of 49 pathogenic bacteria were isolated, including 27 gram-negative bacteria (55.1%), 21 gram-positive bacteria (42.86%), and 1 fungus (2.04%, Candida albicans). Gram-negative bacteria comprised of E.coli and Klebsiella pneumoniae, which were highly sensitive to compound preparations containing β-lactamase inhibitors, and carbapenem antibacterial drugs, were the first choice. Gram-positive bacteria were mainly Staphylococcus epidermidis and Streptococcus agalactiae. Staphylococcus epidermidis was highly resistant to penicillins and can be treated with vancomycin. Streptococcus agalactiae was highly resistant to penicillins and can be treated with penicillin and vancomycin. Amniotic fluid pollution, intrauterine distress, premature rupture of membranes, and maternal fever were risk factors for EOS in VLBWIs, with odds ratios (ORs) of 9.369, 6.217, 5.638, and 4.267, respectively. In summary, timely and reasonable treatment should be given based on the types and drug resistance characteristics of pathogens of neonatal sepsis and the risk factors of EOS.

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

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.