Early-onset neonatal sepsis: It is not only group B streptococcus

International Journal of Contemporary Pediatrics, 2020

The source of the pathogen might be attributed to an inutero infection, acquisition from maternal flora, or postnatal acquisition from the hospital or community. The time of exposure, pathogen, immune status of the infant, and virulence influence the clinical expression of neonatal sepsis. Neonatal sepsis includes septicemia, pneumonia, meningitis, osteomyelitis, arthritis and urinary tract infections.

Cambridge University Press eBooks, 2017

acterial infections leading to sepsis in the neonate can occur from exposure to bacteria in the intrauterine environment or in the immediate postnatal environment. Infection and sepsis are not differentiated in neonates, as most infections develop into sepsis in neonates due to their weaker immune systems, poor responsiveness to bacteria, and immaturity (see Defi ciencies in newborn immune systems). If a neonate gets an infection, it almost always results in sepsis; this is why any neonate brought into the ED with a fever receives an immediate workup for sepsis and meningitis. An infection can cause pneumonia, septicemia, urosepsis, or meningitis. Early onset sepsis is defi ned as a life-threatening infection that occurs within the fi rst week of a newborn's life, with late-onset sepsis occurring after the fi rst week of life. Most early onset infections in neonates are either pneumonia or overwhelming sepsis and present with signs and symptoms within the fi rst 24 hours after birth. 1,2 Meningitis is often associated with late-onset sepsis but can also occur with early onset sepsis. 2 This article provides a broad overview of bacterial sepsis in the neonate, including pathogens, clinical manifestations, diagnosis, and antimicrobial treatment. The incidence of early onset neonatal sepsis is less than one case per 1,000 live births. 3 The incidence in preterm

Journal of Ayub Medical College, Abbottabad : JAMC

Neonatal sepsis is one of the major causes of neonatal morbidity and mortality, particularly in developing countries. The objective of this study was to determine the causative bacteria and level of their resistance to commonly used antibiotics. This descriptive study was carried out at Ayub Teaching Hospital, Abbottabad from April 2009 to January 2010. All neonates of either gender admitted in neonatology unit with clinical sepsis and positive blood culture were included in the study. Neonatal period was defined as 28 days of life at term and up to 44 weeks of gestational age in preterm babies. One hundred and thirty neonates of either gender were studied during the period. Blood sample for culture was taken from a peripheral vein or an artery ensuring standard anti-septic measures. BACTEC technique was used for obtaining bacterial growth and drug sensitivity after incubation of 24-48 hours. Second blood culture was also performed in few cases which were not showing improvement aft...

The Indian Journal of Pediatrics, 2000

A 22 months prospective study of neonatal gram-negative bacteremia was undertaken in a 15 bed NICU to find out the incidence and antibiotic resistance patterns. Clinically suspected 1326 cases of neonatal sepsis were studied during this period. More than 25% of the cases were microbiologically positive for sepsis. Among 230 (67.2%) cases of gram-negative bacteremia, the predominant isolates were Pseudomonas aeruginosa (38.3%), Klebsiella pneurnoniae (30.4%), Escherichia carl (15.6%) and Acinetobactersp. (7.8%). Fifty-nine per cent of the neonates were born in hospital while 41% were from community and referral cases. Lower respiratory tract infection, umbilical sepsis, central intravenous line infection and infection following invasive procedures were the most commonly identified sources of.septicemia. Prematurity and low birth weight were the main underlying conditions in 60% of the neonates. Total mortality was 32%. Increased mortality was mainly associated with neutropenia, nosocomial infection and inappr6priate antibiotic therapy. Resistance was increasingly noted agains't many antibiotics. The isolates were predominantly resistant to extended spectrum cephalosporins (25%-75%), piperacillin (68%-78%), and gentamicin (23%-69%). The commonest microorganisms causing gram-negative bacteremia were Pseudomonas aeruginosa followed by Klebsiella pneumoniae. The community-acquired bacteremia was mainly due to E. coil The proportion of preterm and low birth weight babies was significantly high, and the major contributing factor in total mortality. Sensitivity to different antibiotics conclusively proved that a combination of ampicillin + sulbocfam with amikocin or ampicillin + sulbactam with ciprofloxacin is most effective.

Italian Journal of Pediatrics, 2011

Pediatrics International, 2009

Background : Clinical features and outcomes of neonatal sepsis caused by resistant Gram-negative bacteria are not well described in Jordan . The aim of the present study was therefore to describe microbiology and clinical features, laboratory fi ndings and outcomes of early-and late-onset Gram-negative neonatal sepsis. Methods : All patients with Gram-negative bacteremia between July 2003 and June 2005 were retrospectively included. Resistance profi les, clinical features and outcomes of early and late-onset neonatal sepsis were compared. Results : A total of 79 patients (after excluding all nine cases of Gram-positive bloodstream infection (BSI ) were identifi ed as having Gram-negative BSI (25 had early-onset and 54 had late-onset neonatal sepsis). Respiratory distress, metabolic acidosis and requirement of ventilation were found in 74.7%, 40.5%, and 58.2%, respectively. Hypotension was found in 22.9% of patients. Klebsiella pneumoniae was responsible for 43 cases (54.4.2%). Klebsiella pneumoniae resistance rates to ampicillin and ceftazidime were 100% and 50%, respectively. Mortality rate was 30.9%. Forty-eight percent of deaths occurred within 3 days of sepsis. Meningitis was diagnosed in fi ve cases. Elevated C-reactive protein (CRP) and thrombocytopenia were seen in 28% and 24% of infants with early-onset sepsis, respectively, and in 79.6%, 59.3% of infants with late-onset sepsis respectively. Conclusion : Both early-and late-onset neonatal sepsis are caused by highly resistant Gram-negative bacteria. Mortality of sepsis is high. Elevated CRP and thrombocytopenia is seen more commonly in late-onset neonatal sepsis.

Antibiotics

Bloodstream infections play an important role in neonatal morbidity and mortality. In this study, we retrospectively analyzed etiology and antibiotic resistance profiles of bacteria isolated from blood or Cerebro Spinal Fluid (CSF) cultures to evaluate the appropriateness of initial empirical therapy of neonatal sepsis. Methods: microbiological data from patients admitted to Neonatal Intensive Care Unit (NICU), from January 2005 to October 2018, were anonymously extracted from the Laboratory of Microbiology database. According to the neonatal sepsis definition for patients admitted to NICU, positive cultures obtained within the first 72 h of life were labeled as Early Onset Sepsis (EOS); and Late Onset Sepsis (LOS) for those obtained later. Results: 859 bacterial strains, 846 from blood and 13 from CSF, were detected in 611 neonates. In EOS, 75 blood cultures were found: 61 yielded Gram-positives and 14 Gram-negatives. Coagulase Negative Staphylococci (CoNS) represented the majority...

2015

Background: To determine the spectrum of causative bacteria and their antibiotics sensitivity and resistance patterns in neonatal sepsis. Methods: In this descriptive study 50 newborns having blood culture proven septicemia were included. Neonates delivered at home or other health facility and consent refused by parents / guardian of neonate were excluded. Information regarding the organisms grown on blood culture (done by BACTEC method) was noted along with the sensitivity and resistance patterns ( checked by standard disc diffusion method) of commonly used antibiotics. During analysis, frequencies and percentages for all categorical variables, i.e. organisms grown on blood culture, their antibiotic sensitivity and resistance patterns, gender, birth weight ( low, very low or normal ), gestational age ( pre, post or term), mode of delivery ( vaginal or caesarean section) and age of onset of illness (early or late ), were calculated. Results: A total of 50 newborns with blood culture...

International Journal of Health Sciences and Pharmacy (IJHSP), 2020

Neonatal sepsis is one of the most prevalent major health problems, affecting an estimate of around thirty million newbornseach year throughout the world. The onset of sepsis within the first fourty-eight hours after birth is associated with prenatal and perinatal predisposing factors. The on set of sepsis between fourty-eight and seventy-two hours of life usually indicatesnosocomially acquired infections. Klebsiella Pneumonia is the leading pathogenic organism causing neonatal sepsis in Asian countries, and the most important etiological factor for neonatal sepsisis found to be low birth weight. Sepsis score is a useful method for early and rapid diagnosis of neonatal sepsis. Antibiotics are given to most neonates suspected to be infected. Ampicillin and gentamicin are the first line treatment. The occurrence of neonatal sepsis can be brought down by practising clean and safe delivery, early & exclusive breast feeding, strict postnatal cleanliness which should be followed by adequate hand-washing and aseptic methods. Neonatal sepsis is the third leading cause of neonatal mortality and a major public health problem. Despite major advances in neonatal medical care, the frequent presence of non-infectious conditions resembling sepsis pose a challenge to the diagnosis of neonatal sepsis, especially seen in preterm infants. Another factor complicating the diagnostic procedure is the absence of optimal diagnostic tests. Neonatal sepsis is among the leading high-risk diseases that infect newborns, especially preterm infants, warranting an aggressive line of treatment. Clinical practitioners are compelled to use broad spectrum antibiotics to neonates with high risk factors and/or signs of suspected infection. But the use of empirical antibiotic coverage and also their prolonged use contribute to the rising incidence of resistance amongst microbial strains.Apart from the high occurrence rate and mortality rate of sepsis in preterm infants, its long-term consequences also include adverse effects on growth and development. In our review, we touch upon the most common doubts and challenges faced during the diagnosis and management of neonatal sepsis. [1].

Journal of Hygiene, 1985

SUMMARYOver a two-year period 160 episodes of serious infection occurred in 139 infants admitted to a regional neonatal intensive-care unit. Eighty-seven (26%) of very low birth weight (VLBW) neonates and 52 (8%) of infants of birth weight > 1500 g were infected. The majority (84%) had bactcraemia alone. Though the clinical features of infection were not distinctive, in 94% of episodes the peripheral white blood cell or band counts were abnormal. Thirty-three (21%) of the infections occurred in infants under 48 h old and 15 of these followed prolonged rupture of membranes (>48h). All of the infections due to group B streptococci (5),Streptococcus viridans(2) andHaemophilus influenzae(3) occurred in this group. Coagulase-negativc staphylococci (CONS) accounted for 49% of the infections and there was a marked increase in incidence of such infections during the survey. Infections with CONS were not necessarily associated with parenteral nutrition, the presence of intra-arterial c...