Study of the immediate clinical outcome of neonatal sepsis in the neonatal I.C.U. of a tertiary care hospital

Background: According to the status of newborns report 2014, about 0.76 million neonatal deaths occur in India, the highest for any country in the world. Although the neonatal mortality rate (NMR) has declined in the last 2 decades, the early NMR has been the slowest to decline. The three major causes of neonatal deaths are preterm birth complications, infections, and intrapartum related complications; together, they contribute to nearly 90% of total neonatal deaths. The aim of the study was to study the immediate clinical outcomes of culture proven neonatal sepsis in the NICU of Yenepoya Medical College Hospital during the period January 2016 to June 2016.Methods: Retrospective hospital based study of records of all neonates admitted to the NICU with blood culture positive neonatal sepsis from January 2016 till June 2016. Blood cultures were done using the BACTEC 460. Data analysed using SPSS version 20.Results: A diagnosis of probable sepsis was made in 84 (54%) of the total neonates (154) admitted to the NICU during the study period of which 6 were out born babies. Culture positive sepsis was found in 11.6% (18). The most commonly isolated organisms were Escherichia coli, Enterococcus and coagulase negative Staphylococcus aureus. Of the total 18 culture positive cases, urine culture was positive in only 2 cases while the remaining had a positive blood culture. Among the 18 cases of culture positive neonatal sepsis, 8 died while 10 survived.Conclusions: Incidence of neonatal sepsis was relatively high in YMCH with the most predominant organism being coagulase negative Staphylococcus aureus. 12.7% of the sepsis cases died. Resistance to cefotaxime and ampicillin was prevalent.

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Clinical and Bacteriological Profiles of Blood Culture Positive Sepsis in Newborns

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v27i2.1411 ◽

1970 ◽

Vol 27 (2) ◽

pp. 64-67 ◽

Cited By ~ 8

Author(s):

P Shrestha ◽

BK Das ◽

NK Bhatta ◽

DK Jha ◽

B Das ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Blood Culture ◽

Neonatal Sepsis ◽

Tertiary Care ◽

Antibiotic Sensitivity ◽

Coagulase Negative Staphylococcus ◽

Care Hospital ◽

Klebsiella Species ◽

First Choice ◽

Gram Negative Organisms

Neonatal infections currently cause about 1.6 million deaths annually in developing countries. Sepsis and meningitis is responsible for most of these deaths. This study was undertaken to determine the clinical presentations, bacteriological profiles and antibiotic sensitivity patterns of isolates from blood cultures of neonates admitted in a tertiary care hospital in Eastern Nepal. All blood culture reports (n=103) during January 2006 - February 2007 from newborns admitted in neonatal division at BP Koirala Institute of Health Sciences, Nepal were analyzed and antibiotic sensitivity patterns were studied. The positive blood culture was 20% (103/513). Most (97.1%) of the sepsis was caused by single organism, while polymicrobial aetiology was observed in 2.9% cases. Meningitis was documented in 9(8.7%) cases. Staphylococcus aureus (38.8%) and coagulase negative staphylococcus (CONS) (21.3%) are the commonest isolates in blood culture. Among gram-negative organisms, Klebsiella species (11.6%) and Enterobacter species (9.7%) were the leading cause of neonatal sepsis. Majority of newborns with neonatal sepsis presented with refusal to feeds (42.7%), fever (41.7%) and jaundice (41.7%). Most of the organisms showed sensitivity with amino glycosides (gentamicin and amikacin) and third generation cephalosporins. It is concluded that Staphylococcus aureus, CONS, and Klebsiella species remain the principal organisms causing neonatal sepsis and first line antibiotics like amino glycosides should be first choice of drugs. Key words: Blood culture, neonatal sepsis, antibiotic sensitivity. doi:10.3126/jnps.v27i2.1411 J. Nepal Paediatr. Soc. Vol.27(2) p.64-67

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Glycemic Status and its Effect in Neonatal Sepsis in a Tertiary Care Hospital

Bangladesh Journal of Child Health ◽

10.3329/bjch.v40i1.31551 ◽

2017 ◽

Vol 40 (1) ◽

pp. 21-25

Author(s):

Mohammad Saiful Islam ◽

Mohammad Abdul Hai Mia ◽

Khandaker Rokshana Akhter ◽

Mujibul Haque ◽

MA Malik

Keyword(s):

Blood Glucose ◽

Blood Culture ◽

Blood Glucose Level ◽

Glucose Level ◽

Neonatal Sepsis ◽

Tertiary Care ◽

Care Hospital ◽

Glycemic Status ◽

The Difference ◽

Culture Positive

Introduction: Neonatal sepsis can alter the glucose level and both hypoglycemia and hyperglycemia may occur. A high or low blood glucose level may have a significant effect on the outcomes in patients of neonatal sepsis.Objective: To see the glycemic status and its effect on outcome of neonatal sepsis.Methods: This prospective observational study was done in the department of paediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet from July 2013 to December 2013. Clinically suspected neonatal sepsis cases were enrolled in the study. Venous blood was collected before giving any intravenous fluid or antibiotics for blood sugar, full blood counts, CRP levels and blood culture and send to labouratory within half hour of collection. All patients included in this study were treated accordingly and followed up strictly. Blood glucose level and mortality of neonates having hypoglycemia and hyperglycemia were analyzed among CRP and culture positive patients. Quantitative data were expressed as mean and standard deviation. Qualitative data were expressed as frequency and percentage and comparison carried by Chisquare (÷2) test.Results: A total of 62 patients clinically diagnosed as neonatal sepsis were studied. Fifty two (83.9%) patients were found CRP positive and 21(33.9%) patients were blood culture positive. Glycemic status was analyzed among CRP and culture positive patients. Majority (71.2%) patients were found normoglycemic, 13.5% were found hypoglycemic and 15.3% were found hyperglycemic in this study. Fifty one (82.2%) patients were cured and 9(17.8%) were died. Mortality was high in hypoglycaemic patients (42.8%) compare with normoglycaemic patients (10.8%), but the difference was not statistically significant (p>0.05) between two groups whereas mortality was also high in hyperglycaemic patients (50%) compare with normoglycaemic patients (10.8%) and the difference was statistically significant (p<0.05) between two groups.Conclusion: Alteration of glycemic status occurred in septic newborn. Mortality is higher among the septic newborn with hyperglycemia.Bangladesh J Child Health 2016; VOL 40 (1) :21-25

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Neonatal sepsis in a tertiary care hospital in Delhi, India: study of microbial profile and antimicrobial susceptibility pattern

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190036 ◽

2019 ◽

Vol 6 (2) ◽

pp. 384

Author(s):

Sangita Gupta ◽

Varun Kumar Singh ◽

Sanjay Singhal ◽

Priti Chowdhary

Keyword(s):

Blood Culture ◽

Antibiotic Therapy ◽

Antimicrobial Susceptibility ◽

Neonatal Sepsis ◽

Tertiary Care ◽

Coagulase Negative Staphylococcus ◽

Care Hospital ◽

Susceptibility Pattern ◽

Antibiotic Policy ◽

Antimicrobial Susceptibility Pattern

Background: Sepsis is one of the most common cause of neonatal deaths globally more so in low and middle-income countries. The key to management is high degree of clinical suspicion and prompt initiation of empirical antibiotic therapy pending investigations’ results. Knowledge of one’s own NICU flora and antimicrobial susceptibility pattern guides in choosing correct antibiotic therapy to pediatrician. If this data is standard and comparable across different sites, then it also helps in formulating regional and National treatment guidelines. Present study was therefore undertaken to study microbial flora of present NICU and analyze their antimicrobial susceptibility pattern and formulate antimicrobial policy.Methods: Data of blood culture isolates sent from suspected cases of neonatal sepsis received from January 2017 to July 2018 was analysed by “WHONET”.Results: One hundred ninety-three non-repeat isolates were obtained from 992 blood culture samples. Coagulase negative Staphylococcus and K. pneumoniae were the most common isolates. Non albicans Candida were responsible for majority of fungal infection. There was an outbreak of C. pelliculosa for six months. Most of the bacteria were multidrug resistant (MDR). However, except one all other Candida isolates were sensitive to antifungal drugs.Conclusions: WHO guidelines suggest use of penicillin and gentamicin for neonatal sepsis. But in present study, they were not found useful, instead amikacin, netilmicin and piperacillin-tazobactam were found useful and changes were made in antibiotic policy. Authors therefore recommend regular monitoring of antimicrobial susceptibility pattern followed by necessary changes in antibiotic policy for reasonable empirical therapy.

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Clinical and Bacteriological Profile of Early Onset Neonatal Sepsis Admitted in NICU of Tertiary Hospital in Biratnagar

Birat Journal of Health Sciences ◽

10.3126/bjhs.v3i1.19764 ◽

2018 ◽

Vol 3 (1) ◽

pp. 370-376

Author(s):

Arun Giri ◽

Vijay Kumar Sah ◽

Bikash Sharma Poudel ◽

Niraj Niraula ◽

Raju Sedai

Keyword(s):

Escherichia Coli ◽

Staphylococcus Aureus ◽

Blood Culture ◽

Neonatal Sepsis ◽

Early Onset ◽

Clinical Signs ◽

Signs And Symptoms ◽

Coagulase Negative Staphylococcus ◽

Sensitivity Pattern ◽

Clinical Signs And Symptoms

Introduction: Neonatal sepsis is one of the major causes of neonatal morbidity and mortality especially in developing countries. The clinical signs and symptoms of neonatal sepsis are non specific and blood culture report is considered gold standard for confirmation of neonatal sepsis. Organisms and their sensitivity pattern vary from place to place. The confirmation of diagnosis and management of neonatal sepsis is challenging and time consuming.Objective: The aim of this study was to find incidence of blood culture proven sepsis in suspected early onset neonatal sepsis, find out sensitivity pattern of isolated organism and to find association of risk factors and clinical signs and symptoms with blood culture proven sepsis.Methodology: Prospective study was conducted in Nobel Medical College, Biratnagar from November 2016 to November 2017. Sample size was calculated to be 300 and blood culture was sent of each neonates admitted with suspected early onset neonatal sepsis before giving neonates with first dose of antibiotics and report of 72 hours was taken into consideration.Results: Out of 300 cases of suspected early onset neonatal sepsis 70.3% presented with lethargy, followed by other symptoms like poor feeding, respiratory distress, fever, hypothermia, feeding intolerance, abnormal body movement and abdominal distension. Low birth weight neonates, preterm neonates, prolonged duration of per vaginal leaking and low platelets count were significantly associated with blood culture proven sepsis in this study. Incidence of blood culture positive sepsis in suspected early onset neonatal sepsis was 27%. Coagulase negative Staphylococcus aureus(21%) was predominant organism isolated followed by Klebsiella Pneumonia, Pseudomonas, Escherichia coli. All of the isolated Klebsiella and Pseudomonas and 86% of Escherichia coli were found to be resistant to ampicillin. All isolated Coagulase negative Staphylococcus aureus were sensitive to vancomycin.Conclusion: Coagulase negative Staphyloccus aureus was predominant organism detected but majority of organisms were gram negative organisms. High resistance to ampicillin was found and cefotaxime was also less sensitive to isolated organism. Vancomycin was found to be sensitive to all isolated Staphylococcus aureus and coagulase negative Staphylococcus aureus. Amikacin was highly sensitive among causative organisms isolated. BJHS 2018;3(1)5 : 370-376

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Paradigm Shift in Antimicrobial Resistance Pattern of Bacterial Isolates during the COVID-19 Pandemic

Antibiotics ◽

10.3390/antibiotics10080954 ◽

2021 ◽

Vol 10 (8) ◽

pp. 954

Author(s):

Vikas Saini ◽

Charu Jain ◽

Narendra Pal Singh ◽

Ahmad Alsulimani ◽

Chhavi Gupta ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antimicrobial Resistance ◽

Tertiary Care ◽

Public Health Problem ◽

Resistance Pattern ◽

Coagulase Negative Staphylococcus ◽

Care Hospital ◽

Bacterial Isolates ◽

Hospital Infection Control ◽

And Staphylococcus Aureus

Antimicrobial resistance (AMR) is an emerging public health problem in modern times and the current COVID-19 pandemic has further exaggerated this problem. Due to bacterial co-infection in COVID-19 cases, an irrational consumption of antibiotics has occurred during the pandemic. This study aimed to observe the COVID-19 patients hospitalized from 1 March 2019 to 31 December 2020 and to evaluate the AMR pattern of bacterial agents isolated. This was a single-center study comprising 494 bacterial isolates (blood and urine) that were obtained from patients with SARS-CoV-2 admitted to the ICU and investigated in the Department of Microbiology of a tertiary care hospital in Delhi, India. Out of the total bacterial isolates, 55.46% were gram negative and 44.53% were gram positive pathogens. Of the blood samples processed, the most common isolates were CoNS (Coagulase Negative Staphylococcus) and Staphylococcus aureus. Amongst the urinary isolates, most common pathogens were Escherichia coli and Staphylococcus aureus. A total of 60% MRSA was observed in urine and blood isolates. Up to 40% increase in AMR was observed amongst these isolates obtained during COVID-19 period compared to pre-COVID-19 times. The overuse of antibiotics gave abundant opportunity for the bacterial pathogens to gradually develop mechanisms and to acquire resistance. Since the dynamics of SARS-COV-2 are unpredictable, a compromise on hospital antibiotic policy may ultimately escalate the burden of drug resistant pathogens in hospitals. A shortage of trained staff during COVID-19 pandemic renders it impossible to maintain these records in places where the entire hospital staff is struggling to save lives. This study highlights the extensive rise in the use of antibiotics for respiratory illness due to COVID-19 compared to antibiotic use prior to COVID-19 in ICUs. The regular prescription audit followed by a constant surveillance of hospital infection control practices by the dedicated teams and training of clinicians can improve the quality of medications in the long run and help to fight the menace of AMR.

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Levonadifloxacin, a recently approved benzoquinolizine fluoroquinolone, exhibits potent in vitro activity against contemporary Staphylococcus aureus isolates and Bengal Bay clone isolates collected from a large Indian tertiary care hospital

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa142 ◽

2020 ◽

Cited By ~ 2

Author(s):

Yamuna Devi Bakthavatchalam ◽

Abirami Shankar ◽

Rajeshwari Muniyasamy ◽

John Victor Peter ◽

Zervos Marcus ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Vitro Activity ◽

Care Hospital ◽

In Vitro Activity ◽

College Hospital ◽

Diabetic Foot Infections ◽

Broth Microdilution Method

Abstract Objectives Levonadifloxacin (WCK 771; IV) and its prodrug alalevonadifloxacin (WCK 2349; oral) are benzoquinolizine fluoroquinolones, recently approved in India for the treatment of acute bacterial skin and skin structure infections with concurrent bacteraemia and diabetic foot infections. Ahead of its market launch, the present study aimed to assess the in vitro activity of levonadifloxacin against contemporary Staphylococcus aureus isolates collected from a large tertiary care hospital in India. Additionally, levonadifloxacin activity was tested against hVISA and Bengal Bay clone MRSA isolates. Methods Non-duplicate S. aureus (n = 793) isolates collected at Christian Medical College hospital, Vellore, India during 2013–19 were included in the study. MRSA isolates were identified using a cefoxitin disc diffusion assay. MICs of levonadifloxacin and comparator antibiotics were determined using the broth microdilution method. Mutations in QRDRs were identified for selected levofloxacin-non-susceptible isolates. MLST profiling was undertaken to detect the Bengal Bay clone. Results Among the 793 isolates, 441 (55.6%) were MRSA and 626 (78.9%) were non-susceptible to levofloxacin. Levonadifloxacin showed MIC50 and MIC90 values of 0.25 and 0.5 mg/L, respectively, for all S. aureus, which included hVISA and Bengal Bay clone MRSA. The potency of levonadifloxacin was 16 times superior compared with levofloxacin. Conclusions The present study demonstrated potent activity of levonadifloxacin against contemporary S. aureus isolates, which included MRSA isolates, hVISA isolates, Bengal Bay clone isolates and a high proportion of quinolone-non-susceptible isolates. The potent activity of levonadifloxacin observed in this study supports its clinical use for the treatment of S. aureus infections.

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Mean platelet volume (MPV) as a diagnostic marker in neonatal sepsis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20191008 ◽

2019 ◽

Vol 6 (3) ◽

pp. 1036

Author(s):

Prathyusha . ◽

Shreekrishna G. N. ◽

Sinchana Bhat ◽

Sahana P.

Keyword(s):

Neonatal Sepsis ◽

Predictive Value ◽

Neonatal Intensive Care ◽

Diagnostic Marker ◽

Tertiary Care ◽

Study Groups ◽

Care Hospital ◽

Neonatal Deaths ◽

Significant Difference ◽

Group B

Background: Neonatal sepsis is a frequent and important cause of morbidity and mortality which accounts for one quarter of neonatal deaths. There are very few studies done in India to evaluate the role of MPV as diagnostic marker of neonatal sepsis.Methods: Prospective case control study in a tertiary care hospital. Neonates > 30 weeks gestation admitted to neonatal intensive care unit during the study period of 1 year with clinically suspected were included in the study. Neonates with Septic screen positive and culture positive sepsis were included in group A and normal neonates were included in Group B. MPV was done for all the subjects and values more than 10.2fl was considered positive. Newborns with congenital anomalies and who were already on antibiotics prior to admission were excluded from the study. Statistical analysis was done using Statistical Package of Social Sciences (SPSS) version 17.0.Results: 106 neonates were included in the study. MPV showed statistically significant difference between the study groups (mean 12.8±1.52, 10.82±1.20 respectively) at a cut of value of 10.2fl and a sensitivity of 93%, specificity of 84 % with a positive predictive value of 83% and negative predictive value of 94%.Conclusions: MPV can be used as an adjuvant marker along with established septic screen to ensure early diagnosis and treatment of neonatal sepsis with no additional expense.

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Blood culture positive sepsis and sensitivity pattern in a tertiary care neonatal centre in eastern India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190686 ◽

2019 ◽

Vol 6 (2) ◽

pp. 487

Author(s):

Soumini Rath ◽

Santosh Kumar Panda ◽

Manas Kumar Nayak ◽

Deepti Damayanty Pradhan

Keyword(s):

Blood Culture ◽

Neonatal Sepsis ◽

Early Onset ◽

Tertiary Care ◽

Neonatal Care ◽

Care Practice ◽

Klebsiella Pneumonia ◽

Gram Positive ◽

Gram Negative ◽

Culture Positive

Background: The objective of this study is to evaluate sensitive pattern of causative organisms of neonatal sepsis with its clinical outcome in a tertiary neonatal care unit of eastern India.Methods: This retrospective observational cohort study was done in a tertiary care hospital of Odisha. All the blood culture positive neonatal sepsis cases, excluding neonates with multiple congenital malformations, diagnosed during January 2017 to December 2018 were analysed using descriptive summary statistics.Results: A total of 73 neonatal sepsis cases were diagnosed by BacT/Alert and VITEK-2 blood culture method. Among them, 50 (68%) babies had gram negative sepsis,14 (19%) cases of gram-positive sepsis and nine (13%) cases of fungal sepsis. In present study 38 (52%) cases were early onset sepsis, 38(52 %) babies were term, 55(75%) were male and 44 (60%) babies were out born. Klebsiella pneumonia and Acinetobacter were the most common organism in early onset and late onset sepsis respectively. Among gram negative organism (GNB), 66% were multi drug resistant. A fifty percent of gram-negative organism were sensitive to meropenem and 28% were sensitive to piperacillin/tazobactam. The sensitivity of GNB to colistin, ciprofloxacin, amikacin was 76%, 64% and 56% respectively. The sensitivity of gram-positive organisms to linezolid, vancomycin, teicoplanin and penicillin were 92%, 85%,85% and 20% respectively. Survival rate among culture positive sepsis was 83%.Conclusions: Multi drug organisms are emerging in modern neonatal care practice. Practice of antibiotic stewardship may save the babies from multidrug resistance organism in future.

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Trends and Determinants of Perinatal Mortality in a Tertiary Care Hospital of Nepal

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v20i1.29133 ◽

2021 ◽

Vol 20 (1) ◽

pp. 77-82

Author(s):

Yuba Nidhi Basaula ◽

Radha Kumari Paudel ◽

Ram Hari Chapagain

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Neonatal Sepsis ◽

Perinatal Asphyxia ◽

Tertiary Care ◽

Care Hospital ◽

Perinatal Deaths ◽

Neonatal Deaths ◽

Perinatal Mortality Rate ◽

Increasing Trend

Introduction: Perinatal mortality rate (PMR) in Nepal is still very high. In major hospitals of Nepal, it is still ranging from 20 to 30 per thousand births. This study was carried out to review the different aspects of PMR and classifying them and identify the causes of perinatal and neonatal deaths and assessing the need for improvement in quality of pregnancy and newborn care. Methods: It was a retrospective study carried out in Bharatpur Hospital, Chitawan, Nepal. Data of all stillbirths from 22 weeks of pregnancy and neonatal deaths up to seven days of life was taken from monthly perinatal audit and annual mortality review. The data was taken from July 2017 to Jun 2019. All the perinatal deaths were then classified. Results: Over a two year period, there were total 25,977 births and total death was 369. Thus perinatal mortality rate was 12.3 per thousand births. Still births (fresh and macerated) contributed almost 82.4% of the perinatal deaths and neonatal death contributed 17.6% of total deaths. Deaths related to unexplained intrauterine fetal death (IUFD) showed an increasing trend and have increased by more than 20% in past two years from 39.1% to 60.8%. Deaths due to perinatal asphyxia, neonatal sepsis, respiratory distress syndrome and extreme prematurity were increased. Conclusions: PMR over the two years has shown increasing trend at our institute. There is need to improve antenatal, obstetric as well as intra-partum services to further reduce the still birth as well as deaths due to prematurity, RDS, neonatal sepsis and perinatal asphyxia.

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Anti-microbial sensitivity and resistance of organisms in blood-culture samples from prolonged fever cases: evidence from a tertiary care hospital in West Bengal, India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20184323 ◽

2018 ◽

Vol 7 (11) ◽

pp. 2173

Author(s):

Somanjana Ghosh ◽

Arista Lahiri ◽

Siddhartha Bera ◽

Soumyajyoti Bandyopadhyay

Keyword(s):

Blood Culture ◽

Tertiary Care ◽

Systemic Infection ◽

Cross Sectional Study ◽

Background Information ◽

Resistance Pattern ◽

Coagulase Negative Staphylococcus ◽

Care Hospital ◽

Cross Sectional ◽

High Level

Background: Currently there is a rise in resistance to anti-microbials which is a matter of concern in treatment of systemic infections. Blood culture is considered “gold standard” in diagnosis of suspected systemic infection. The susceptibility to antibiotics thereafter determine the future course of treatment. The current study aims to find out the sensitivity and resistance pattern of the blood culture isolates.Methods: A cross-sectional study was performed on the blood culture samples sent within 24hours of admission of the adult patients reporting fever for 7 days or more with no history of consumption of any antibiotics within last month. Total 134 blood samples were analysed. The proportion of sensitivity and resistance to anti-bacterial agents was calculated among those samples which showed growth in the culture. Background information of the patients in terms of age, sex and religion were also noted.Results: Mean age of the patients was 39.33 (±12.19) years. Overall 47.76% were female patients and remaining were male. Among the Hindu patients majority were male while among Muslims majority were female. Of the total number of blood cultures examined 46.27% showed growth of bacteria. Staphylococcus aureus was the most frequently found bacteria isolated in cultures, followed by coagulase negative Staphylococcus and Pseudomonas. Of the frequently used antibiotics, higher sensitivity was seen with vancomycin, amikacin, netilmycin, imipenem, gentamicin. High resistance was observed in use of antibiotics like cefixime, amoxicillin-clavulanic acid and azithromycin.Conclusions: High level of resistance to several commonly used advanced antibiotics warrant judicial and evidence-based use of these drugs.

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