Ralstonia mannitolilytica, an unusual pathogen in the Neonatal Intensive Care Unit: a case of neonatal sepsis and literature review

2020 ◽  
Vol 20 ◽  
Author(s):  
Panagiotis Lampropoulos ◽  
Despoina Gkentzi ◽  
Sotirios Tzifas ◽  
Georgia Kapnisi ◽  
Ageliki Karatza ◽  
...  
Keyword(s):  
Premature Infant ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Antimicrobial Agents ◽  
Late Onset ◽  
Extremely Low Birth Weight ◽  
Respiratory Impairment ◽  
Gram Negative ◽  
Sensitivity Pattern ◽  
Resistance Patterns

Background: Premature infants are considered high-risk subgroup for neonatal sepsis due to yet defective immune system, interventions practised and synergy of factors favoring multiple resistance of Gram-positive and Gram-negative pathogens to antimicrobial agents. Case presentation: We present a case of late-onset neonatal sepsis in a premature infant caused by an uncommon pathogen; a premature infant of extremely low birth weight had in his 4th week of life severe clinical deterioration with lethargy, fever, pallor, 1 mottling, abdominal distention, tachycardia, and worsening respiratory impairment. Full septic screen was performed, broad-spectrum antibiotic therapy was initiated and supportive care per needs was provided. Blood cultures (and endotracheal tube tip cultures) isolated meropenem- and gentamicin-resistant strain of rare pathogen Ralstonia mannitolilytica. Ralstonia spp are aerobic, Gram-negative, lactose nonfermenting, oxidase- and catalase-positive bacilli, thriving in water and soil. Ralstonia spp are identified only sporadically as causative agents of neonatal sepsis; to our knowledge this is the second report of neonatal sepsis due to R. mannitolilytica in the literature so far. Our patient was eventually treated (per sensitivity pattern) with intravenous ciprofloxacin, and recovered well from the infection. Conclusion: We intend to raise awareness among neonatologists with regards to early detection of unusual pathogens, emergence of antibiotic resistance patterns, and obligation for adherence to infection control policies.

scholarly journals Bacterial Isolates of Early Onset Neonatal Sepsis and Their Antibiotic Susceptibility Pattern

2018 ◽  
Vol 17 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Md Abdul Mannan ◽  
Shahed Iqbal ◽  
SM Rezaul Karim ◽  
Talim Uddin Ahmed ◽  
Md Hakimul Haque Khan ◽  
...  
Keyword(s):  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Sensitivity Pattern ◽  
Rule Out

Background: Neonatal infections are the commonest cause of neonatal mortality along with perinatal asphyxia and consequence of Prematurity and Low Birth Weight (LBW) in Bangladesh. Early Onset Neonatal Sepsis (EONS) is neonatal sepsis occurring within the first 72 hours of birth and it is much more fulminant and has a higher mortality than Late Onset Sepsis (LOS). Sepsis in neonate remains a significant cause of mortality and morbidity in developing countries. Changing bacterial flora and emergence of resistant strains adds to the problem. Thus, neonatal sepsis requires accurate and timely clinical and laboratory diagnosis and proper management for better outcome. The organisms responsible for Early Onset Sepsis (EOS) are different than Late Onset Sepsis (LOS). In this study an attempt has been made to know the positivity rate of EOS and profile of bacteria responsible for EOS and determine the antimicrobial sensitivity pattern that were investigated for rule out sepsis. Methods: This was a prospective observation single centre study over a period of nine months (January to September, 2017) conducted on neonates born at Ad-din Medical College Hospital (AMCH), Dhaka and subsequently admitted in Neonatal Intensive Care Unit (NICU) within 72 hours of birth that were investigated for rule out sepsis. Dual blood sample for cultures from separate area along with essential investigations were sent by collecting samples under aseptic precautions. Empirical antimicrobial therapy was started according to antimicrobial guidelines in the NICU. The blood cultures test were carried out by BD BACTEC automated blood culture system and susceptibility testing was done for all blood culture isolates according to the criteria of the National Committee for Clinical Laboratory Standards by disk diffusion method. Results: A total of 700 neonates were investigated to rule out sepsis and 5.43% neonates were found with culture proven sepsis in the study. The gram positive bacteria accounted for 71% and gram negative 29% of the total isolates. Out of total 38 isolates, Coagulase-Negative Staphylococci (CONS) (68.4%) was the commonest followed by Acinetobacter (18.4%) and E. coli (7.9%) was common culture isolates. Among the gram positive, CONS (96.3%) was commonest isolate and in gram negative Acinetobacter (63.6%) was the most prevalent bacteria followed by E.coli (27.3%). Gram positive isolate, especially CONS (68.4%) was the major culprit for the early onset sepsis. Among the commonly used antibiotics, the susceptibilities were remarkably low to Amikacin (16%) in comparison to Ampicillin (42%) Cefotaxime (45%) and moderately high to Gentamicin (58%) for both gram positive & gram negative isolates. All (100%) gram positive isolates were resistant to Amikacin. Majority of the gram positive showed low susceptibilities to Meropenem (22%) Ciprofloxacin (41%) Ampicillin (48%) & Oxacillin (48%) in comparison to Cefotaxime (52%) Levofloxacin (55%) Gentamicin (70%), Linezolid (70%) and Vancomycin (74%). 50% of Coagulase Negative Staphylococcus (CONS) were resistant to Methicillin/Oxacillin. The sensitivity pattern of majority of gram negative isolates showed high level of resistance to Piperacillin+Tazobacterm (9%) and Ampicillin (27%) Gentamicin (27%) Cefotaxime (27%) less sensitive to Ciprofloxacin (45%); moderately high to Levofloxacin (54%) & Amikacin (54%) and highly sensitive to Imipenem/Meropenem (73%) & Colistin (91%). Gentamicin (58%) and Levofloxacin (55%) were showed marginal superiority compared to Ampicillin (42%) and Cefotaxime (45%) for effective coverage of both. Conclusion: Present study indicated that gram positive species especially CONS continue to be the predominant causative organism followed by Acinetobacter and E. coli in gram negative species. The antibiotic susceptibility profile suggested that for a given cohort empiric (initial) choice of Ampicillin and Gentamicin in EOS. Routine bacterial surveillance and their sensitivity patterns must be an essential component of neonatal care Chatt Maa Shi Hosp Med Coll J; Vol.17 (1); Jan 2018; Page 3-8

scholarly journals Study on Bacteriological Profile and Sensitivity Pattern of the Organisms in Neonatal Sepsis

2021 ◽  
Vol 44 (3) ◽  
pp. 133-138
Author(s):  
Subir Dey ◽  
MA Mannan ◽  
Sanjoy Kumar Dey ◽  
Yasmin Sabina ◽  
Ferdous Navila
Keyword(s):  
Neonatal Intensive Care ◽  
Late Onset ◽  
Causative Organism ◽  
Gram Positive ◽  
College Hospital ◽  
Gram Negative ◽  
Mortality And Morbidity ◽  
Antimicrobial Sensitivity ◽  
Early Onset Sepsis ◽  
Sensitivity Pattern

Background: Sepsis in neonates by resistant strains remains a significant cause of mortality and morbidity in developing countries. This study attempted to find out the organisms responsible for early onset sepsis (EOS) and late onset sepsis (LOS) and determine their antimicrobial sensitivity pattern. Materials & Methods: This prospective observational single centre study was conducted on 1000 neonates during January to September 2018, that were investigated for rule out sepsis, at the Neonatal Intensive Care Unit of Ad-din Medical College Hospital, Dhaka. Results: Fifty-four neonates were found with culture proven sepsis.Coagulase-negative Staphylococci (CONS) (68.42%)was the commonest and followed by Acinetobacter (18.42%) were found on culture isolates in EOS. In LOS, CONS (75%) is the most predominant organism. Among the gram negative Acinetobacter (50%) was the most prevalent bacteria followed by E.coli (28.57%). None of the gram positive isolates were sensitive to Amikacin. Majority of the gram positive showed susceptibilities to Vancomycin (83%) and Linezolid (78%). Among gram negative isolates 93% were sensitive to Colistin, 63% to Gentamicin & 54% to Levofloxacin. Conclusion: Present study indicated that gram positive species especially CONS continue to be the predominant causative organism in both EOS and LOS and followed by Acinetobacter and E. coli in gram negative species. Bangladesh J Child Health 2020; VOL 44 (3) :133-138

scholarly journals Bacterial etiology and antimicrobial susceptibility pattern of neonatal sepsis at a tertiary care hospital in Nepal

2021 ◽  
Vol 8 (5) ◽  
pp. 830
Author(s):  
Kiran Sharma ◽  
Love Kumar Sah ◽  
Prince Pareek ◽  
Sanjay Shah ◽  
Reema Garegrat
Keyword(s):  
Staphylococcus Aureus ◽  
Neonatal Sepsis ◽  
Late Onset ◽  
Antibiotic Sensitivity ◽  
Care Hospital ◽  
Gram Negative ◽  
Common Organism ◽  
Early Onset Sepsis ◽  
Sensitivity Pattern ◽  
Gram Negative Organisms

Background: Sepsis is the second major cause of mortality among neonates. Present study was done to identify the common organisms which cause early and late onset neonatal sepsis in neonates admitted in our department and their antibiotic sensitivity patterns.Methods: All neonates weighing more than 1500 gms and born to mothers with pre-existing infection, admitted to neonatal intensive care unit for suspected neonatal sepsis were included in the present study. They underwent blood culture and antibiotic sensitivity profiling.Results: 210 newborns were admitted to the NICU of our department for suspected neonatal sepsis. Longer duration of rupture of membranes was found to be significantly associated with growth of organisms. Amongst the cases with gram positive organisms, most were due to Coagulase-negative staphylococci (CoNS) (n=25), followed by Staphylococcus aureus (n=14), and, Enterococcus (n=4). Gram negative organisms isolated constituted 17 organisms. Amongst the cases with gram negative organisms, mostly were due to Klebsiella (n=10), followed by Pseudomonas (n=5) and E. coli (n=2). The most common organism causing early onset sepsis was CoNS, while Staphylococcus aureus was the most common organism causing late onset sepsis. CoNS was fully sensitive to Vancomycin and Amikacin. Staphylococcus aureus was fully sensitive to Amikacin, α-hemolytic. Streptococcus were sensitive to Amikacin, Vancomycin and Piperacillin and Tazobactum and Enterococcus was sensitive to Amikacin and Vancomycin.Conclusions: Antimicrobial surveillance of neonatal septicaemia is required to know the antibiotic sensitivity pattern and thus to formulate policies on use of antibiotics and to know the changing spectrum of antimicrobial sensitivity patterns.

scholarly journals Bacteriological profile and antimicrobial sensitivity pattern in neonatal sepsis: a study from North India

2017 ◽  
Vol 5 (4) ◽  
pp. 1541 ◽  
Author(s):  
Poonam Dalal ◽  
Geeta Gathwala ◽  
Mohit Gupta ◽  
Jasbir Singh
Keyword(s):  
Blood Culture ◽  
Neonatal Sepsis ◽  
Late Onset ◽  
Microbial Flora ◽  
Gram Positive ◽  
Gram Negative ◽  
Antimicrobial Sensitivity ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Sensitivity Pattern

Background: Neonatal sepsis is a leading cause of neonatal mortality and continues to be a formidable problem for neonatologists and pediatricians world over.  Knowledge of microbial flora and their susceptibility will help us to decide empirical treatment for the neonatal sepsis. The objective of this study was to determine the bacteriological flora prevalent in NICU and the antimicrobial sensitivity pattern.Methods: The blood culture reports of all the neonates with culture proven neonatal sepsis during the period July 2010 to September 2013 were reviewed retrospectively. A retrospective review in tertiary care teaching medical college. The data was entered in Excel sheets and percentages of various outcomes were calculated.Results: A total of 28,927 babies were born during the study period and 336 among them had positive blood culture. The incidence of neonatal sepsis was 11.62 per 1,000 live births. Three hundred fifty- six microbes were isolated, out of which 50% presented as early onset sepsis and remaining as late onset sepsis. Pseudomonas aeruginosa was the most common organism encountered in both early (43.82%) and late onset sepsis (51.35%). Gram negative bacilli were sensitive to carbapenems (92%) followed by piperacillin-tazobactam (90%) whereas linezolid (90%) was most sensitive antimicrobial for gram positive cocci.Conclusions: Pseudomonas was most commonly isolated in both early and late onset sepsis.  Gram negative bacilli were most sensitive to piperacillin-tazobactam and the carbapenems whereas linezolid and vancomycin were most effective against the gram-positive cocci. Resistance to third generation cephalosporins was rampant. Continuous surveillance for microbial flora, their antibiotic susceptibility, rational use of antibiotics and the strategy of antibiotic cycling may be of help to curtail emerging antimicrobial resistance.

scholarly journals To Study Bacteriological Profile and Antibiotic Sensitivity Pattern in Cases of Neonatal Sepsis

2015 ◽  
Vol 2 (1) ◽  
pp. 20
Author(s):  
Sagar Sonawane ◽  
M. K. Tolani ◽  
Milind Suryawanshi ◽  
Priyanka Patil
Keyword(s):  
Blood Culture ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Antibiotic Sensitivity ◽  
Automated Method ◽  
Bacteriological Profile ◽  
Late Onset Sepsis ◽  
Sensitivity Pattern ◽  
Sepsis Screen

<strong>Objective:</strong> To study the bacteriological profile and sensitivity pattern in cases of Neonatal sepsis at 12 bedded Neonatal Intensive Care Unit (NICU). <strong>Methods:</strong> This was a prospective study of neonates admitted to our NICU from Jan 2010 to Oct 2011 with diagnosis of neonatal sepsis or those who developed sepsis later during their stay in NICU. All newborns diagnosed as a case of neonatal sepsis, based on clinical features with positive sepsis screen and/or positive blood culture, were included in our study. Blood Culture&amp;Sensitivity was done with conventional non-automated method using Herley's Broth. <strong>Results:</strong> Out of 55 cases blood culture was positive in 27 (49.09%) cases. Klebsiella Pneumoniae 15 (55.55%) was the most common organism isolated in both early and late onset sepsis showed sensitivity to collistin in 86.6% of cases followed by sensitivity to imipenam-cilastin in 46.67% cases. Only 20% Klebsiella isolates were sensitive to drugs like Ampicillin-sulbactum, Amikacin, Tazobactum, cefpime and for other antibiotics like Meropenam, Piperacillin-tazobactum, Vancomycin it was less than 20%. Other organisms isolated were Staph. aureus, E. Coli, Pseudomonas, Enterobactor, Acinetobactor and candida species. <strong>Conclusion:</strong> Gram negative organisms are most common cause of early as well as late onset sepsis and there is alarming degree of antibiotic resistance to commonly used antibiotics.

scholarly journals Bacteriological Profile and Antibiotic Sensitivity of Neonatal Septicemia Admitted in Neonatal Intensive Care Unit (NICU) of Dhaka Shishu Hospital

2020 ◽  
Vol 35 (2) ◽  
pp. 130-134
Author(s):  
Md Mosharaf Hossain ◽  
Mir Mohammad Yusuf ◽  
Md Kamrunzzaman ◽  
Maksudur Rahman ◽  
Md Jahangir Alam
Keyword(s):  
Blood Culture ◽  
Neonatal Sepsis ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Antibiotic Sensitivity ◽  
Gram Negative ◽  
Mortality And Morbidity ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Gram Negative Organisms

Background: Septicemia in neonates refers to bacterial infection documented by positive blood culture in the first four weeks of life and is one of the leading causes of neonatal mortality and morbidity. Objective: To isolate and identify the bacterial etiologic agents responsible for neonatal sepsis and to determine the susceptibility pattern of isolates in A NICU of Dhaka Shishu (Children) Hospital. Methods: This is a prospective observational study conducted in the NICU from July 2018 to December 2018. Two hundred ninty blood samples were collected and processed from patients in accordance with standard protocols. Antibiotic susceptibility of the isolates was done. Results: Blood culture reports were positive in 9.31% cases. Among the culture positive cases, there were 65.5% males and 34.5% females. Early onset sepsis was present in 74.8% and late onset sepsis was observed in 25.2% of the cases. Best overall sensitivity among Gram negative (Acinetobacter, Klebsiella, Pseudomonas) isolates was to netilmycin (61%), followed by ceftazidim (57%) and amikacin (56%).Gram positive (Staphylococci, streptococci) isolates had sensitivity of 50% to levofloxacin, 50% to ceftriaxon. Conclusion: Gram negative organisms are the leading cause of neonatal sepsis in this study and most of them are resistant to multiple antibiotics. Therefore the results of this study suggest that, surveillance of antimicrobial resistance in our hospital is necessary. DS (Child) H J 2019; 35(2) : 130-134

Late-onset pubic-phallic idiopathic edema in premature recovering infants

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
Bengt-Ola S. Bengtsson ◽  
John P. van Houten
Keyword(s):  
Neonatal Intensive Care ◽  
Chart Review ◽  
Late Onset ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Extremely Low Birth Weight ◽  
Genital Area ◽  
Level 3 ◽  
Prolonged Observation ◽  
Idiopathic Edema

AbstractObjectiveSeveral cases of isolated localized edema of the genital area in extremely low birth weight (ELBW) infants within the last 5 years prompted a search for possible explanations and a search of the literature.Study designA retrospective chart review of all cases of localized genital area edema in our 16-bed community level-3 neonatal intensive care unit (NICU) between January 2007 and December 2017.ResultsA total of six patients with localized edema of the genital area were found. Among the six cases, five provided descriptions of time of onset. Only one case had a plausible etiology [inguinal hernia (IH)].ConclusionsTo our knowledge, this entity is not well described in the literature. Etiologies are speculative. Prolonged observation in the NICU by virtue of ELBW-status suggests that there are no detrimental effects, the condition does not appear to preclude discharge and cautious expectant management and reassurance are therefore in order.

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