scholarly journals Diagnostic accuracy of clinical tool ‘STOPS’ and Serum Procalcitonin for optimizing antibiotic therapy in Neonatal Sepsis

2021 ◽  
Vol 13 (1) ◽  
pp. e2021019
Author(s):  
Vishal Vishnu Tewari
Keyword(s):  
Antibiotic Therapy ◽  
Diagnostic Accuracy ◽  
Neonatal Sepsis ◽  
Skin Color ◽  
Late Onset ◽  
Tertiary Care ◽  
Negative Likelihood Ratio ◽  
Care Hospital ◽  
Clinical Tool ◽  
Mortality And Morbidity

Background:  Antibiotic therapy is initiated in neonates on suspicion of sepsis. Optimizing therapy is a felt need of clinicians as injudicious prolonged use increases mortality and morbidity risk. Objective: To evaluate the diagnostic accuracy of clinical tool ‘STOPS’ and serum procalcitonin (PCT) for identifying neonates with early onset neonatal sepsis (EONS) or late onset neonatal sepsis (LONS) and early discontinuation in those with no sepsis. Methods: The study had a prospective analytical design conducted at a tertiary care hospital. All neonates with suspected EONS or LONS were enrolled. The ‘STOPS’ tool comprising of sensorium, temperature, oxygenation, perfusion, skin color and blood sugar was applied at 6 and 12 hr of enrollment. Serum PCT was sent at 12 hr. The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) were estimated. Results:  The study enrolled 380 neonates of which 330 were given antibiotics for EONS and 50 for LONS. Temperature recording in the EONS group at 12 hr showed a PPV of 100% and a PLR of 9.1 (7.7 – 18). Perfusion assessment at 12 hr had a PPV of 77% and PLR of 8.25 (2.3 – 29). Skin color assessment at 12 hr it had a PPV of 100% and PLR of 13.5 (9.7 – 27). The diagnostic accuracy of PCT in the EONS group was unremarkable. In the LONS group, skin color at 12 hr had a PPV of 100% and PLR of 11.2 (8.6 – 19.5). The diagnostic accuracy of PCT in the LONS group showed a PPV of 82% and PLR of 7 (1.7 – 29). Conclusion: Identifying abnormal STOPS parameters was superior to PCT alone in EONS and as good as PCT in LONS. The ‘STOPS’ tool allows early identification of neonates with no sepsis thereby optimizing antibiotic use.

scholarly journals Clinical profile and outcomes among neonatal pneumonia patients admitted in a tertiary care hospital, Gujarat, India

2021 ◽  
Vol 8 (5) ◽  
pp. 914
Author(s):  
Jigisha R. Patadia ◽  
Ankit Parmar ◽  
Vijay B. Shah ◽  
Praful R. Bambharoliya
Keyword(s):  
Early Onset ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Antibiotic Sensitivity ◽  
Clinical Profile ◽  
Care Hospital ◽  
Mortality And Morbidity ◽  
X Ray

Background: Neonates are highly vulnerable to infection due to factors like immaturity, immunologic deficiencies at time of birth and in-utero maternal infection. Neonatal pneumonia continues to remain important cause of mortality and morbidity in developing countries like India. The aim of this study was to study the clinical profile and outcome of neonatal pneumonia.Methods: This descriptive observational study was carried out at NICU of tertiary care hospital with level III nursery during August-October 2012. A total of 200 neonates admitted in NICU during the study period were included as per inclusion criteria. All neonates were observed on day of admission, on day of deterioration and day of discharge. Clinical parameters, investigation profile, probable aetiology, intervention required and outcome was noted.Results: Out of 200 neonates admitted during study period, 64 neonates were having neonatal pneumonia, making incidence of 32%. All symptomatic patients having respiratory distress were evaluated by taking blood samples for blood culture with antibiotic sensitivity, C-reactive protein, sepsis screen and X-ray chest. Onset of pneumonia was decided on basis of appearance of symptoms like early onset (<72hours) or late onset (>72 hours). Half of the patients had shown improvement after intervention but 16% deteriorated which required ventilatory support. Mortality was 32.81% and it was more in early onset (40%) than late onset (28.2%).Conclusions: There was no single parameter which can be used for diagnosis of neonatal pneumonia. Clinical features with chest X-ray with sepsis markers have to be considered in diagnosing pneumonia.

scholarly journals Bacterial etiology and antibiotic resistance pattern of neonatal sepsis: a study in a tertiary care hospital, in Bangladesh

2019 ◽  
Vol 6 (5) ◽  
pp. 1839
Author(s):  
Mahfuza Shirin ◽  
M. Monir Hossain ◽  
Manifa Afrin ◽  
Mohammad Abdullah Al Mamun
Keyword(s):  
Neonatal Sepsis ◽  
Tertiary Care ◽  
Resistance Pattern ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Gram Positive ◽  
Cross Sectional ◽  
Gram Negative ◽  
Mortality And Morbidity ◽  
Gram Positive Bacteria

Background: Neonatal sepsis is a leading cause of neonatal mortality and morbidity. The objective of the study was to detect causative microorganisms of neonatal sepsis and their antimicrobial resistance patterns.Methods: This prospective cross-sectional study was conducted from July 2017 to June 2018 in the Department of Neonatal Medicine and NICU of Dhaka Shishu (Children) Hospital (DSH). Neonates diagnosed with probable sepsis were studied. After enrollment, 1 mL blood was taken and sent to Microbiology department of DSH for culture and sensitivity. With baseline characteristics, clinical examination findings and outcome, were also recorded.Results: Rate of isolation of single organism was 9.2% (84/913). Out of 84 isolates, gram negative bacteria were 77.4% with Klebsiella pneumonae being the commonest (35, 41.7%), gram positive bacteria were 11.9% with Staphylococcus aureus and Streptococcus were equal (5, 5.95% each) and the remaining (9, 10.7%) isolated organism was Candida. Most of the isolated gram-negative bacteria were resistant to ampicillin, gentamicin, and ceftazidime; but gram-positive bacteria preserved 20-80% sensitivity. Klebsiella was more resistant than Acinetobacter to amikacin, netilmicin, ciprofloxacin and levofloxacin. Around 45-65% of gram-negative bacteria were resistant to imipenem and meropenem but gram-positive bacteria showed lesser resistance. Among the gram-negative bacteria, Klebsiella and Acinetobacter were resistant to piperacillin as same as carbapenem group, but gram-positive bacteria were 100% sensitive to piperacillin. All the gram-negative bacteria showed more resistance to 4th generation cephalosporin, cefepime than carbapenem. Out of culture positive 84 neonates, 63 (75.0%) were cured but 21 (25.0%) died. Among the 21 expired neonates, 47.6% (10/21) were infected with Klebsiella.Conclusion: This study observed that gram-negative bacteria causing neonatal sepsis predominantly, with emergence of Candida. All the isolated gram-positive and gram-negative organisms were mostly resistant to available antibiotics

scholarly journals PATTERN OF ANTIBIOTICS UTILIZATION IN NEONATAL SEPTICEMIA: A CROSS-SECTIONAL STUDY FROM RURAL TERTIARY CARE HOSPITAL WESTERN MAHARASHTRA, INDIA

2017 ◽  
Vol 9 (3) ◽  
pp. 60 ◽  
Author(s):  
Shinde A. R. ◽  
Mohite R. V. ◽  
Shinde R. V.
Keyword(s):  
Neonatal Sepsis ◽  
Tertiary Care Hospital ◽  
Late Onset ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Antibiotic Regimen ◽  
Sectional Study ◽  
Cross Sectional ◽  
Empiric Antibiotic

Objective: To assess the quantification of use of antibiotics and to find out empiric antibiotic regimen practiced for neonatal sepsis in rural tertiary health care centre.Methods: A hospital, record based cross-sectional study was conducted in Neonatal Intensive Care Unit(NICU) at tertiary care hospital located in western Maharashtra, India. The study was planned during the year 2011-12 among 84 neonates with sepsis. Data were collected by using proforma includes demographic details, antibiotic prescriptions and relevant information.Results: Among the total 84 neonates, max, 60.71% had a history of term delivery. The proportion of early and late onset of sepsis was 47.61% and 52.38% for which total 18 antibiotics were used of which max, 88.88% were injectables. Amikacin was used in max, 78.57% neonates followed by cefotaxime, 45.23% and ampicillin, 35.71% in single or combination form respectively. Amikacin was used for max; 929 d followed by cefotaxime, 523 d and ampicillin 331 d respectively. Antibiotics used in single, double and multiple regimens were 19.04%, 46.42% and 34.52% respectively. Empiric antibiotic regimens practiced were cefotaxim+amikacin and cefotaxim+ampicillin, of which max, 80% patients were treated with the cefotaxim+amikacin antibiotic regimen. Out of 84 neonates max, 70% were improved at the time of discharge.Conclusion: Neonatal sepsis was well treated by cefotaxim+amikacin empirical injectable regimen with maximum survival.

scholarly journals Paperless partogram: a simple clinical tool in effective labour management

2021 ◽  
Vol 10 (6) ◽  
pp. 2308
Author(s):  
Shaik Reshma ◽  
Sri Lakshmi Ambarkar
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Clinical Tool ◽  
Maternal Deaths ◽  
Mortality And Morbidity ◽  
Obstructed Labour ◽  
Labour Room ◽  
A Prospective Study ◽  
User Friendly

Background: Maternal mortality is unacceptably high, about 830 women die from pregnancy or child birth related complications around the world every-day. Prolonged and obstructed labour is one of the major causes of maternal and perinatal mortality and morbidity worldwide. In developing countries like India, around 5% of total maternal deaths are caused by prolonged and obstructed labour. The purpose of the present study is to evaluate the role of paperless partogram in management of labour, identification of abnormal labour and early intervention to prevent the maternal and perinatal morbidity. The objective of this study was to assess the role of paperless partogram in labour monitoring and decision-making in overburdened Indian labour room setup and to evaluate the outcome of the cases.Methods: A prospective study was conducted at a tertiary care hospital, Kurnool, Andhra Pradesh, between January 2020 to March 2020. A total of 300 pregnant mothers in established labour who fulfilled the inclusion criteria, were included in the study after taking informed consent.Results: In our study, of all the pregnant women 23 crossed the alert ETD but 16 had delivered vaginally and 2 by caesarean section before action ETD and 5 women crossed the action ETD. Among the 5 who crossed action ETD 3 delivered vaginally and 2 had cesarean section. Majority, of the women who crossed the alert and action ETDs were primigravidae.Conclusions: From our study, it is concluded that paperless partogram was effective and user friendly in management of labour and prevention of abnormal or prolonged labour.

scholarly journals Role of C-Reactive Protein in Deciding Duration of Antibiotic Therapy in Neonatal Septicemia

2021 ◽  
Vol 16 (4) ◽  
pp. 230-237
Author(s):  
Love Kumar Sah ◽  
Prince Pareek ◽  
Atanu Pan ◽  
Sameera Thapa ◽  
Reema Garegrat
Keyword(s):  
Antibiotic Therapy ◽  
Neonatal Sepsis ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Acute Phase Reactant ◽  
Care Hospital ◽  
C Reactive Protein ◽  
Group Iii ◽  
Reactive Protein ◽  
Neonatal Septicaemia

IntroductionNeonatal septicemia is one of the commonest causes of neonatal morbidity and mortality worldwide. C-Reactive Protein (CRP) is an acute phase reactant that can be expected to fall quickly after efficientelimination of microbial stimulus due to its short half-life. CRP levels may sufficiently reflect the balancebetween microbes and immune system of the neonate for monitoring the effect of antibiotic treatmentand for guiding the duration of antibiotic therapy. MethodsA prospective study conducted in ninety neonates admitted with suspected neonatal sepsis during oneyear in tertiary care hospital in the department of pediatrics, College of Medical Sciences, Bharatpur,Nepal from October 2013 to September 2014. CRP was estimated within 24–72 hours of admission.Then neonates were assigned to one of 3 groups according to CRP levels. Infection unlikely group,infection likely group with two subgroups- CRP guided therapy and 7 days antibiotic therapy. ResultsOut of 90 cases of suspected neonatal septicaemia antibiotics were stopped in ≤7 days in 61 cases(67.8%). In 25 out of 30 cases (27.8%) of neonatal septicaemia, antibiotics were stopped after 72 hoursof initiation. In group II, antibiotics could be stopped in five days in 4 cases and remaining 26 casesantibiotics were given for 7 days. In group III, antibiotics could be stopped in 7 days in one case andremaining 29 cases antibiotics were given more than 7 days. ConclusionsCRP has a high negative predictive value 96-100% and can be used as a marker of neonatal sepsis toreduce duration of antibiotics.

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

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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