Microbiological Profile of Neonatal Septicemia by Automated Blood Culture System (BacT/ALERT) at a Tertiary Care Hospital in Jamnagar, Gujarat, India

Background: This study was carried out to do rapid diagnosis of neonatal septicemia to prevent septicemia related complications and neonatal morbidity and mortality. Materials and Methods: This study was carried out in a tertiary care hospital from a period of March 2014 to August 2015. This is a non-randomized, prospective study in which one hundred and nine cases of suspected neonatal septicemia on the basis of antenatal high risk factors and signs and symptoms of sepsis were studied. Blood samples were collected from neonates in whom septicemia was suspected usually before antibacterial agents were given and both positive and negative samples were detected by automated system BacT/ALERT. Results: Out of 109 samples tested, 69 samples were positive and 40 samples were negative. The incidence of neonatal septicemia due to Gram positive organisms (62.85%) was found to be high. Among them Coagulase negative staphylococci (CONS) (27) (38.57%) was most common organism followed by Staphylococcus aureus (11) (15.71%), Enterococcus spp. (7.14%) and Streptococcus spp. (1.43%). Rate of Gram negative organisms was quite low (32.85%). Out of them Acinetobacter spp. (17.14%) was most common followed by Klebsiella spp. (7.14%), E.coli (5.71%) and Pseudomonas spp. (2.86%). Conclusion: Early detection of infection in neonates and proper antibiotics for the treatment leads to reduced morbidity and mortality.

Neonatal septicemia and current scenario of antibiotic sensitivity pattern – A study of blood culture isolates in a tertiary care hospital, Rajkot

Neonatal sepsis is one of the leading causes of neonatal mortality in developing countries. Neonatal sepsis can be classified into two subtypes depending upon onset of symptoms- before 72 hours of life (early-onset neonatal sepsis—EONS) or later (late-onset neonatal sepsis—LONS). Bacteriological profile and antibiotic susceptibility pattern in neonatal septicemia are changing time-to-time and place-to-place. This study is aimed to know the current scenario of neonatal septicemia and antibiotic susceptibility pattern for determining effective treatment, hence reducing burden of antibiotic resistance.This is a Retrospective study. Data was collected from Bacteriology lab, PDUMC Rajkot (May 2020 – May 2021). Blood cultures were performed on suspected neonates. Both BACTEC and conventional methods were used. Organisms were isolated by standard microbiological protocols and antibiotic sensitivity was performed by Kirby-Bauer disc diffusion method as per CLSI- 2020/2021 guidelines. Total 1402 samples were screened. 326 were positive (23.25%). 214(65.64%) were male and 112(34.36%) were female. CONS (32.21%) was found to be the predominant pathogen followed by Klebsiella (19.63%), Staphylococcus aureus (18.10%), E. coli (15.95%), Acinetobacter (12.27%) and Enterococcus spp. (1.84%). EONS was seen in 195(59.82%) cases and LONS was seen in 131(40.18%) cases. Gram-negative bacteria are predominant in EONS (76.28%) and gram-positive bacteria is predominant in LONS (64.12%). Gram negative isolates are mostly susceptible to Meropenem, Piperacillin-tazobactam, Cefepime, Ceftazidime. Gram positive isolates mostly showed sensitivity to Vancomycin, Linezolid.Multi-drug resistant organism are emerging in neonatal septicemia. Strict antibiotic stewardship should be practiced to avoid the upcoming treatment difficulties.

Neonatal Septicemia and Drug Resistance; 2 Year Prospective Study

Neonatal sepsis is a worldwide problem with the prevalence at 1 to10 per 1000 live birth and one of the indicator for measuring the health status of a nation. According to WHO there are about 5 million neonatal death per year with 98% occurring in developing countries. Antimicrobial resistance is a growing threat worldwide. Blood culture is considered as the gold standard technique for diagnosis of neonatal septicemia. The main objectives includes, to know the various bacteria causing neonatal septicemia and their antibiogram. To detect drug resistance among the isolated bacteria. A Prospective study was done over a period of 2 year. Blood samples for culture were collected aseptically before starting antibiotic therapy and subcultures were performed. The isolates were identified by standard biochemical tests and antibiogram of the isolates were studied. Out of 360 cases 160 were bacteriologically positive, Klebsiella was the most common organism isolated (21%), followed by Staphylococcus aureus (20%) Acinetobacter (15%), Pseudomonas (13%). Maximum sensitivity was seen by Linezolid, Erythromycin for Gram positive organisms and Gram negative organisms were sensitive to Piperacillin/ Tazobactum, Imipenem, Levofloxacin, Meropenem. Knowledge of likely causative organism causing neonatal septicemia can help in instituting prompt and appropriate therapy which in turn reduce morbidity and mortality.

Diagnostic Utility of Cord Blood Serum Procalcitonin in Early Onset Neonatal Sepsis in Comparision to Sepsis Screening Parameters

Neonatal sepsis is an important cause of neonatal deaths globally. Diagnosis of neonatal sepsis is established based on microbiological tests of sepsis screen and clinical status. Mid phase markers of inflammation like CRP & Serum Procalcitonin are considered useful and sensitive for diagnosis. Most of the studies evaluating serum PCT as a diagnostic marker for neonatal septicemia have been carried out in peripheral venous blood with smaller sample sizes with inclusion of neonates without considering perinatal sepsis score. This hospital based, prospective study compares the diagnostic utility of cord blood Procalcitonin (PCT) with venous blood PCT; alone and as part of sepsis screening parameters currently in use in perinatal sepsis score positive neonates. Statistical analysis for cord blood Serum Procalcitonin (PCT) for detecting blood culture positive patients showed that PCT has a sensitivity of 44.4%, a high specificity of 86.4%, a low PPV of 33.3% and a high NPV of 91.1%. Overall diagnostic accuracy is 80.9%, indicating that cord blood PCT is a good test for identifying these patients (p < 0.05). However, venous blood PCT failed to demonstrate similar results. Conclusions- Umbilical blood sampling protects the neonates from pain of venipunctures. Cord blood PCT estimations have statistically significant correlation with blood culture and other sepsis screen parameters and better sensitivity and specificity than venous blood PCT. This early serological biomarker is valuable for the diagnostic armamentarium of neonatal septicemia for early diagnosis and management while awaiting blood culture reports and helps in reducing separation of probable sepsis neonates from mother, thus contributing in developmental supportive care.

A study to evaluate the diagnostic value investigations in early diagnosis of septicemia in newborn

Background: The early diagnosis of neonatal septicemia still poses great difficulties. Early clinical symptomatology of neonatal septicemia is mimicked by a lot of other disorders affecting the newborn. To study the diagnostic value of the combination of CRP, absolute neutrophil count, band form count to the total neutrophil ratio in early diagnosis of neonatal septicemia.Methods: A total 75 babies who got admitted to Mahavir institute of medical sciences between October 2018 to September 2019 (12) months were included in the study medical college hospital in a newborn with age less than 3 days and with well-defined maternal risk factors or clinical evidence of sepsis are included in the study. In all neonates, the blood sample was collected from a peripheral vein with all aseptic precautions, before administration of any antibiotic therapy.Results: A total 20 preterm babies (62.5%) were affected by septicemia.12 full-term babies (37.5%) were affected by septicemia. The sensitivity of a lab test is defined as the proportion of infants with proven sepsis in whom the result is abnormal. Specificity is the proportion of healthy infants in whom the result is normal.Conclusions. When both CRP and band form to mature neutrophil counts were positive the sensitivity and the negative predictive value were high compared to other combinations of two.