Bacteriological profile, antibiotic susceptibility and factors associated with neonatal Septicaemia at Kilembe mines hospital, Kasese District Western Uganda

Introduction Neonatal septicaemia is one of the most common leading causes of neonatal morbidity and mortality in developing countries. It is estimated to affect more than 30 million people worldwide annually, potentially leading to 6 million deaths. Objective(s) To determine the prevalence, bacteriological profile, antibiotic susceptibility and factors associated with neonatal septicaemia among neonates suspected to sepsis at Kilembe mines hospital. Methods We conducted a descriptive cross-sectional study, where purposive sampling technique was used and blood was drawn from 122 neonates suspected to sepsis attending Kilembe Mines Hospital during the period (July to November 2020). Specimens were inoculated in Brain heart infusion broth, transported to Fortportal Regional Referral Hospital, plated daily up to 7 days on blood, chocolate, MacConkey agar and incubated in aerobic and 5% carbondioxide. Pure colonies were identified by Gram stain, biochemical tests and antibiotic sensitivities obtained by Kirby Bauer disc diffusion method. Associations were tested using Chi square with Fisher’s exact or Yates correction tests where necessary and statistical significance was set at P < 0.05. Stata (version 14) used for statistical analysis. Results Blood cultures were positive in 59.0% cases with 55.5% male and 44.4% female. EOS was present in 56.9% and LOS 43.1% of the cases. Gram negative (56.9%) organisms were most implicated with neonatal septicaemia than Gram positives ones (43.1%). Gram positive organisms exhibited better susceptibility to amikacin, linezolid and vancomycin but more resistant to ampicillin and gentamicin. Of the aminoglycosides, amikacin exhibited a verge over netilmicin and gentamicin against Gram negative isolates. Risk factors of neonatal septicaemia were mother’s age of ≥25 years, employed mothers, tertiary-level of education, SVD, ANC attendance of ≥4 times, UTI during pregnancy, PROMS, foul Smelling liquor, urban residence, neonatal birth weight of ≥2500 g, Apgar score 1st and 5th min ≥6 and resuscitation. Conclusion Multi-drug resistant organisms were isolated. Therefore caution is required in selection of antibiotic therapy and avoid empirical treatment.

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

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.

Bacteriological Profile, Antibiotic Susceptibility and Factors Associated with Neonatal Septicaemia at Kilembe Mines Hospital, Kasese District Western Uganda

Introduction: Neonatal septicaemia is one of the most common leading causes of neonatal morbidity and mortality in developing countries. It is estimated to affect more than 30 million people worldwide annually, potentially leading to 6 million deaths. Objective(s): To determine the prevalence, bacteriological profile, antibiotic susceptibility and factors associated with neonatal septicaemia among neonates seeking medical services at Kilembe mines hospital.Methods: We conducted a descriptive cross-sectional study where blood was drawn from 122 neonates that were seeking medical attention at Kilembe Mines Hospital during the period of July to November 2020. Specimens were inoculated in BHI broth, transported to Fortportal Regional Referral Hospital, plated daily up to 7 days on blood, chocolate, MacConkey agar and incubated in aerobic and 5% carbondioxide. Pure colonies were identified by gram stain, biochemical tests and antibiotic sensitivities obtained by Kirby Bauer disc diffusion method. Statistical significance set at P< 0.05 and logistic regression was used to determine predictors of neonatal septicaemia. Stata (version 14) used for statistical analysis.Results: Blood cultures were positive in 59.0% cases with 55.5% male and 44.4% female. EOS was present in 56.9% and LOS 43.1% of the cases. Gram negative (56.9%) organisms were most implicated with neonatal septicaemia than gram positives ones (43.1%). Gram positive organisms exhibited better susceptibility to amikacin, linezolid and vancomycin but more resistant to ampicillin and gentamicin. Of the aminoglycosides, amikacin exhibited a verge over netilmicin and gentamicin against gram negative isolates. Risk factors of neonatal septicaemia were mother’s age of ≥25 years, employed mothers, tertiary-level of education, SVD, ANC attendance of ≥4 times, UTI during pregnancy, PROMS, foul Smelling liquor, urban residence, neonatal birth weight of ≥2500g, Apgar score 1st and 5th min ≥6 and resuscitation.Conclusion: Multi-drug resistant organisms were isolated. Therefore caution is required in selection of antibiotic therapy and avoid empirical treatment.

Diversity and Prevailing Antimicrobial Resistance in Blood Stream Pathogens at NICU of a Tertiary Care Institute in Kolkata

BACKGROUND Septicaemia is a leading cause of morbidity and mortality in neonates. Antimicrobial prescription for neonatal septicaemia (NS) should be wisely used depending on the regional spectra of infecting microbes and their antimicrobial resistance (AMR) patterns which vary over time, place and host factors. METHODS This was a descriptive cross-sectional study conducted from January 2017 to June 2017 among 102 cases of NS admitted in neonatal intensive care units (NICU). Demographic data of the concerned neonates was collected through a predesigned checklist. Blood collected from neonates was processed for culture and sepsis screen. Antimicrobial susceptibility testing was performed for the cultured isolates and phenotypic AMR patterns were observed. RESULTS Most of the studied neonates had subnormal birth weight (86). Blood culture showed predominance of gram-negative bacilli (GNB) among which Klebsiella pneumoniae was the most common followed by Burkholderia cepacia complex. Coagulase negative staphylococcus species (CoNS) was most numerous among the cultured gram-positive cocci (GPC). Candidemia of late onset was confirmed in 25 neonates. Early onset sepsis was predominantly caused by GNB (29 / 31) predominated by Klebsiella pneumoniae. Multi drug resistant (MDR) pathogens viz., extended spectrum beta-lactamase (ESBL) producing GNB, carbapenem resistant-GNB (CR-GNB) and methicillin resistant staphylococcus (MRS) phenotypes were notably prevalent. CONCLUSIONS Multidrug resistant microorganisms are notably prevalent in neonatal septicaemia. In clinically suspected very sick septicaemic neonates not showing much improvement with guideline-led empirical antimicrobial therapy, an early antibiogram guided change over to meropenem and amikacin or even to colistin in case of reported carbapenem resistance, is highly recommended. KEYWORDS Antimicrobial Resistance, Blood Culture, Multi Drug Resistance, Neonatal Septicaemia

Haematological Parameters in Neonatal Sepsis in a Tertiary Care Centre Study

BACKGROUND Neonatal septicaemia is a bacterial infection with positive blood culture in first four weeks of life. The early sepsis screen is vital as it detects earlier and benefits the clinician to treat the infection reducing neonatal mortality and morbidity. We wanted to evaluate various haematological screening parameters and C-reactive protein (CRP) in blood culture positive neonates in sepsis. METHODS This prospective study was conducted for a period of one year. Blood samples from hundred clinically suspected neonatal septicaemia cases were subjected to aerobic culture and sepsis screen tests like C-reactive protein, erythrocyte sedimentation ratio (ESR), total WBC count, absolute neutrophil count, immature / total neutrophil count (I / T) ratio and platelet count. The culture results were correlated with the sepsis screen tests. RESULTS Of the hundred cases studied, 18 % were blood culture positive and 66 % were males. Early onset septicaemia was more common, seen in 64 % of cases than late onset septicaemia (26 %) cases. Staphylococcus aureus was the commonest organism isolated in 38.46 % of cases followed by Klebsiella pneumoniae & E. Coli. Among the haematological parameters, the positivity was best with Creactive protein (94.44 %) followed by immature & mature neutrophil ratio (I / M) (94.44 %), I / T ratio (88.88 %) and the least with absolute neutrophil count (66.0 %). Any two or more parameters were positive in 94.44 % of the subjects. CONCLUSIONS Sepsis screen has good sensitivity, specificity and is a valuable aid for early diagnosis of neonatal septicaemia. Sepsis screen is simple, cost effective, less time consuming and easy to perform. As an individual test C-reactive protein has shown highest sensitivity, specificity and is a sensitive and responsive indicator of neonatal sepsis. KEYWORDS Blood Culture, Neonatal Septicaemia, Sepsis Screen