Dissertation neonatal septicemia

Dissertation neonatal septicemia

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Dissertation Neonatal Septicemia

Little dissertation neonatal septicemia known about the epidemiology and antimicrobial susceptibility pattern of sepsis causing bacterial pathogens in Nepal.

A prospective study was carried out among neonates suspected to have sepsis and admitted to Tribhuwan University Teaching Hospital from January to December Clinical suspicion of sepsis was made based on clinical findings and laboratory parameters, later confirmed by isolation of organisms in blood culture.

Drug resistance pattern of Gram-positive and Gram-negative bacteria were studied by standard methods. Meropenem resistant Gram-negative bacteria were processed for the detection of β-lactamases and resistant genes were detected by X-pert Carba-R Cepheid Assays. Of neonates with clinically suspected sepsis, Coagulase-negative Staphylococcus aureus Dissertation neonatal septicemia was the most common dissertation neonatal septicemia Of all isolates, 81 aureus MRSAand 14 The bla KPC dissertation neonatal septicemia was detected in four isolates of K.

pneumoniaetwo of E. colione ABC Acinetobacter baumanii complexand one Enterobacter aerogenes whereas bla NDM gene was detected in one isolate of K. colitwo Pseudomonas aeruginosaone Acinetobacter baumanii complex, and one Enterobacter aerogenes.

Overall mortality due to sepsis-related causes was 7. One-third of clinically suspected neonatal sepsis cases were culture positive, dissertation neonatal septicemia.

Late-onset sepsis was more common than early onset. CoNS was the predominant bacterial isolate followed by Klebsiella pneumoniae, with high rates of multi-drug resistance. Neonatal sepsis NS is a clinical syndrome presented with clinical features of infection with or without underlying bacteremia in the first month of life. Early onset sepsis EOS : Presentation within the first 72 hours of life. Infants with EOS mostly present with pneumonia and respiratory distress, dissertation neonatal septicemia.

Maternal genital tract is the primary source of infection. Antibiotic treatment should be initiated for the newborn if there is foul-smelling liquor or three of the above-mentioned risk factors. If only two risk factors are present then infants should be investigated for possible infection and then treated accordingly. Late onset sepsis LOS Presentation after 72 hours of life. Nosocomial hospital-acquired or community-acquired can be source of infection in LOS.

Predisposing factors that increased risk of nosocomial sepsis include prematurity, low birth weight, invasive procedures, dissertation neonatal septicemia, mechanical ventilation, admission in intensive care unit, administration of parenteral fluids, and use of stock solutions.

Neonatal sepsis can be classified into three major groups according to the criteria for the diagnosis of neonatal sepsis. The organisms that cause EOS of term and preterm infants dissertation neonatal septicemia are Group B Streptococcus GBS and E. Others organism that cause EOS are Streptococcus viridans, dissertation neonatal septicemia, Streptococcus pneumoniae, dissertation neonatal septicemia, Enterococcus spp.

aureus, E. coli, K, dissertation neonatal septicemia. pneumoniae, Enterobacter spp. Dissertation neonatal septicemia ongoing efforts for early diagnosis, dissertation neonatal septicemia, treatment, and prevention, it remains a challenge for clinicians due to frequent changes in epidemiology, non-specific symptoms, dissertation neonatal septicemia, lack of ideal diagnostic markers, and emergence of multi-drug resistant MDR pathogens.

This study was conducted among neonates, both in-born and brought-in cases, admitted to the Neonatal Intensive Care Unit NICU and non-NICU units neonatal unit and neonatal ward at the Department of Pediatrics in Tribhuwan University Teaching Hospital TUTH from January to December All newborns with clinical suspicion of sepsis were enrolled into the study and their body samples blood, urine, cerebrospinal fluid, pus, sputum were processed for sepsis work-up.

In clinically suspected cases, additionally, the following inflammatory variables were investigated. Micro-ESR was performed in the bed side; total leucocyte count TLCdifferential count DCand platelet count were tested in the hematology laboratory; and blood culture and C-reactive protein CRP tests in microbiology laboratory by following the standard methods. One ml of blood was mixed with nine ml of Brain Heart Infusion BHI broth under aseptic condition then transported to the microbiology laboratory.

BHI broth with blood samples were incubated at dissertation neonatal septicemia aerobically and observed for turbidity and other signs of bacterial growth. Sub-culture was done in Chocolate, Blood and MacConkey agar plates from turbid BHI broths and incubated at 37°C for hours.

The organisms were isolated and identified as Gram-positive or Gram-negative according to the American Society for Microbiology ASM guidelines. Results of Gram staining test were informed to the clinicians. Antibiotic susceptibility testing AST was done simultaneously with isolate identification and reports were dispatched accordingly. Patterns of MDR i. organism is resistant to at least three groups of antimicrobial agents were also noted, dissertation neonatal septicemia.

In Gram-positive organisms, methicillin resistance was identified according to Clinical and Laboratory Standard Institute CLSI guidelines, dissertation neonatal septicemia. In Gram-negative cases, cefotaxime resistant organisms were tested for Extended Spectrum β-lactamase ESBL and AmpC type β-lactamase.

Modified Hodge test was performed in meropenem resistant organisms following the CLSI guidelines. Organisms that tested positive for Modified Hodge test were processed for the detection of Metallo-β-lactamase MBLKlebsiella pneumonia carbapenemase type β-lactamases KPCsand Oxacillinase type β-lactamases OXA drug resistance patterns according to the standard guidelines.

Figures Tube coagulase test showing Negative and Positive result. Biochemical reaction of Burkholderia cepacia complex BCC. Methicillin-resistant Staphylococcus aureus MRSA showing resistant to cefoxitin 30 microgram. Modified Hodge test showing positive result. Test and positive control show indentation. Detection of NDM by using Xpert Carba-R Assay Genetic confirmation by detecting blaNDM drug resistance gene. The patients included into the study were prospectively followed up until discharge or death.

All reports were recorded in the case report forms Performa. IRB of Institute of Medicine, dissertation neonatal septicemia, TUTH has approved this study. Descriptive analysis of data was done by SPSS Inc.

version Identification of microorganisms isolated from Blood culture. CoNS: Coagulase-negative Staphyloccocus aureus ; BCC: Burkholderia cepacia complex ; ACBC: Acinetobacter calcoaceticus baumanii complex. During one-year study period, dissertation neonatal septicemia, neonates were admitted to the neonatal units with the diagnosis of suspected sepsis, Of suspected sepsis cases, Overall, the most common isolates were coagulase-negative Staphylococcus CoNS In EOS, CoNS and Klebsiella pneumoniae were most common isolates, whereas Staphylococcus aureus and Enterococcus species were most common in LOS.

Table 1. Table 1 : Age-wise distribution of blood culture isolates in culture-positive cases. CoNS: Coagulase-negative Staphyloccocus aureus; BCC: Burkholderia cepacia complex; ACBC: Dissertation neonatal septicemia calcoaceticus baumanii complex. Following treatment, Of improved cases, 56 Nearly half Table 2. Table 2 : Risk factors of neonatal sepsis in culture-positive cases.

As high as Table 3. Table 3 : Proportion of multi-drug resistant organisms among blood culture isolates. Note: One of the isolates of blood culture was Candida albicans. Among 16 Staphylococcus aureus isolates, three Xpert Carba-R Assays confirmed KPCs and New Delhi Metallo-β-lactamase NDM by detecting bla KPC and bla NDM drug resistance genes respectively. pneumoniae, two of E. coli, one ABC, and one Enterobacter aerogenes. bla NDM gene was detected in one isolate of K.

pneumoniae, two isolates of E. coli, two isolates of Pseudomonas aeruginosa, one isolates of Acinetobacter baumanii complex ABCand one isolates of Enterobacter aerogenes. Neonatal sepsis continues to remain a major clinical problem with high rates of morbidity and mortality, especially in resource-poor countries like Nepal. In our study, more than one third This finding is in agreement with other studies done in Nepal in which rates of culture-proven sepsis were The clinical signs and symptoms in neonates are rather subtle and nonspecific which dissertation neonatal septicemia it difficult for an early diagnosis of neonatal sepsis.

Sepsis diagnosis may also be interfered by other life-threatening diseases in newborns such as perinatal asphyxia and necrotizing enterocolitis. The rate of culture-proven neonatal sepsis rubella, cytomegalovirusprotozoa for e.

Toxoplasma gondiiand treponema for e. Treponema pallidum, dissertation neonatal septicemia. The incidence of septicemia has been reported to be higher in males than in females. Dissertation neonatal septicemia another study from Nepal, male-to-female ratio was 1.

Prevalence of gender bias in the society especially while seeking health caredissertation neonatal septicemia of study, and sample-related factors could be the potential reasons for male preponderance, dissertation neonatal septicemia. The proportion of late onset sepsis was higher than early onset sepsis in our setting incidence of LOS vs.

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