Covid-period-associated changes in organism profile of neonatal sepsis in a tertiary center from East India

Abstract

Introduction Neonatal sepsis is a major cause of morbidity and mortality with a higher burden from the low- and middle-income countries. The coronavirus disease 2019 (Covid 19) pandemic has impacted healthcare in various ways including healthcare-associated infections (HAI). The objective of the present study was to determine changes in organism profile and incidence rates of HAI in neonates admitted to the index hospital during the pandemic and compared it with the data from the pre-pandemic period. Materials and methods The study design was a retrospective, observational analysis of data from neonates with culture-positive sepsis, in a tertiary care children’s hospital, between January 2018 and December 2021. Pre-Covid (January 2018 to December 2019) and Covid period data (January 2020 to December 2021) were analyzed for the significance of change. Results The prevalence of culture-positive sepsis, in pre-Covid and Covid periods, was 19.55% [95% confidence interval (95% CI) 17.13–21.52)] and 18.36% (CI 16.05–20.74), respectively. HAI rates/1000 patient days increased slightly during the Covid pandemic [7.2% (95% CI 6.98–10.08) to 9.8% (95% CI 9.78–13.67)] mainly due to an increase in fungal HAI (26% pre- vs. 41.5% Covid period). However, the proportion of Gram-negative (GN) infections fell significantly (70.5% vs. 48.6%) during the same period. In the pre-Covid period, Klebsiella followed by Burkholderia cepacia, Acinetobacter spp and Pseudomonas, were the major HAI isolates. During the Covid period, there was a decline in these isolates and Burkholderia spp was not detected. All fungal isolates were Candida species. The case fatality ratio (CFR) from HAI decreased significantly from 38% to 15.45%, mainly due to a decrease in GN HAI. Conclusion During Covid pandemic, there was a significant decline in GN HAI and CFR from HAI, due to improved compliance with infection control measures in the neonatal intensive care unit (NICU). At the same time, there was a rise in the fungal HAI, possibly because of a higher proportion of premature, and sick neonates with longer hospital stay and more invasive procedures. Consolidations of gains in infection control and restriction of invasive procedures could help to minimize HAI in NICUs.

Epidemiologic features of neonatal sepsis and its COVID-19 associated temporal patterns in Jimma Medical Center, Ethiopia: A Joinpoint regression analysis

“…Evidence also points to a clear relationship between the incidence trend of newborn sepsis and the intensity of the COVID-19 containment measures. Despite several confounding variables, this finding is similar to the lesson learned in India, where strict adherence to COVID-19 containment measures resulted in a 1.19% decrease in the incidence trend of neonatal sepsis [ 55 ]. More importantly, compliance levels in the center were variable during intense periods, and they eventually diminished with the pace of the pandemic [ 56 ], likely contributing to the instability of neonatal sepsis incidence trends [ 57 , 58 ].…”

The relevance of coagulase-negative Staphylococcus isolates in blood culture in the context of a tertiary neonatal unit from East India

“…However, CoNS HAI did not show a significant decline due likely to their immune mechanism evading abilities. 19 CoNS HAI rates are influenced by GA, BW, and duration of hospital stay and presence of CL among others. 10 In the index study, the majority of neonates with definite or probable CoNS BSI were >2 kg in weight (73%) and >34-week GA (60%) (Table 2).…”