Early-Onset Neonatal Sepsis

Abstract

SUMMARY Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.

Evaluation of Polymorphnuclear Leucocyte Elastase as Diagnostic Tool in Neonatal Sepsis

“…This was agreed with Tsai et al (13) who detected that E.coli is more common in premature infant and sepsis onset on the 1 st day of life than non-E.coli, also Simonsen et al (14) ; Shah and Padbwy (15) , revealed in their study that E.coli is the organism most frequently involved in early onset sepsis. More over Liaquat et al (16) concluded that gram negative bacteria are the commonest cause of neonatal sepsis, and in their study they showed that E.coli is the most common gram negative bacteria causing neonatal sepsis.…”

Características microbiológicas y terapéuticas de la sepsis neonatal confirmada en un hospital de Lima, Perú

“…Estados Unidos del 2005 al 2008, la tasa de letalidad fue de 10,9%, aumentando en pretérminos según (negros con 24,4% y blancos con 21,5%) en comparación con neonatos a término (negro con 1,7% y blanco con 1,6%) (7) . En un estudio chileno, la mortalidad asociada a sepsis neonatal ha permanecido baja (2,2%) (19) .…”

“…Esto resulta importante al redundar en un menor tiempo de inicio de tratamiento y, probablemente, en disminuir la elevada carga de morbimortalidad asociada a sepsis neonatal (6) . En Estados Unidos, del 2005 al 2008, la mortalidad asociada a sepsis neonatal fue de 10,9% (7) . En Perú, no se ha reportado la mortalidad asociada.…”

“…También existen otros reportes nacionales en los que predominan los gérmenes Gram positivos, siendo el más frecuente el S. epidermidis (8) .En los Estados Unidos predominan las cepas de Streptococcus del grupo B (GBS) y los Gram negativos (9,10) .En Latinoamérica, los GBS son poco frecuentes, pero los Gram negativos son prevalentes (11,12) . Actualmente, en países desarrollados y en vías de desarrollo existe tendencia al aislamiento de Staphylococcus spp., en Estados Unidos se ha descrito esto en neonatos sometidos a procedimientos invasivos y en sepsis tardía (7) . Evidenciar el perfil microbiológico local resulta necesario para un adecuado manejo de la sepsis neonatal.…”

Role of Sepsis Screening in Early Diagnosis of Neonatal Sepsis

“…Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infection especially among very low birth weight infants. 4 The most common risk factors are pre maturerupture of membrane (>18 hr prior to delivery), maternal fever, maternal urinary tract infection, vaginal colonization with GBS, low levels of maternal antibody to GBS, and the presence of chorioamnionitis, 5 foul smelling liquor, multiple digital vaginal examinations, poor maternal nutrition, prematurity/Low birth weight, congenital anomalies, complicated or instrumentassisted delivery, low sapgar score (score of <6 at 5 min) and low socio economic status. 4 Sepsis in neonates may be difficult to differentiate from other conditions because the clinical signs are nonspecific.…”