Late-onset neonatal sepsis: Overview of risk factors and bacterial etiology in a tertiary care hospital in North India
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Clinical profile of infants with late onset sepsis admitted in a North East Indian tertiary care center: insights into the uncharted
Objectives To assess the clinical profile of infants with late onset sepsis admitted in a tertiary care hospital in North-East India. Methods Prospective observational study was carried out in Department of Paediatrics, Regional Institute of Medical Sciences hospital during a period of 2 years (September 2019–August 2021). Results A total of 109 patients were included in the study, of which 80 were community-acquired and 29 infants were hospital-acquired cases of late onset sepsis (LOS). The major risk factors were low socioeconomic status, prematurity, low birth weight, a history of intervention (mechanical ventilation, umbilical venous catheter, total parenteral nutrition, resuscitation) and lack of exclusive breastfeeding. The most common presenting features were decreased feeding, lethargy and respiratory distress. Blood cultures were positive in 33% of patients. Klebsiella was the most common hospital-acquired pathogen while Escherichia coli was the most common isolate in community-acquired cases. Thrombocytopenia was the most common complication. The in-hospital mortality rate was 13.7%. Conclusion Low socioeconomic status, low birth weight, prematurity, invasive interventions and lack of exclusive breastfeeding are the major risk factors of LOS. The clinical signs and symptoms are varied and subtle. The mean C-reactive protein in the hospital-acquired group was significantly higher as compared to the community-acquired group. There is substantial morbidity and mortality, resulting in an increased toll on resources, therefore, an aggressive preventive and treatment approach is recommended for late onset sepsis.
Clinical profile of infants with late onset sepsis admitted in a North East Indian tertiary care center: insights into the uncharted
Objectives To assess the clinical profile of infants with late onset sepsis admitted in a tertiary care hospital in North-East India. Methods Prospective observational study was carried out in Department of Paediatrics, Regional Institute of Medical Sciences hospital during a period of 2 years (September 2019–August 2021). Results A total of 109 patients were included in the study, of which 80 were community-acquired and 29 infants were hospital-acquired cases of late onset sepsis (LOS). The major risk factors were low socioeconomic status, prematurity, low birth weight, a history of intervention (mechanical ventilation, umbilical venous catheter, total parenteral nutrition, resuscitation) and lack of exclusive breastfeeding. The most common presenting features were decreased feeding, lethargy and respiratory distress. Blood cultures were positive in 33% of patients. Klebsiella was the most common hospital-acquired pathogen while Escherichia coli was the most common isolate in community-acquired cases. Thrombocytopenia was the most common complication. The in-hospital mortality rate was 13.7%. Conclusion Low socioeconomic status, low birth weight, prematurity, invasive interventions and lack of exclusive breastfeeding are the major risk factors of LOS. The clinical signs and symptoms are varied and subtle. The mean C-reactive protein in the hospital-acquired group was significantly higher as compared to the community-acquired group. There is substantial morbidity and mortality, resulting in an increased toll on resources, therefore, an aggressive preventive and treatment approach is recommended for late onset sepsis.
Burden of Klebsiella pneumoniae in late onset neonatal sepsis in a tertiary care hospital in Western Maharashtra
is a notorious superbug that is rapidly becoming the most common nosocomial pathogen to be isolated from intensive care settings. : To determine the burden of and associated risk factors of late onset sepsis among neonates admitted into neonatal intensive care unit (NICU).: A prospective study was conducted among 200 neonates admitted into the NICU of Sassoon General Hospital from January 1, 2019 to December 31, 2019. Neonates <28 days of age exhibiting clinical signs and symptoms of sepsis >72hrs after birth were included in the study. A detailed case history format of patient information was prepared. Blood sample was subjected to identification by culture and real time polymerase chain reaction (RT-PCR). Neonates who were positive by blood culture were confirmed as having sepsis.: Frequency of was 33.3% by blood culture and 38.1% by RT-PCR. Most of the septic neonates were males (n=6; 60%), formula fed (n=7; 70%), extremely low birth weight (n=6; 60%), delivered through caesarean section (n=6, 60%) and were preterm (n=7; 70%). Mortality was seen in 2 (20%) cases. All the isolates were sensitive to meropenem, piperacillin + tazobactam, amikacin, polymyxin B and colistin. : Occurrence of was 33.3% in late onset neonatal sepsis by blood culture. Low birth weight, formula feeding, prematurity and caesarean section were associated with a higher risk of sepsis in these patients. Antimicrobial stewardship and hospital infection control measures are need of the hour in preventing late onset neonatal sepsis.
BACKGROUND – Sepsis in neonates may be difcult to differentiate from other conditions, because the clinical signs are non-specic. It is a common cause of morbidity and mortality amongst neonates in NICU. Neonatal sepsis is a clinical syndrome which is accompanied by signs and symptoms of infection during rst 4 weeks of life. Neonatal mortality accounts for about 40% deaths under ve years of age. Global incidence of neonatal deaths caused by sepsis is only 15% but in a developing country like our sepsis accounts for about 30% -50% of neonatal mortality. Delay of even few hours in initiating treatment can increase mortality and morbidity considerably. AIMS AND OBJECTIVESAIM- To correlate procalcitonin with sepsis screen and blood culture in neonatal sepsis. OBJECTIVESA. To compare procalcitonin and CRP with culture positivity in diagnosing neonatal sepsis. B. To Determine sensitivity, specicity and predictive value of Procalcitonin as an indicator of neonatal sepsis in comparison with blood culture. C. To predict the value of altered WBC and platelet counts in diagnosing neonatal sepsis. D. To correlate culture proven sepsis with maturity of neonate, birth weight and mode of delivery. Material: 100 clinically suspected cases of Sepsis in neonates admitted to MMIMSR, Mullana, Ambala. Methods: All neonates who were suspected clinically as a case of sepsis based on sepsis score and categorized into (0- 72 hours PNL) EOS or LOS (>72hours PNL) depending on day of presentation of clinically suspected sepsis. Detailed history along with clinical ndings of neonates were noted. SERUM PROCALCITONIN, SEPSIS SCREEN with predetermined cut off values and during the same time blood culture was taken and sent. Depending on clinical condition CSF analysis, Urine analysis, Chest Xray were sent. Sensitivity, specicity and predictive values of procalcitonin, CRP and other parameters were assessed. RESULTS- In this study of 100 neonates with clinical suspicion of sepsis admitted in NICU in MMIMSR over a period of 16 months from JAN 2020 to JUNE 2021. Out of 100 cases of the number of male neonates included in this study was greater than the female neonates suggesting that in clinically suspected neonatal sepsis male neonates were affected more than female neonates. Out of 100 neonates 63 neonates were male (63%) and 37 were female (37%). Laboratory nding of positive blood culture of sepsis of male neonates is 10 (56%), whereas female neonates of positive blood culture of sepsis is 8 (44%). Culture positivity showed only a slight rise in male neonates than females which was not much of a difference. . About three-fold increase in culture positivity was seen in preterm neonates (55%) when compared to term neonates (19%). Laboratory nding of positive blood culture of SGA neonates is 10 (19%), AGA is 8 (17%). Culture positivity showed SGA neonates has greater sepsis cases than AGA neonates. Association of sepsis score with procalcitonin value. On applying regression analysis, we found there is no association with R square 0.004. Association of CRP value with procalcitonin value. On applying regression analysis, it was found very mild association with R square 0.028. shows Association of absolute leucocyte count value with procalcitonin value. On applying regression analysis, we found very mild association with R square 0.069. Association of blood culture with procalcitonin. On applying t test between positive and negative blood culture with procalcitonin value we found significant association of procalcitonin value (p value <0.05). CONCLUSION-In this study the risk factors commonly associated with neonatal sepsis were found to be LBW, VLBW, ELBW, Prematurity, LSCS, instrumental delivery that is assisted vaginal. delivery. EONS was more common than LONS. Procalcitonin was found to be a sensitive tool for diagnosis and it also helps predicting the outcome of sepsis as compared to CRP but it cannot be used as a sole marker as its neither 100% sensitive and it's not 100% specic. The predictability can be achieved by a combination of markers of neonatal sepsis rather than a single marker but as of now BLOOD CULTURE remains the gold standard in diagnosis of neonatal sepsis.
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