Early-onset neonatal sepsis: Organism patterns between 2009 and 2014

Sgro, Michael; Campbell, Douglas M.; Mellor, Kaitlyn Luisa; Hollamby, Kathleen; Bodani, Jaya; Shah, Prakesh S.

doi:10.1093/pch/pxz073

Cited by 9 publications

(12 citation statements)

References 38 publications

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“…Similar to previous studies neonates born by vaginal delivery were at a higher risk of neonatal sepsis compared with those delivered through Cesarean section [23,27]. Further, culture confirmed sepsis was high (89.9%) In this study, gram-negative bacteria were the most common cause of EOS and LOS, which is consistent with previous reports from developing countries [8,9,22,31]. Unexpectedly, B. cepacia emerged as the most common cause of neonatal sepsis.…”

Section: Discussionsupporting

confidence: 91%

“…Bacteria are the most common pathogens, and they vary in the distribution between countries, regions and according to the disease onset EOS versus LOS [7]. The commonly involved bacteria in developing countries include Klebsiella species, Staphylococcus aureus, E. coli, and Group B Streptococcus [8,9]. Recently, B. cepacia, a bacterial pathogen that has intrinsic drug resistance and ability to live inside drug products [10,11], has emerged as a significant pathogen causing neonatal sepsis [12][13][14][15][16].…”

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confidence: 99%

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Neonatal sepsis in Sana’a city, Yemen: a predominance of Burkholderia cepacia

et al. 2021

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Background Neonatal sepsis is a global concern with increasing morbidity and mortality. The burden of neonatal sepsis is highest in developing countries, especially in those lacking proper surveillance systems. The causative pathogens and their drug-resistance levels vary between countries with emergence of multidrug resistance organisms. Thus, accurate records on the recent trends of organisms causing neonatal sepsis will provide vital information for appropriate intervention. We aimed to investigate neonatal sepsis, identify its associated factors and causative pathogens and to assess the antibiotic susceptibility patterns in Sana’a city, Yemen. Methods A cross-sectional study was conducted on neonates admitted to intensive care units of six hospitals in Sana’a city, Yemen, in the period from January 15, to March 30, 2020. Natal and prenatal medical data were collected using well-structured questionnaire. Neonates were subjected to sepsis work-up including blood culture, complete blood count and C-reactive protein. Organisms were identified by Gram staining and analyzed by the VITEK II system for bacterial bio-typing and antibiotic susceptibility testing. Findings Of the 199-neonates with suspected neonatal sepsis, 154 (77.38%) had culture-proven sepsis. Early-onset neonatal sepsis (EOS) was higher (50.25%; 100/199) than late-onset neonatal sepsis (LOS) (27.13%; 54/199). Multivariable analysis identified vaginal delivery as an independent risk factor for neonatal sepsis p = 0.005. Majority of isolated bacteria (74.39%) were gram-negative with Burkholderia cepacia (39%) and Klebsiella oxytoca (13%) being the most common pathogens of EOS and LOS. The most common gram-positive pathogens were Staphylococcus haemolyticus (9.1%) and Staphylococcus epidermidis (7.1%). B. cepacia showed multidrug resistance except for cefepime. All Klebsiella species isolates (100%) and most Pantoea species (93%) were ESBL and carbapenemase positive. All Escherichia coli and Acinetobacter baumannii isolates were ESBL positive. A significant number of gram-positive bacteria showed resistance to vancomycin. Conclusion The study findings show a high proportion of neonatal sepsis among neonates admitted to hospitals in Sana’a city with antibiotic-resistant B. cepacia being the single most common pathogen causing EOS and LOS. Findings also emphasize the emerging threat of multidrug-resistant bacteria in neonatal units and will help develop evidence-based management of neonatal sepsis in Yemen.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Neonatal sepsis in Sana’a city, Yemen: a predominance of Burkholderia cepacia

et al. 2021

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“… 1 In Canada, E. coli has surpassed group B Streptococcus (GBS) as the most common cause of EOS as screening and prophylactic intrapartum antibiotics have become the standard of care. 2 …”

Section: Introductionmentioning

confidence: 99%

“…1 In Canada, E. coli has surpassed group B Streptococcus (GBS) as the most common cause of EOS as screening and prophylactic intrapartum antibiotics have become the standard of care. 2 A number of risk factors for EOS have been identified, but the only recommendation is by the American Academy of Pediatrics (AAP) for asymptomatic siblings of a patient with EOS in a multigestational pregnancy is close observation, as EOS is usually caused by vertical transmission from the mother. 3 In a small case series and literature review, Almidani et al found a wide variation in practice and no consensus on management in this situation.…”

Section: Introductionmentioning

confidence: 99%

NeonatalEscherichia coliinfection in twins: clinical spectrum and management dilemma

et al. 2021

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The clinical manifestation of Escherichia coli could vary from asymptomatic bacteraemia to systemic bloodstream infection and meningitis. We describe an unusual course of E. coli infection in twins, emphasising commencement of appropriate antimicrobial therapy. A set of male dichorionic diamniotic twins were delivered at 34 weeks of gestation by caesarian section. Pregnancy was complicated by diabetes, pre-eclampsia and cholestasis. Antenatal ultrasounds noted a congenital pulmonary airway malformation in twin A. Following delivery, twin A developed respiratory distress, but twin B was asymptomatic. Partial septic work-up at admission in the neonatal intensve care unit was done. Twin A’s blood culture grew E. coli, while twin B’s blood culture was negative. Twin A was treated with 7 days of intravenous antibiotics. At 11 days of age, twin B acutely developed a scrotal swelling. On suspicion of testicular torsion, he was taken for urgent surgery, which revealed a scrotal abscess positive for E. coli. The scrotum was irrigated and successfully treated with 4 weeks of antibiotics. Both twins were doing well at 3 months of follow-up.

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“…D espite significant advances in perinatal care, neonatal sepsis remains a predominant cause of morbidity and mortality in newborn infants, with group B streptococci (GBS) being one of the most common causative and clinically relevant pathogenic organisms. [1][2][3][4] Early-onset neonatal sepsis (EOS) is a life-threatening condition requiring prompt intravenous therapy with broad-spectrum antibiotics. Benzylpenicillin (BPEN), a time-dependent β-lactam antibiotic with narrow-spectrum activity, is the treatment of choice for the definitive treatment of GBS disease in newborn infants.…”

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confidence: 99%

Benzylpenicillin Serum Concentrations in Neonates With Group B Streptococci Sepsis or Meningitis

Jansen¹,

Lopriore²,

Bredius

et al. 2020

Pediatric Infectious Disease Journal

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Background: Adequate dosage recommendations are imperative for successful treatment of invasive infections. We evaluated the occurrence of sub-and supratherapeutic serum and cerebrospinal fluid (CSF) concentrations of benzylpenicillin (BPEN) in neonates treated for a severe group B streptococci (GBS) sepsis and/or meningitis as well as discrepancies in dosing recommendations provided by pediatric reference sources. Methods: Retrospective analysis of (pre)term infants treated with BPEN undergoing therapeutic drug monitoring (TDM) between May 2015 and May 2019. Outcomes included numbers of sub-and supratherapeutic concentrations, and dose adjustments, clinical evolution, and dosing recommendations from six pediatric reference sources. Results: A total of 21 TDM samples from 8 neonates were evaluated. Among serum concentrations, 9/21 (43%) were below and 8/21 (38%) above the pre-specified therapeutic target range of 10-20 mg/L. Only 1 patient had BPEN determined in CSF whose concentration was below the lower limit of quantification. TDM identified a need for dose modification in 10/21 (48%) instances. Three of eight patients exhibited complete resolution of clinical, laboratory and radiologic signs of infection. Substantial variation in dosing recommendations (50,000-400,000 IE/kg/d) was present between reference sources. Conclusions: Our data reveal that under current dosage recommendations, the predefined target serum or CSF concentrations of BPEN are not achieved in all children. In case of clinical failure, serum and/or CSF BPEN concentrations should be determined. Given the wide variation in concentrations and subsequent dose requirements, further exploration of the clinical and pharmacologic characteristics of BPEN in (pre)term neonates is essential to optimize therapeutic efficacy.

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Early-onset neonatal sepsis: Organism patterns between 2009 and 2014

Cited by 9 publications

References 38 publications

Neonatal sepsis in Sana’a city, Yemen: a predominance of Burkholderia cepacia

Neonatal sepsis in Sana’a city, Yemen: a predominance of Burkholderia cepacia

NeonatalEscherichia coliinfection in twins: clinical spectrum and management dilemma

Benzylpenicillin Serum Concentrations in Neonates With Group B Streptococci Sepsis or Meningitis

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