Risk Factors for 30-Day Mortality in Neonatal Gram-Negative Bacilli Sepsis

Thatrimontrichai, Anucha; Premprat, Nutchana; Janjindamai, Waricha; Dissaneevate, Supaporn; Maneenil, Gunlawadee

doi:10.1055/s-0039-1688820

Cited by 12 publications

(11 citation statements)

References 24 publications

(35 reference statements)

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“…The time to recovery of NS in neonates with septic shock were delayed by 92% as compared to neonates without septic shock. Similar associations have been found in previously conducted study of Thailand and the systematic review of prognosis [40,50]. Septic shock was independently associated with bacteremia-related neurologic complications or sequelae [46].…”

Section: Plos Onesupporting

confidence: 88%

“…Previous studies and reviews have shown that risk factors that significantly affect the survival status of neonates with sepsis are prematurity, Low Birth Weight (LBW), low APGAR score, a requirement of assisted ventilation, intrapartum fever, chorioamnionitis, the induced onset of labor, young age at admission, organ dysfunction, infectious complications, poor feeding, prolonged Capillary Refilling Time (CRT), cyanosis, convulsions, septic shock, lethargy, nasogastric tube feeding, LONS, sex of neonate, and unable to initiate early Exclusive Breastfeeding (EBF) [13,14,16,24,[27][28][29][30][31][32][33][34][35][36][37][38]. Furthermore, it is mainly affected by the type of bacterial isolates in the blood culture [3,26,36,[39][40][41]. In addition, delays in the identification, initiation of treatment, care-seeking at the household level, and the lack of access to high-quality services contribute to the poor recovery rate of NS [6,42,43].…”

Section: Introductionmentioning

confidence: 99%

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Time to recovery of neonatal sepsis and determinant factors among neonates admitted in Public Hospitals of Central Gondar Zone, Northwest Ethiopia, 2021

2022

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Background Neonatal sepsis is a leading cause of neonatal morbidity and mortality, particularly in developing countries. Time to recovery is an indicator of the severity of sepsis, and risk factors varied significantly according to study population and settings. Moreover, published literature regarding the time to recovery of neonatal sepsis is scarce. Objective The aim of this study was to assess the time to recovery of neonatal sepsis and determinant factors among neonates admitted in the Public Hospitals of Central Gondar Zone, Northwest Ethiopia. Methods An institution-based prospective follow-up study design was conducted among 631 neonates with sepsis. A structured, pre-tested, interviewer-administered questionnaire was used. The median time to recovery, life-table, the Kaplan Meier curve, and the log-rank test were computed. Both bi-variable and multivariable Cox regression models were applied to analyze the data. Results Of all septic neonates, 511 successfully recovered. They were followed for a total of 4,740-neonate day’s observation and the median time to recovery was 7 days (IQR = 5–10 days). After adjusting for covariates, intrapartum fever (AHR = 0.69, 95%CI: 0.49, 0.99), induced onset of labor (AHR = 0.68, 95%CI: 0.49, 0.94), chest indrawing (AHR = 0.67, 95%CI: 0.46, 0.99), late onset sepsis (AHR = 0.55, 95%CI: 0.40, 0.75), non-oral enteral feeding (AHR = 0.38, 95%CI: 0.29, 0.50), assisted with bag and mask (AHR = 0.72, 95%CI: 0.56, 0.93), normal birth weight (AHR = 1.42, 95%CI: 1.03, 1.94), gestational age of 37–42 weeks (AHR = 1.93, 95%CI: 1.32, 2.84), septic shock (AHR = 0.08, 95%CI: 0.02, 0.39), infectious complications (AHR = 0.42, 95%CI: 0.29, 0.61), being in critical conditions (AHR = 0.68, 95%CI: 0.52, 0.89), and early recognition of illness (AHR = 1.83, 95%CI: 1.27, 2.63) were independently associated with the time to recovery of neonatal sepsis. Conclusions and recommendations The time to recovery of this study was moderately acceptable as compared to the previous studies. The above-mentioned factors could be used for the early identification of neonates with sepsis at risk for protracted illness and it could guide prompt referral to higher centers in primary health sectors. This also will provide prognostic information to clinicians and families as longer recovery time has economic and social implications in our country.

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Section: Plos Onesupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Time to recovery of neonatal sepsis and determinant factors among neonates admitted in Public Hospitals of Central Gondar Zone, Northwest Ethiopia, 2021

2022

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“…Some large cohorts have not found a clear correlation between AMR and adverse outcome [8,12,13]. Data from this small study did not confirm a significant impact of resistance profile on neonatal mortality [5].…”

Section: Discussioncontrasting

confidence: 71%

“…Appropriate empirical treatment is considered crucially important in reducing mortality. However, despite the improvement in neonatal care, the 2 of 17 fatality rate in babies with GN-BSIs remains around 15-20%, also during the emergence of antimicrobial resistance (AMR) [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Susceptibility, Virulome, and Clinical Outcomes in European Infants with Bloodstream Infections Caused by Enterobacterales

et al. 2021

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Mortality in neonates with Gram-negative bloodstream infections has remained unacceptably high. Very few data are available on the impact of resistance profiles, virulence factors, appropriateness of empirical treatment and clinical characteristics on patients’ mortality. A survival analysis to investigate 28-day mortality probability and predictors was performed including (I) infants <90 days (II) with an available Enterobacterales blood isolate with (III) clinical, treatment and 28-day outcome data. Eighty-seven patients were included. Overall, 299 virulence genes were identified among all the pathogens. Escherichia coli had significantly more virulence genes identified compared with other species. A strong positive correlation between the number of resistance and virulence genes carried by each isolate was found. The cumulative probability of death obtained by the Kaplan-Meier survival analysis was 19.5%. In the descriptive analysis, early age at onset, gestational age at onset, culture positive for E. coli and number of classes of virulence genes carried by each isolate were significantly associated with mortality. By Cox multivariate regression, none of the investigated variables was significant. This pilot study has demonstrated the feasibility of investigating the association between neonatal sepsis mortality and the causative Enterobacterales isolates virulome. This relationship needs further exploration in larger studies, ideally including host immunopathological response, in order to develop a tailor-made therapeutic strategy.

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“…Whereas in developed countries, the incidence is lower, with estimates around 0.2-0.3 per 1,000 live births, an overall mortality rate of 10% with 50% of cases having some form of disability at 5-year follow-up is observed [4,8,11]. Neonatal multidrug-resistant (MDR) sepsis and meningitis are a serious threat because of their high mortality and morbidity [8,10,12,13]. Incidence of multidrug-resistant (MDR) meningitis was 41%, and increased from 32% (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002) to 58% (2003-2014); however, there was no statistically significant difference [10].…”

Section: Introductionmentioning

confidence: 99%

Neonatal multidrug-resistant bacterial meningitis: a 29-year study from a tertiary hospital in Thailand

Thatrimontrichai

Janjindamai

Dissaneevate

et al. 2021

J Infect Dev Ctries

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Introduction: This study aimed to compare the risks and case fatality rate (CFR) between neonatal multidrug-resistant (MDR) and non-MDR meningitis. Methodology: a secondary analysis of a case-control studies in a Thai neonatal intensive care unit between 1990 and 2018 was performed. The pathogenic organisms causing neonatal meningitis were Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae, Acinetobacter spp., and Pseudomonas aeruginosa. A MDR organism was defined as an isolate that was non-susceptible to at least 1 agent in at least 3 antimicrobial categories. The multivariate regression was analyzed for MDR and non-MDR samples of neonatal meningitis. Results: Over a period of 29 years, the number of neonatal MDR and non-MDR meningitis cases were 17 and 21, respectively. The medians (interquartile ranges) of gestational age, birthweight and onset of meningitis were 35 (29.5-38) weeks, 1,945 (1,218-2,859) grams and 6.5 (2.8-17.9) days, respectively. The most common organism was Acinetobacter baumannii (32%). By multivariate analysis, neonates who had MDR meningitis were more likely to have a lower Apgar score at 5 minutes (adjusted odds ratio: 95% confidence intervals = 0.66 [0.44-0.99], p = 0.04). The crude CFR of neonatal meningitis was 32%. Non-survivors in MDR meningitis (58.8%) were significantly higher than non-MDR meningitis (9.5%, p = 0.004). The most common pathogen in non-survivors was carbapenem-resistant Acinetobacter baumannii. Conclusions: Neonatal MDR meningitis has an association with lower APGAR scores, and higher CFR as well as Acinetobacter baumannii. Multifaceted infection prevention, and control programs for MDR organisms are crucial, and must be strictly implemented in high MDR areas.

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Risk Factors for 30-Day Mortality in Neonatal Gram-Negative Bacilli Sepsis

Cited by 12 publications

References 24 publications

Time to recovery of neonatal sepsis and determinant factors among neonates admitted in Public Hospitals of Central Gondar Zone, Northwest Ethiopia, 2021

Time to recovery of neonatal sepsis and determinant factors among neonates admitted in Public Hospitals of Central Gondar Zone, Northwest Ethiopia, 2021

Antibiotic Susceptibility, Virulome, and Clinical Outcomes in European Infants with Bloodstream Infections Caused by Enterobacterales

Neonatal multidrug-resistant bacterial meningitis: a 29-year study from a tertiary hospital in Thailand

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