Role of Sepsis Screening in early diagnosis of Neonatal Sepsis

Lakhey, A; Shakya, Henish

doi:10.3126/jpn.v7i1.16944

Cited by 26 publications

(27 citation statements)

References 15 publications

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“…The most common clinical manifestation of neonatal sepsis in our study was respiratory distress (79%). Similar findings were noted in studies from KIST Medical College, Nepal (54%) and Beni Suef University Hospital, Egypt (36%) [9,12]. At our center, we take CRP as a biomarker of sepsis and its serial decline is taken as laboratory evidence of improvement.…”

Section: Discussionsupporting

confidence: 72%

“…However, our study, which is first of its kind to be conducted in NICU of the same institute, showed culture positivity of neonatal sepsis to be 20.7%. In contrast, studies conducted at KIST Medical College and Manipal College of Medical Sciences, Nepal showed culture positivity to be 48 and 44.9% respectively [9,10]. Variations in culture positivity rate of neonatal sepsis in different studies seem to arise from differences in culture-techniques and study designs.…”

Section: Discussionmentioning

confidence: 83%

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Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal

et al. 2018

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BackgroundNeonatal sepsis, one of the leading causes of mortality in neonatal intensive care units (NICU) of developing countries like Nepal, is often not extensively studied. In order to decrease the morbidity and mortality associated with neonatal sepsis, neonatologists should have a keen knowledge of the existing bacteriological flora and their antibiotic susceptibility pattern. In this study, we aim to determine the bacteriological profile and antibiotic susceptibility pattern of culture positive neonatal sepsis in the NICU of a tertiary teaching hospital in Nepal.MethodsThis was a retrospective cross-sectional study of all blood culture positive sepsis cases among neonates admitted to the neonatal intensive care unit of Patan Hospital, Nepal between April 15, 2014 and April 15, 2017. All neonates with a clinical suspicion of sepsis with a positive blood culture were identified. Patient demographics, clinical details, maternal risk factors, and laboratory data including bacteriological profiles and antimicrobial susceptibilities were recorded and analyzed.ResultsOf the 336 neonates admitted in the NICU, 69 (20.5%) had culture-positive sepsis. The majority were early-onset sepsis (n = 54, 78.3%) and were among the preterm babies (n = 47, 68.1%). Most bacterial isolates were gram-negative, predominantly the Klebsiella species (n = 23, 33.3%). Klebsiella showed high resistance to commonly used antibiotics such as; Cefotaxime (90.5%), Gentamicin (75%), Ciprofloxacin (76.2%), Ofloxacin (72.2%) and Chloramphenicol (65%). However, they showed good susceptibility to Carbapenems (100%), Colistin (88.8%) and Tigecycline (81.8%). Among cultures with gram-positive species, Coagulase-negative Staphylococci (CONS) (n = 14, 20.3%) predominated. CONS showed high resistance to Oxacillin (80%), Cefotaxime (66.7%) and Meropenem (80%) but good susceptibility (100%) to Vancomycin and Linezolid. Prevalence of multidrug-resistant strain was 73.9%.ConclusionsKlebsiella species and CONS were the most common causes of neonatal sepsis in our study. A significant proportion of the isolates were multidrug resistant strains, which pose a great threat to neonatal survival, and thereby, warrant modification of existing empirical therapy. Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed. We recommend a combination of Piperacillin-Tazobactam and Ofloxacin as the first line therapy and combination of Vancomycin and Meropenem as the second line empirical therapy in our NICU.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 83%

Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal

et al. 2018

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“…In contrast to the present study, Zaka-ur-Rab Z et al found that amongst individual markers of sepsis screen, CRP had good diagnostic utility with highest sensitivity (82%) and specificity (89%) [18]. Lakhey A et al found that CRP (78%) and IT ratio (73%) had highest sensitivity [21].…”

Section: Original Research Articlecontrasting

confidence: 90%

Diagnostic efficacy of sepsis-screen parameters (individual and combined) compared to blood culture and clinico-etiological profile of neonatal sepsis in preterm newborns

2019

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Introduction: Sepsis alone or along with other morbidity is the major contributor to mortality in both preterm and term babies accounting for more than a third of neonatal deaths in developing countries. Overall incidence of early onset sepsis (EOS) is higher in preterms and very low birth weight babies. Sepsis and related mortality is largely preventable with rational antimicrobials plus supportive therapy after timely detection of clinical sepsis, risks, complications, and with help of early screening laboratory-markers. Material and Method: This was a prospective, observational, hospitalbased study to compare the efficacy between various sepsis-screening tests & blood culture in early diagnosis of neonatal sepsis in preterms, conducted in NICU at Pt. JNM Medical College, Raipur, conducted during April 2018-September 2018. By using statistical Sample-size formula, 125 preterm neonates were enrolled. Detailed history and clinical findings were recorded on a predesigned proforma. All five sepsis-screen tests were done within 24 hours of birth or at clinical presentation before starting antibiotics, for all preterms at risk of EOS (based on neonatal/maternal risk factors>3) and/or developing clinical sepsis. Data was compiled, tabulated and analyzed using Microsoft-SPSS version20. Result: Out of 125 patients, all were preterm <37weeks by gestation (<28 week=3.2%, 28-32 weeks=52%, 32-35 weeks=33.6% and late preterm: 35-37weeks =11.2%). Birth weight wise, 15.2% were ELBW, 45.6% were VLBW, and 39.2% weighed >1500g. Out of all sepsis-suspect and at risk cases, EOS risk factors (>/=3 of maternal plus neonatal risks) was present in 47.2%, while EOS was suspected at admission in 83.2% cases on clinical ground. Overall sepsis screening was positive (>=2 parameters) in 40% of all subjects [24% having only 2, 10.4% having 3 and 5.6% having 4 tests positive], though >50%cases had single test positive (considered screen-ve). Although >88%cases developed clinical sepsis (EOS+LOS), only 40% were detected by screen positive (as probable sepsis), and 35.2% were blood culture positive (proven sepsis). Conclusion: The combinations of sepsis makers yielded better diagnostic results than single tests and proved to be a valuable aid for early diagnosis of neonatal sepsis in preterms along with blood culturesensitivity.

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“…A study done by Lakhey et al, in Nepal found respiratory distress (56%), fever (26%) and feeding problems (12.6%) the most common clinical features. 15 EOS generally presents itself with respiratory distress, apnea, lethargy or irritability, temperature instability, and feeding difficulties. 16 Overall the most common organism isolated was CONS (27%) followed by Klebsiella (24%) and Staphylococcus aureus (18%).…”

Section: Resultsmentioning

confidence: 99%

Clinical features and septic screen in neonatal sepsis in a teaching hospital in India

Vijayan¹,

Nair²,

Narayanan³

2019

Int J Contemp Pediatr

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Background: Sepsis remains a leading cause of mortality and morbidity, especially during the first five days of life and in low and middle-income countries. The purpose of this study was to note the clinical features and analyze the relationship between the septic screen and blood culture positive sepsis in the neonatal unit.Methods: A one-year descriptive cross-sectional study was carried out at the NICU of a teaching hospital in India.Results: The incidence of clinically suspected septicemia was 19.3 per 1000 live births and the incidence of blood culture positive septicemia was 2.9 per 1000 live births among the inborn of the hospital. The most common clinical features were poor suck and lethargy in culture positive sepsis. The most common organisms causing sepsis were Coagulase negative staphylococci and Klebsiella. In the septic screen CRP was found to have a statistically significant association with blood culture positive sepsis. CRP also had the highest sensitivity and negative predictive value among the studied parameters.Conclusions: Incidence of blood culture positive sepsis was 2.9 per 1000 live births among the inborn of the hospital. The most common clinical features were poor suck and lethargy in culture positive sepsis. The most common organism isolated in neonatal sepsis in the NICU was Coagulase negative staphylococcus. In resource poor settings, CRP continues to be an important tool in diagnosis and treatment of neonatal sepsis.

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Role of Sepsis Screening in early diagnosis of Neonatal Sepsis

Cited by 26 publications

References 15 publications

Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal

Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal

Diagnostic efficacy of sepsis-screen parameters (individual and combined) compared to blood culture and clinico-etiological profile of neonatal sepsis in preterm newborns

Clinical features and septic screen in neonatal sepsis in a teaching hospital in India

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