ABSTRACT
The most frequent cause of mortality in neonates is infections which include sepsis, meningitis, pneumonia, diarrhea and tetanus. Approximately 1.6 million deaths due to neonatal infections occur annually in developing countries. The causes of sepsis vary from one geographic area to another. Thus, it is important to create a database for the Philippines regarding the etiologies of neonatal sepsis. Objectives: The study was undertaken to determine the most common bacterial pathogens of neonatal sepsis in the Philippines and the antibiotic sensitivity patterns of these pathogens. Methods: A multicenter surveillance and chart review was conducted in five hospital sites for a period of six months- from July to December 2006. All neonates less than or equal to 28 days who had positive cultures from a sterile site and or had fulfilled the SIRS criteria as defined by the International Pediatric Sepsis Consensus Conference in the presence of suspected or proven infection were included in the study. Results: A total of 289 neonates fulfilled the criteria of sepsis. More than 61% of the patients had early onset neonatal sepsis. The most common site of infection was the lungs, (57%), followed by sepsis without an obvious site of infection (35%). In 50% of patients, an organism was identified; gram-negative bacteria were the dominant bacteria found (Pseudomonas, Burkholderia, Klebsiella) which comprised 94% of the bacteria isolated. Resistance patterns varied among the different urban study centers. The Pseudomonas and Burkholderia isolates from the Philippine General Hospital (PGH) were sensitive to ceftazidime. All Klebsiella isolates from St. Louis University (SLU) were resistant to third generation cephalosporins. In contrast, Klebsiella isolates from PGH and Davao were sensitive to third generation cephalosporins but resistant to piperacillin-tazobactam. The overall mortality rate was 11%. Ampicillin and an aminoglycoside were the most common regimens used but were only successful in less than 50% of cases. Conclusion: Gram-negative organisms comprised the majority of the neonatal infections, with Pseudomonas and Burkholderia being the most prevalent. Resistance patterns differed among the different centers. Continuing surveillance of infections is still needed in order choose the most appropriate empiric therapy for each center.
Subject(s)
Humans , Male , Female , Sepsis , InfectionsABSTRACT
The Philippine General Hospital (PGH) has the most number of high-risk infant admissions locally. Neonatal bacteremia and sepsis are the perennial problems encountered. Previous researches may not be reflective of the current situation in the Neonatal Intensive Care Unit (NICU) of PGH, thus an updated study on neonatal bacteremia becomes important. Objectives: This study was performed to describe the clinical profile of neonates born with positive blood cultures together with the new criteria for sepsis as defined by the 2001 International Pediatric Consensus Conference at PGH from July to December 2006. Methods: A prospective chart review of all neonates born with positive blood cultures at UP-PGH from July 1 to December 31, 2006 was performed. Demographic, clinical, and laboratory data were then analyzed. Results: Out of 3,870 live births, 103 (2.6%) patients with positive blood cultures fulfilled the criteria of sepsis. Mothers were around 20 to 25 years of age comprising 35 (34%), less than half had prenatal check-ups and more than 2/3 had not maternal immunizations. Fifty-eight (56%) of the neonates were males, 68 were premature (66%), 76 were appropriate for gestational age (74%), and 37 were of low birth weight (36%). Most patients (62 or 60%) developed sepsis within the first 3 days of admission, while 65 (63%) patients had pneumonia. The most common organisms isolated were Pseudomonas putida (50 or 49%), Burkholderia mallei (15 or 15%) and Burkholderia cepacia (8 or 8%). The organisms were sensitive Ceftazidime, Cefepime and Piperacillin-Tazobactam. Of 103 subjects, 58 or 56% fulfilled the criteria for systemic inflammatory response syndrome (SIRS) for sepsis. Multivariate analysis showed that those with SIRS were 4.89 times more likely to die than those without SIRS. Conclusion: Sepsis usually develops among neonates in less than 72 hours after their delivery at PGH. The neonates who were prone to develop sepsis were those who are male, premature, appropriate for gestational age, and of low birth weight. The organisms that predominate in PGH are usually gram-negative pathogens. The number of hospital-acquired infection is significant. SIRS could be an important prognostic factor in affecting outcome and may aid significantly in the proper diagnosis of sepsis in newborns.