ABSTRACT
Background: Bacterial resistance to antibiotics was a global problem. Multidrug-resistant bacteria causing neonatal septicemiaswere increasing in the world. It was difficult to compare the bacterial profile and antibiotic susceptibility pattern of the isolatesamong the neonatal septicemia between countries because the epidemiology of neonatal septicemia was extremely variable.Objective: Timely identification of bacterial profile and antibiotic susceptibility pattern of the isolates among the neonatalsepticemias are essential to guide the clinicians regarding both the empirical and definitive treatments of neonatal septicemia.Materials and Methods: Based on the AIIMS protocol 2014 of neonatal sepsis-World Health Organization newborn CC,an operational definition of clinically diagnosed neonatal septicemia was established for the selection of participants inthe study for blood culture and sensitivity test (CST). Hence, in this study, blood CST was done only among the selectedpatients for clinically diagnosed neonatal septicemia as recommended in the National Committee for Clinical LaboratoryStandards.Results: This study observed that there was a shift from the predominance of Gram-negative organisms to Gram-positiveorganisms, especially Staphylococcus aureus. Acinetobacter and Citrobacter were emerging organisms.In this study,aminoglycosides and fluoroquinolones were sensitive to organisms, especially in Gram-negative organisms. Imipenem andmeropenem were also sensitive in both Gram-positive and Gram-negative organisms. Imipenem was more sensitive toorganisms than meropenem. Tobramycin, doxycycline, gatifloxacin, and chloramphenicol were more sensitive to organismsthan erythromycin, azithromycin, and clindamycin.Conclusion: Early clinical diagnosis and prompt initiation of empirical antimicrobials therapy to patients of pending culturesensitivity reports for definitive therapy may be life-saving. Hence, periodic surveillance for bacteriological profile and antibioticsusceptibility pattern of the isolates among the neonatal septicemia for appropriate choice of antimicrobials for empirical therapycan be outlined and reevaluated in a timely manner to save the life of 5 million neonatal deaths a year, with 98% occurringin developing countries and limited resource rural areas. This study concluded that empiric therapy for clinically diagnosedneonatal septicemia should cover both Gram-negative and Gram-positive organisms. Hence, the combination of one antibioticfrom each of the following two groups, (1) Imipenam/piperacillin/cefotaxime and (2) amikacin/gentamicin/netilmicin, can beincluded as an initial therapy for neonatal septicemia.
ABSTRACT
Background: Diagnosing tuberculosis (TB) was still a worldwide big challenge in cases with negative reports of Xpert MTB/RIF, smear, and culture test of acid-fast bacilli (AFB). A single, direct Xpert MTB/RIF test identified 98.2% of the sputum smearpositive TB cases and 72.5% of those with sputum smear-negative TB. Such a diagnosis was often made based on the clinicalcriteria and other supportive findings like tuberculin skin test (TST).Objective: Hence, this study was to help in the diagnosis and treatment of clinically diagnosed childhood TB, especially in thelimited resource rural areas and developing countries.Materials and Methods: Based on the WHO revised criteria of TB diagnosis, to include clinically diagnosed TB instead ofsmear-negative TB disease, an operational definition of clinically diagnosed TB for the selection of participants for TST wasestablished for this study. Based on the recommendation of the CDC team at the Saskatchewan Lung Association, 2007-03-21at the Wayback Machine, the TST results of the study were interpreted.Results: Hence, in our study, the sensitivity of TST was 82.35% (≥10 mm) in the age group of 1–4 years and 60.16% (≥15 mm)in the age group of >4–12 years. However, this study shows that the positivity rate of TST was increased from 60.16% (≥15 mm)to 86.15% (≥10 mm), if the TST results≥10 mm were interpreted as positive even in this age group of >4 years–12 years.Conclusion: In such very difficult situations of clinically diagnosed TB, this study observed that empiric anti-TB treatment may bestarted without microbiological confirmation to clinically diagnosed childhood TB patient with negative reports of Xpert MTB/RIF,smear, and culture test of AFB, presented with one or more of the following symptoms and signs of clinically diagnosed childhoodTB: (1) Chronic anorexia, (2) ill health and fatigue, (3) weight loss of >5% during the past 3 months or documented failure to striveduring the preceding 3 months, (4) night sweating and persistent fever >2 weeks, and (5) non-remitting cough >2 weeks but cannot bediagnosed clinically by any possible causes than TB, and positive TST report, in resource-limited rural areas anddeveloping countries.