Clinical and Bacteriologic profile of Neonatal Sepsis in a tertiary care hospital: A 5-year review

Background@#Neonatal sepsis, a clinical syndrome characterized by non-specific signs and symptoms, is the most common cause of neonatal mortality and morbidity. It is classified into early or late-onset depending on the onset of symptoms, if within the first 72 hours or later. Early onset sepsis (EOS) occurs due to ascending infection following rupture of membranes or during passage through an infected birth canal. Late onset sepsis (LOS) can be nosocomial or community-acquired. A high index of suspicion and timely and judicious use of antibiotics are needed to achieve good outcomes. @*Objective@#This study looked into the clinical and bacteriologic profile of neonatal sepsis in a tertiary care hospital from January 2013 to December 2017. @*Methodology@#This was a retrospective observational study. Data on maternal risk factors, mode of delivery, gestational age, birth weight, birth setting, clinical manifestations, and blood culture and sensitivity were gathered. Descriptive statistics was used to analyze the data.@*Results@#Majority of cases were late onset sepsis with an equal distribution in those born via normal spontaneous delivery (NSD) and cesarean section (CS). There were more culture- positives in low birth weight (LBW) infants and those not delivered within a hospital. The most common maternal risk factor was UTI. Majority of culture-positive newborns presented with respiratory distress, poor feeding, fever, and irritability with respiratory distress being the most common manifestation for both EOS and LOS. Predominant isolates were CONS, E. coli and Klebsiella sp. Both E. coli and Klebsiella were resistant to both first-line empiric antibiotics – ampicillin and gentamicin but highly sensitive to piperacillin-tazobactam and imipenem.@*Conclusion@#Clinical signs and symptoms of neonatal sepsis are non-specific. The presence of respiratory distress, fever, poor feeding, and irritability together with other risk factors should raise suspicion for sepsis and prompt investigation and treatment. Predominant isolates seen were CONS, E. coli and Klebsiella sp. with resistance to first-line empiric antibiotics.

Evaluation of Risk Factors Associated with Venous Thromboembolism in the Lebanese Population

Background: Venous thromboembolism (VTE) is a multifactorial disease with a preventable characteristic. The knowledge of its predictive risk factors will help in preventing it. Therefore, the aim of this study is to assess the predictive risk factors of VTE in the Lebanese population so that effective recommendations can be drawn out. Methodology: A retrospective case-control study was carried between the periods of March till June 2017 in two tertiary care hospitals in Beirut-Lebanon. Patients with a confirmed official diagnosis of VTE between the period going from 2008 till 2016 were taken as cases. Each case was randomly matched with 2 hospitalized controls. Questionnaires concerning VTE risk factors and symptoms were filled. Data were then entered into SPSS version 21 to explore the association between the risk factors and VTE. Bi-variate and multivariate logistic regression were done and a p-value less than 0.05 was considered. Results: 430 patients were included in our study. Among these, 140 were cases of deep vein thrombosis and/or pulmonary embolism and 290 were matched controls. The results of the bi-variate analysis was significant for history of VTE, active cancer, general surgery, thrombophilia, immobility, active/recent pneumonia, trauma, and hormone replacement therapy/contraceptives use (p-value<0.001). It was also significant for history of coronary artery disease/myocardial infarction (p-value=0.018), neurological disease (p-value=0.001), stroke (p-value=0.033) liver diseases and varicose veins (p-value=0.045) and spinal cord injury (p-value=0.034). In multivariate analysis, the probability of VTE was significant for: VTE history (OR=32.8; p-value<0.001), thrombophilia (OR=25.4; p-value<0.001), major trauma (OR=11.5; p-value<0.001), general surgery (OR=10.2; p-value<0.001), immobility (OR=6.9; p-value=0.003), history of stroke (OR=6.8; p-value=0.001), serious liver disease (OR=6.5; p-value=0.016), cancer (OR=5; p-value<0.001), central venous catheter or pacemaker implantation (OR=4.4; p-value=0.025), active/recent pneumonia (OR=3.2; p-value=0.023), neurological disorders (OR=3; p-value =0.047), coronary artery disease/myocardial infarction (OR=2.3; p-value=0.017) and chronic lung diseases (OR= 2.2; p-value=0.033). There was a lack of testing for thrombophilia in the Lebanese hospitals. Conclusion: The knowledge of these causative risk factors and their influence on VTE is crucial to initiate awareness in the population and strict prophylactic procedures for hospitalized patients. Furthermore, physicians must be more aware of the possible thrombophilic factors behind VTE cases by searching through thrombophilia testing. Larger studies must be done to investigate risk factors not detected in this study in order to further generalize the results.