[Resistance pattern of bacterial agents causing ophtalmia neonatorum]

One of the most common infections in neonatal period is ophthalmia neonatorum. In this study, the bacterial agents, drug resistance and susceptibility of bacterial agents were studied. In this study a total of 72 newborns with ophthalmia neonatorum admitted in Bahrami Hospital in Tehran during the years 2008-2011 were continuously enrolled in a case series, descriptive study. Demographic data, including age, sex, cause of admission and culture of discharge from the eyes and its antibiogram, as well as experimental treatments and treatment outcomes were collected. Forty four infants [61.1%] were males and 28 [38.9%] were females and the mean age on admission was 11.6 +/- 7.7 days. In 51 patients [70.8%] the onset of ophthalmia neonatorum was prior to admission. More than 56% of cases with ophthalmia neonatorum were associated with sepsis. On the other hand, positive blood culture was detected in 15.3% of cases. Among 72 neonates with ophthalmia neonatorum, 26 [36.1%] had a positive culture of the eye discharge. The most common causes of bacterial agents were Staphylococcus aureus [46.1%] [12 of 26 cases]. Other causes included streptococcus species [23%], Pseudomonas [15.3%], E-coli [11.5%] and Haemophilus influenza [3.8%]. The most frequent causes of drug resistance were Ampicillin, Penici-llin, Cefixime, and Ceftazidime [100% resistance]. The most sensitive antibiotics were vancomycin and imipenem [100% sensitivity]. Based on the conventional treatment, clinical response to local gentamicin was approximately 60%. Sulfacetamide was associated with no clinical response in 40% of cases. The antibiogram and clinical response to empiric treatment showed that resistance to ampicillin and some third generation of cephalosporine was 100%. Aminoglycosides' sensitivity was more than 50% locally and systemically. Our recommendation is performing eye discharge culture before antibiotic treatment. More studies with numerous cases should be done for better definition of bacterial resistance.

Frequency and susceptibility of bacteria caused urinary tract infection in neonates: eight-year study at neonatal division of Bahrami children's hospital, Tehran Iran

Susceptibility pattern of organisms causing urinary tract infection [UTI] in neonate would potentially improve the clinical management by enabling clinicians to choose most reasonable first line empirical antibiotics. This study aimed to this end by studying isolated organisms from neonates with UTI in an inpatient setting. Current retrospective study has recruited all cases of neonatal UTI diagnosed through a suprapubic/ catheterized sample, admitted to Neonatal Division of Bahrami Children's Hospital, Tehran, Iran, from June 2004 to June 2012. Escherichia coli was the dominant [64.4%] bacteria among a total of 73 cases [69.9% boys and 30.1% girls; aged 14.14 +/- 7.68 days; birth weight of 3055.85 +/- 623.00 g] and Enterobacter [19.2%], Klebsiella [12.3%], and Staphylococcus epidermdisis [4.1%] were less frequent isolated bacteria. E. coli was mostly resistant to ampicillin [93.6%], cefixime [85.7%] and cephalexin [77.3%], and sensitive to cefotaxime [63.6%]. Enterobacter found to be most resistant to amikacin [100%], ampicillin [92.85%], and most sensitive to ceftizoxime [71.4%]. A high ratio [> 92.85%] of resistance toward ampicillin was observed among common neonatal UTI bacterial agents. Having this finding along with previous reports of emerging resistance of neonatal uropathogens to ampicillin could be a notion that a combination of a third generation cephalosporin and an aminoglycoside would be a more reasonable first choice than ampicillin plus an aminoglycoside

Neonatal urinary tract infection: clinical response to empirical therapy versus in vitro susceptibility at Bahrami Children's Hospital- Neonatal Ward: 2001-2010

Urinary tract infection [UTI] is a neonatal life threatening infection which is usually treated with ampicillin plus an aminoglycoside or a third-generation cephalosporin. Recently, growing number of Escherchia coli species resistant to ampicillin and aminoglycosides have raised concerns regarding the necessity to change the empirical therapy. This motivates us to determine neonatal UTI clinical response to the used empirical antibiotics. This study was designed as a Case Series. All neonates admitted to Bahrami Children Hospital, Tehran, Iran, during 2001- 2010 with a diagnosis of UTI surveyed by simple non-random sampling. Totally, 97 cases [including 83 [85.6%] term, 8 [8.2%] post-term and 6 [6.2%] preterm neonates] with a mean age of 15.85 +/- 7.05 days at admission, average weight of 3195.57 +/- 553g at birth and 3276.29 +/- 599.182 g at admission were studied. Ampicillin resistance in 93 cases [95.9%], gentamicin resistance in 51 cases [52.6%] and trimethoprim- sulfamethoxazole resistance in 44 cases [45.4%] were the leading resistances in this study. Escherichia coli was the dominant organism in 76.3% [74 patients] of study population which was resistant to ampicillin in 95.9% [71 cases]. Despite the observed resistant to initial empirical regimen antibiotics [especially ampicillin], 81.4% of patients responded to empirical therapy. However, we believe till conductance of more detailed studies regarding the relationship between empirical therapy and antibiogram concordance, physicians take ampicillin-resistant E coli infection issue into accounts from the first steps of management of critically ill neonates

Is ceftizoxime an appropriate surrogate for amikacin in neonatal sepsis treatment? a randomized clinical trial

Neonatal sepsis, a life-threatening condition, presents with non-specific clinical manifestations and needs immediate empirical antimicrobial therapy. Choosing an appropriate antibiotic regimen covering the most probable pathogens is an important issue. In this study we compared the effectiveness of ceftizoxime and amikacin in the treatment of neonatal sepsis both in combination with ampicillin. In a randomized clinical trial, all term neonates with suspected sepsis referred to Bahrami hospital during March 2008 to March 2010 were evaluated. Patients were randomly recruited into two groups; one group receiving ampicillin and amikacin and the other ampicillin and ceftizoxime. Blood, urine and cerebrospinal fluid cultures, leukocyte count and C-reactive protein level were measured in all neonates. A total of 135 neonates were evaluated, 65 in amikacin group and 70 in ceftizoxime group. 60 neonates [85.7%] in ceftizoxime group and 54 neonates [83.1%] in amikacin group responded to the treatment [P=0.673 and ?2=0.178]. Only 24 [18%] blood samples had a report of positive blood culture. The most frequent pathogen was coagulase negative staphylococcus with the frequency of 58.32% of all positive blood samples. Ceftizoxime in combination with ampicillin is an appropriate antimicrobial regimen for surrogating the combination of ampicillin and amikacin to prevent bacterial resistance against them