Bacterial etiology of early onset and late onset sepsis in menoufia university hospital: trends in antimicrobial susceptibility patterns

Neonatal sepsis is responsible for 30 - 50% of total neonatal deaths each_year in developing countries. Our study aimed to determine the bacterial etiology of early onset sepsis [EOS] and late onset sepsis [LOS] and their antibiotic resistance patterns

This study was conducted at the Microbiology and Immunology department, and Neonatal Intensive Care Unit [NICU], Menoufia University Hospitals. 35 suspected cases of sepsis were included in our study [14 females and 21 males] aged from 1-28 days. They were screened for sepsis by modified clinical sepsis score and hematological sepsis scoring system [total score 7, score > 3 suggestive of sepsis ]

Cases within the first week of life were considered EOS and considered LOS if occurring after the first week. CBC, semi quantitative CRP, blood culture were done for all neonates

Antimicrobial susceptibility and ESfiLs detection were carried out for all isolates. Our results revealed that premature and low birth weight cases were more than full term and normal birth weight cases. Early onset sepsis group included 12 [34.3%] cases while late onset sepsis group included 23 [65.7%]

Total number of isolates were 26, Gram-negative bacteria were more frequent than Gram-positive with a frequency of 57.7% and 42.3% respectively. The most prevalent organism isolated from EOS cases was Klebsiella spp. [26.9%] . Gram negative organisms were seen mainly in early onset sepsis while gram positive organisms were seen in late onset sepsis with predominance of S. aureus. Klebsiella spp. and E. coli were highly sensitive to imipenem [100% each], however, high resistance was observed to penicillin, ampicillin and erythromycin [100% for each] . One out of 5 [20%] E. coli isolates and 2 out of 7 [28.6%] Klebsiella isolates were extended spectrum beta lactamase [ESfiL] producers . S. aureus showed high sensitivity to imipenem [100%], 100% resistant to amoxicillin-davulinic acid . Coagulase -ve staphylococci were highly sensitive to vancomycin [100%] 100% resistant to ampicillin, erythromycin, pipracillin, and penicillin. Gram-positive and negative bacteria have demonstrated high resistance against 3rd generation cephalosporins [more than 60%]. In conclusions, Gram negative bacteria [K. pneumoniae and E. coli] were the main cause of EOS in our study, while S. aureus and CoNS were most common in LOS cases. Emergence of multi-drug resistant strains especially for commonly used antibiotics is an important issue especially in NICU. Most isolates are highly resistant against commonly used antibiotics and are relatively more sensitive to less commonly used drugs like imipenem . Continuous surveillance should be carried out at regular intervals to find out the changing antibiotic susceptibility patterns and advice empirical therapy

Echocardiographic study of the effect of angiotensin converting enzyme inhibitors on the left ventricular systolic function in children with rheumatic mitral regurgitation

Quantitative Echo-doppler can detect easily mitral regurgitation but flow convergence Echo method provides an alternate for the calculation of the effective regurgitant orifice area [EROA]. Angiotensin convening enzyme inhibitors [A CEI] can decrease the mitral regurgitation by peripheral vasodilatation leading to decrease of the after-load. Study of the left ventricular systolic function and quantification of mitral regurgitation by Echo- cardiographic measurements. Assesment of the effect of ACEI on these measurements. 50 patients with mitral regurgitation: 35 with symptomatic regurgitation [GI] and 15 without symptoms [GII] were studied. GI patients were then subdivided into 2 subgroups according to drug intake before and after giving Captopril for one month for the symptomatic patients. The groups were studied by history, clinical examination, E.C.G., X-ray, some laboratory investigations [E.S.R.-A.S.O.T- C.R.P- and C.B.C] and mainly by two-dimension and color Doppler Echocardiography together with quantitative assessment of mitral regurgitant severity by measuring mitral regurgitant volume, regurgitant fraction and effective regurgitant orifice area of the mitral valve with the proximal isovelocity surface area method of the flow convergence region. Our results showed that left ventricular systolic functions [Stroke volume and ejection fraction] increased after A.C.E.I. therapy in both Group1-A and Group1-B together with reduction of the left ventricular end systolic and end diastolic diameters denoting improvement in left ventricular systolic function. As regard mitral regurgitation severity:- Mitral regurgitant volume, regurgitant fraction and effective regurgitant orifice area., all were reduced significantly after A.C.E.I. therapy. A.C.E.I. in children with mitral regurgitation improve significantly left ventricular systolic functions and reduces the severity of mitral regurgitation even if patients were taking previously lanoxine

study of DNA damage and antioxidant defense in the peripheral leucocytes of diabetic mothers and their newborn infants

Oxidative stress plays a key direct and indirect role in the pathogenesis of several diabetes and pregnancy related complications in both diabetic mothers and their infants. Forty women and their newborn infants divided into two groups were studied. Group I included 20 diabetic women and their newborn infants. Group II consisted of 20 clinically healthy women and their twenty newborns as controls. All involved mothers and newborns were subjected to detailed history, thorough clinical examination, routine laboratory investigations, imaging studies, and specific laboratory investigations including assessment of glycosylated hemoglobin [HbA1C] for diabetic mothers, and erythrocyte antioxidant enzymes [superoxide dismutase, catalase and glutathione peroxidase] and DNA fragmentation assay for mothers and neonates of both groups. It was found that 25% of the diabetic women had diabetic complications. About 1/3 of the newborn infants of diabetic mothers were large for gestational age, 10% of them had major congenital anomalies [cyanotic heart disease and meningomyelocele] and 15% of them died. Levels of erythrocytes glutathione peroxidase and catalase were significantly lower in diabetic mothers and their infants than those in nondiabetic mothers and their infants. DNA damage, mainly in the form of apoptosis was present in diabetic mothers and their infants [60% and 50% respectively]. There was a significant difference between the values of maximal optical density at 200bp and 600bp between both groups. Comparison between diabetic mothers with and without diabetic complications as regards HbA1C, antioxidants and DNA damage showed that erythrocytes catalase was significantly lower in those with complications [means 366 +/- 54 units/g Hb, 426.3 +/- 45.7 units/g Hb respectively] as a possible explanation for complications in this group. There was a significant negative correlation between HbA1C of diabetic mothers [i.e. diabetic control] and glutathione peroxidase level [i.e. antioxidant defense] in their infants. A significant negative correlation was found between DNA damage and erythrocytes antioxidant [Superoxide dismutase in diabetic mothers, and glutathione peroxidase in their infants]. It can be concluded that hyperglycemia causes a significant reduction of antioxidant capacity [reduced catalase and glutathione peroxidase] in the diabetic mothers and their infants compared with controls and this may be the cause of increased DNA damage observed in these individuals which may lead to the development of diabetic complications in the pregnant mothers and congenital anomalies in their infants. It is recommended to maintain a good control of diabetes and combat oxidative stress to lessen diabetic complications in pregnancy and to avoid congenital anomalies

Interleukin-2 and Anticardiolipin antibodies in children with acute rheumatic fever and chronic rheumatic heart disease

The pathogenesis of rheumatic fever involves an interaction between the group A streptococcus and the immune system. Although an old disease the exact immunopathogenesis still unclear, so our aim is to determine whether interleukin-2 [IL-2] and anticardiolipin antibodies [aCL ab] have a role in immunopathogenesis of rheumatic fever or not. The work was carried out on 60 patients, 30 patients with acute rheumatic fever ARF [group I], 10 of them with rheumatic arthritis and 20 of them with rheumatic carditis and 30 patients with well documented chronic rheumatic heart disease CRHD [group II]. Twenty apparently healthy children were taken as control [group III]. All patients [group I and II] and control group [group III] were subjected to careful history taking, thorough clinical examination, laboratory investigations: Complete blood picture [CBC], Erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], Antistreptolysin-O titre [ASOT], Serum IL-2 and aCL Ab. Furthermore, patients with ARE and CRUD were sitbjected to: Plain X-ray chest and heart, ECG and Echocardiography. Our results showed that: IL-2 was significantly increased in cases of ARF [both in arthritis and carditis] than in patients with CRHD and normal control. No significant difference in IL-2 was found between cases of arthritis and carditis. Although IL-2 increases in rheumatic carditis, it has no relation to severity of carditis or to degree of ESR elevation. There was significant postive correlation between IL-2 and ASOT and CRP. Anti CL Ab was increased significantly in cases of rheumatic carditis [but not in cases of arthritis] than in patients with CRHD and normal control. A direct relationship was found between aCL Ab and the severity of carditis and ESR. There was significant positive correlation between aCL Ab and ESR, TLC and ASOT. So we suggest, the use of IL-2 [although non specific] to confirm the diagnosis of ARF as well as aCL Ab for the diagnosis of rheumatic carditis and a marker of its severity