Clinical features and septic screen in neonatal sepsis in a teaching hospital in India

Background: Sepsis remains a leading cause of mortality and morbidity, especially during the first five days of life and in low and middle-income countries. The purpose of this study was to note the clinical features and analyze the relationship between the septic screen and blood culture positive sepsis in the neonatal unit.Methods: A one-year descriptive cross-sectional study was carried out at the NICU of a teaching hospital in India.Results: The incidence of clinically suspected septicemia was 19.3 per 1000 live births and the incidence of blood culture positive septicemia was 2.9 per 1000 live births among the inborn of the hospital. The most common clinical features were poor suck and lethargy in culture positive sepsis. The most common organisms causing sepsis were Coagulase negative staphylococci and Klebsiella. In the septic screen CRP was found to have a statistically significant association with blood culture positive sepsis. CRP also had the highest sensitivity and negative predictive value among the studied parameters.Conclusions: Incidence of blood culture positive sepsis was 2.9 per 1000 live births among the inborn of the hospital. The most common clinical features were poor suck and lethargy in culture positive sepsis. The most common organism isolated in neonatal sepsis in the NICU was Coagulase negative staphylococcus. In resource poor settings, CRP continues to be an important tool in diagnosis and treatment of neonatal sepsis.

Neonatal septicemia: bacteriological profile in a tertiary level hospital in South India

Background: Early onset bacterial sepsis remains a major cause of neonatal morbidity and death. The choice of antibiotic for an infant with sepsis depends on the predominant bacterial pathogens and the antibiotic susceptibility profiles for the microorganisms causing disease in a particular geographic region. The purpose of this study was to analyze the bacteriological profile and antibiotic sensitivity pattern of neonatal septicemia in our neonatal unit.Methods: A descriptive cross sectional study carried was out at the NICU of a tertiary level hospital in South India for a period of one year.Results: Clinically suspected septicemia comprised 18.14% of total NICU admissions. Organism was isolated by blood culture in 14.9% of cases. The most common organisms causing septicemia were Coagulase negative Staphylococci, Klebsiella and Staphylococcus aureus. Gram positive isolates were most sensitive to Vancomycin (100%) while the gram negative isolates were most sensitive to Amikacin. Resistance to Crystalline Penicillin, Ampicillin  and 3rd generation cephalosporins was high.Conclusions: The most common organism isolated in septicemia was Coagulase negative staphylococcus in our NICU. Gram positive isolates were most sensitive to Vancomycin (100%) while the gram negative isolates were most sensitive to Amikacin. High resistance to commonly used antibiotics is worrisome. There should be a constant surveillance of the common microbes and their sensitivity pattern in each NICU and the antibiotic protocols should be periodically reviewed. Rational use of antibiotics and preventive measures like hand washing is the need of the hour.

Peritoneal dialysis: trends, outcomes and complications

hospital visits, has greater patient autonomy and could be adjusted to daily personal activities. However, complications such as peritonitis, line blockage, leakage and hernia, may occur. To evaluate the trends of Peritoneal Dialysis, its outcome and associated complications. A Retrospective, Descriptive Study. Peritoneal Dialysis Centers, Ministry of Health, Bahrain. One hundred eight patients who underwent peritoneal dialysis line insertion from January 2007 to January 2015 were included in this study. One hundred eight patients had peritoneal dialysis line insertion from January 2007 to January 2015. Forty-eight [44.44%] patients are currently on regular peritoneal dialysis. Sixty [55.55%] stopped peritoneal dialysis due to several reasons: 23 [38.3%] blockage, 11 [18.3%] death, 5 [8.3%] inadequate dialysis, 4 [6.6%] transplant, 4 [6.6%] social and 8 [13.3%] unknown. Complications occurred in 52 [48.1%] patients: peritonitis in 29 [26.8%], and blockage in 23 [21.3%] patients. No other complications were reported. Peritoneal Dialysis remains an effective method of renal replacement therapy and it offers several advantages in comparison to hemodialysis. Our results are consistent with most reported regional and international findings. However, we look forward to improve our practice, particularly reducing the infection and blockage rates

Vascular access surgery for chronic renal failure patients: trends, outcomes and complications

Vascular access surgery is needed for chronic renal failure patients who require regular hemodialysis to sustain their lives. Access surgery could be central line, graft fistula and native arteriovenous fistula [AVF], the latter has the best outcome in terms of least complication and durability. Therefore, hemodialysis through an AVF should be the main target in hemodialysis centers. To evaluate the trends of access surgery, its outcome and complication rate. A Retrospective Descriptive Study. Hemodialysis Centers, Ministry of Health, Kingdom of Bahrain. Three hundred six chronic renal failure patients were receiving regular hemodialysis until 15 May 2014 were included in the study. All the necessary data were collected through the Dialysis Access Nurse Coordinator. A specific modulated questionnaire was designed for this study. Three hundred six chronic renal failure patients are on regular hemodialysis until 15 May 2014. One hundred thirty-two [43.1%] were more than 60 years, and one hundred twenty-six [41.2%] were between 40 and 60 years. One hundred eighty-nine [61.8%] were receiving dialysis through AVF, eighty-five[27.7%]through central lines and thirty-two [10.5%] through graft fistulae. Fifty-seven [18.6%] patients were started on hemodialysis by fistula first. Twenty-eight [9.2%] patients had vascular access related complications; the most common was aneurysm. The trends and outcome of the hemodialysis access surgeries in the studied population are consistent with the Kidney Disease Outcome Quality Initiative [KDOQI] guidelines. The main complication was arteriovenous aneurysm formation

Diabetic foot

Diabetic foot adds significant morbidity and mortality to patients. Diabetic patients with foot complication require significant foot care and have a risk of limb amputation. The risk factors are controllable and can be prevented with careful blood glycemic control. To determine the risk factors and personal characteristics of diabetic foot patients and their impact on the socioeconomic status in Bahrain. A Prospective descriptive study. Vascular and Thoracic unit, Salmaniya Medical Complex, Bahrain. Eighty-seven patients with diabetic foot were admitted in the Vascular and Thoracic surgery service from March to June 2010. Seventeen [20%] were non-Bahraini. The majority of diabetic foot patients were male, 60 [69%]. Sixty-eight [78%] were diagnosed as first presentation of diabetic foot. Fifty-eight [66.5%] were 40-60 years old. Sixty [69%] were diagnosed with neuropathic foot. Thirty-five [40%] patients were diagnosed with diabetes mellitus for 10 years or less. Sixty-one [70%] patients had HbA1c more than 7. Twenty-two [25%] patients had amputation as a primary treatment. Seventeen [19.5%] patients required minor amputation and 5 [5.5%] patients had major amputation. The majority of patients with diabetic foot in Bahrain are males in the productive age group. A significant number of these patients undergo amputation as a primary treatment; these patients are increasing the socioeconomic burden to the health services in Bahrain as well as to the community