Outbreak investigation of NDM-producing Burkholderia cepacia causing neonatal sepsis in Pakistan.

Aim: To investigate the outbreak of Burkholderia cepacia complex (BCC), mortality, antimicrobial resistance and associated risk factors in the neonatal intensive care unit. Method: Eighteen blood culture samples from neonates and twenty swab samples from different neonatal intensive care unit surfaces were collected. The VITEK 2 was used to confirm the isolates and generate the antibiogram. PCR was used to identify blaNDM. Results: Eighteen samples tested positive for BCC, and 10/18 (55.5%) of the neonates died. 13/18 (72%) of the neonates had late-onset neonatal sepsis, and 10/18 (55%) had low birth weight. Resistance to minocycline and chloramphenicol was 100%, 72.2% to meropenem; 72.2% NDM gene was found in neonates and was 20% from the environment. Conclusion: Outbreak of NDM-producing BCC resulting in high neonatal mortality in NICU.

Neonatal septicemia, or blood poisoning, is a dangerous illness in newborns. It is caused by bacteria or other infections entering the blood and spreading. Pregnancy, labor, delivery and exposure after birth can result in infection of the newborn. Neonatal septicemia kills 700,000 babies worldwide, mostly in low- and middle-income countries. Burkholderia cepacia complex bacteria can cause infections in people with weaker immune systems or other disorders. They are particularly dangerous in hospitals, as they can cause chronic lung problems. This study collected blood samples from newborns with blood poisoning. Most samples that contained Burkholderia cepacia complex were not susceptible to drugs. Four of the newborns carried the same bacteria, indicating that hospital staff should practice hand washing and equipment and environmental cleaning to prevent the spread of the bacteria.

Association between vaginal microbiomes and neonatal septicemia in pregnant women with preterm premature rupture of membranes based on metagenome sequencing.

BACKGROUND: Preterm premature rupture of membranes (PPROM) is closely associated with pathogenic microbiomes in the female reproductive tract, and can lead to neonatal septicemia. The current study aimed to investigate potential pathogenic microbiomes associated with neonatal septicemia based on DNA metagenome sequencing. METHODS: In this study, a total of 7 pregnant women with PPROM presenting neonatal septicemia (experimental group) and 3 pregnant women with normal newborns (control group) were enrolled. Vaginal secretions at admission and before parturition as well as placental tissues after parturition were collected for DNA metagenome sequencing using whole genome shotgun method on the Illumina NovaSeq/HiSeq platform. Raw data were processed by BioBakery workflow, and MetaPhlAn4 was implemented for qualitative and quantitative analyses of microbiome. Lactobacillus crispatus, Gardneralla vaginalis, Fannyhessea vaginae and Streptococcus suis were specifically detected from the experimental group. The two groups were compared using Student's t-tests. RESULTS: The indexes of Chao1 (P=0.00028/P=0.00072), abundance-based coverage estimator (ACE, P=0.00059/P=0.00026), Shannon (P=0.036/P=0.0065) and Simpson (P=0.007/P=0.041) in the experimental group were increased at admission and before parturition as compared with the control group. Several microbiomes, such as Lactobacillus crispatus, Gardneralla vaginalis, Fannyhessea vaginae and Streptococcus suis, were specifically detected in the experimental group. Notably, Gardnerella vaginalis and Streptococcus gallolyticus were identified from the vaginal secretions and placenta tissues of women with neonatal septicemia. Moreover, nucleic acid synthesis and carbohydrate metabolism-related pathways were enriched in the experimental group. CONCLUSION: This study enhanced the current understanding of the mechanisms underlying pathogenic microbiomes in PPROM-induced neonatal septicemia. The trial registry number is ChiCTR2300070666 (URL: https://www.chictr.org.cn/showproj.html?proj=195648).

Relationship between maternal and/or newborn cholesterol levels and neonatal septicemia: protocol for a Ugandan cohort of mother-newborn pairs.

BACKGROUND: Many aspects of microbial dissemination appear to vary with host cholesterol levels. Since neonatal septicemia remains a leading cause of newborn admissions and mortality in resource-limited settings, the contribution of abnormal cholesterol levels in maternal and/or newborn blood to the risk of neonatal septicemia and outcome requires elucidation. We aim to determine a relationship between maternal serum and neonatal cord blood cholesterol levels and neonatal septicemia. METHODS: This will be a mother-newborn pair cohort study. Approximately 353 pregnant women who are eligible and consent to participate in the study will have blood drawn for a lipid profile. Upon delivery, we will analyse the cord blood cholesterol of their newborns and follow them for 28 days to determine whether the infants develop clinical signs and symptoms suggestive of neonatal septicemia. Relative risk will be used to determine the association between cholesterol and newborn septicemia. Poisson regression will be used to estimate the relative risk (with 95% confidence intervals) of developing septicemia. DISCUSSION: Findings from our study will contribute evidence to support the inclusion of lipid profile screening for pregnant women and newborns. Our study will determine whether newborns with abnormal cholesterol or those born to mothers with abnormal cholesterol will require rigorous follow-up in neonatal clinics.

Bacteriological Profile and Antibiotic Susceptibility Pattern of Neonatal Septicemia and Associated Factors of ICU Hospitalization Days.

PURPOSE: To evaluate the microorganisms involved in neonatal septicemia and its antibiotic susceptibility pattern and to further investigate the factors associated with the length of intensive care unit (ICU) stay in neonatal septicemia. PATIENTS AND METHODS: A total of 297 infants with septicemia at neonatal ICU (NICU), Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology from 2016 to 2020 were enrolled. Identification of bacterial species was done using the standard positive blood culture. Data included demographics, signs at time of septicemia, laboratory values, patient sources, complications, microbiologic characteristics, and the duration of ICU stay. Univariate and multivariate gamma regression analyses were applied to determine the variables associated with ICU stay. RESULTS: The result demonstrated that the main causative pathogens of neonatal septicemia in our hospital were Gram-positive bacteria, among which Staphylococcus epidermidis (100 isolates, 47.17%) was the main conditional pathogens; Escherichia coli (27 isolates, 49.09%) was most frequently isolated among Gram-negative pathogens. Gram-positive bacteria had higher susceptibility to vancomycin, tigecycline and linezolid. Escherichia coli was susceptive to piperacillin (27/27, 100.00%), cefotetan (27/27, 100.00%), meropenem and imipenem (27/27, 100.00%). Streptococcus agalactiae (95% CI: 0.140-0.539), for patients who were transferred from other hospital (95% CI: 0.016 to 0.354), septicemia during hospitalization (95% CI: 0.411 to 0.825), the use of antibacterial drug during pregnancy (95% CI: 0.362 to 2.136), feeding intolerance (95% CI: 0.127 to 0.437), bradycardia (95% CI: 0.196 to 0.838), septicemia newborns have complications (95% CI: 0.063 to 0.291), the onset age (95% CI: 0.006 to 0.023), TRIPS score (95% CI: 0.005 to 0.016), and CRP level (95% CI: 0.002 to 0.005) were related to prolonged ICU stay days. CONCLUSION: This study summarized common pathogens and associated drug sensitivity, and factors influencing ICU stay length. Prevention and control policy in the NICU should be strengthened.

Progress of plasma soluble CD14 subtype in neonatal septicemia / 国际儿科学杂志

Neonatal sepsis is a common infectious disease in the neonatal period, and its morbidity and mortality are increasing year by year.Its etiology and pathogenesis have not been fully elucidated.In recent years, studies have confirmed that plasma soluble CD14 subtype(sCD14-ST)plays a certain role in the pathogenesis of neonatal sepsis, and has a certain value in its diagnosis and prevention.The study found that sCD14-ST could be used as an indicator for early auxiliary diagnosis of neonatal sepsis, and the expression of sCD14-ST was positively correlated with the degree of neonatal sepsis.Early detection of sCD14-ST can predict neonatal sepsis.This article reviews the research on sCD14-ST and its application in neonatal sepsis.

Evaluation of Biofilm Formation and Prevalence of Multidrug-Resistant Strains of Staphylococcus epidermidis Isolated from Neonates with Sepsis in Southern Poland.

Staphylococcus epidermidis strains play an important role in nosocomial infections, especially in the ones associated with biofilm formation on medical devices. The paper was aimed at analyzing the mechanisms of antibiotic resistance and confirming the biofilm-forming ability among S. epidermidis strains isolated from the blood of hospitalized newborns. Genetic analysis of resistance mechanism determinants included multiplex PCR detection of mecA, ermA, ermB, ermC, msrA, and mef genes. Biofilm analysis comprised phenotypic and genotypic methods including Christensen and Freeman methods and PCR detection of the icaADB gene complex. Among the tested S. epidermidis strains, 89% of the isolates were resistant to methicillin, 67%-to erythromycin, 53%-to clindamycin, 63%-to gentamicin, and 23%-to teicoplanin, while all the strains were susceptible to vancomycin and linezolid. The mecA gene was detected in 89% of the isolates, the ermC gene was the most common and present among 56% of the strains, while the msrA gene was observed in 11% isolates. Eighty-five percent of the strains were described as biofilm-positive by phenotypic methods and carried the icaADB gene cluster. Multidrug resistance and the biofilm-forming ability in most of the strains tested may contribute to antimicrobial therapy failure (p < 0.05).

Detailed nursing intervention on neonatal septicemia can improve the clinical symptoms of children and reduce the inflammatory reaction.

OBJECTIVE: To explore the application effect of detailed nursing intervention in neonatal septicemia. METHODS: Altogether 60 neonates of neonatal septicemia admitted to our hospital from November 2019 to October 2020 were selected as the research participants, and all the children have received routine treatment, among which 30 neonates received routine nursing intervention as the regular group, and the remaining 30 received detailed nursing intervention as the detail group. The clinical effects, improvement of clinical symptoms, length of stay, and guardian satisfaction were compared, and the levels of serum inflammatory factors (TNF-α, IL-6 and IL-17) and immune function indicators (CD4+, CD8+) before and after nursing intervention were detected. RESULTS: The total effective rate in the detail group was higher than that in the regular group (P < 0.05). Compared with the regular group, the temperature stabilization time, blood culture turning negative time, improvement time of milk rejection and hospital stay in the detail group were significantly shortened (P < 0.05). The guardian satisfaction score in the detail group was higher than that in the regular group (P < 0.05). After nursing, the levels of TNF-α, IL-6 and IL-17 decreased in both groups, and the levels of these three in the detail group were lower than those in the regular group (P < 0.05). After nursing, CD4+/CD8+ of children in both groups increased, and CD4+/CD8+ in the detail group and regular group were higher than those in the regular group (P < 0.05). CONCLUSION: The adoption of detailed nursing modes in the treatment of neonatal septicemia can further improve the treatment effect, shorten the hospital stay and the improvement time of clinical symptoms, reduce the incidence of complications, improve the nursing satisfaction of guardians, reduce the inflammation of the body and improve the immune function of the body.

Clinical analysis and examination of neonatal sepsis.

OBJECTIVE: The purpose of this study is to analyze the different clinical manifestations of neonatal sepsis, the related factors leading to neonatal complications, and the related factors of common complications, so as to provide a theoretical basis and logical proof for the treatment of neonatal sepsis. METHODS: This article collects clinical data of 110 cases of septicaemic neonates, compare the clinical characteristics, general conditions, pathogen distribution, laboratory test data of two groups of patients with septicaemic, and conduct statistics and analysis. RESULTS: The results showed that among 110 patients, there were 53 (48%) cases of premature septicaemic and 9 (8%) cases were infected during pregnancy. There were 7 (6%) cases of amniotic fluid contamination. There were 26(23%) cases of risk factors in the womb. 25 (23%) cases of children with multiple symptoms., The positive rates of white blood cell and platelet examination, c-reactive protein examination and neutrophil rod-nucleus/neutrophil examination were 59.64%, 38.77%, 38.6% and 5.66% respectively. Procalcitonin level was positively correlated with c-reactive protein (P<0.01, r=0.7). Among them, 6 (5.45%) cases were positive in blood culture, including 3 (2.72%) cases of staphylococcus epidermidis, 2(1.81%)cases of staphylococcus aureus and 1(0.90%)case of escherichia coli. CONCLUSIONS: The clinical manifestations of neonatal sepsis are relatively concealed, and antibiotics are used reasonably in the early treatment process to deal with the symptoms of the disease and promote the improvement of the treatment effect.

Frequency of Early-onset Neonatal Sepsis Following Prolonged Rupture of Membranes.

Introduction In developing countries, sepsis and associated mortality rates in neonatal patients is a serious concern. To improve the outcomes and mortality posed by sepsis, physicians need to know the local epidemiology of the microbial pathogens and their resistance patterns to antimicrobial agents. Therefore, our aim was to determine the frequency of early-onset neonatal sepsis (EONS) following prolonged rupture of membranes (PROM). Materials and methods After approval from the ethical review committee, this cross-sectional study was conducted at a tertiary care hospital of a developing country, and informed consent was taken from patients' parents. All neonates born to a mother with PROM after 24 weeks of gestation up to seven days of life were included. Demographic features, signs of sepsis, blood culture results, and laboratory markers of sepsis were recorded. All data were analyzed by using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY). Results A total of 124 patients were enrolled in the study. Seven neonates (5.6%) developed EONS and positive cultures were seen in four neonates (3.2%) with a maternal history of PROM. The organisms identified in cultures were Klebsiella pneumonia, group B streptococcus, Staphylococcus aureus, and Streptococcus species in EONS caused by prolonged PROM. Conclusions Early recognition of risk factors, recognition of clinical conditions with prompt laboratory screening for infection, and early establishment of empirical antibiotic treatment are effective preventive measures. Such approaches would be a secure and efficient strategy, particularly in developing countries.

Evaluation of a modified protocol that decreases the turnaround time of positive blood cultures.

BACKGROUND AND OBJECTIVES: Neonatal septicemia can be rapidly fatal if not treated promptly. A speedy laboratory diagnosis would improve the outcome. The BacT/ALERT 3D system (bioMerieux, Durham, North Carolina) is currently being used for laboratory diagnosis of blood stream infections. In the present study, a modified protocol was employed in which the broth was subcultured into two nutrient broth tubes and these tubes were used for biochemical tests and antimicrobial susceptibility testing to decrease the turnaround time. MATERIALS AND METHODS: A prospective study was conducted in the Department of Microbiology, SDM College of Medical Sciences and Hospital, Dharwad from October 2010 to July 2012 after receiving clearance from the institutional ethics committee. Automated blood cultures of 250 neonates admitted to the Neonatal Intensive Care Unit (NICU), clinically diagnosed to have septicemia, were performed using BacT/ALERT 3D. Bottles flagged positive within 72 hours of loading were processed for identification and antibiotic susceptibility testing using a modified protocol. The results were assessed for time saved in reporting in comparison with standard protocol. Student's t test was used for statistical analysis. RESULTS: Of the 250 cases studied, 117 cases yielded a positive blood culture giving a yield of 46.8%. The number of cases yielding monomicrobial growth were 73, which were included for further analysis. Of the remaining samples, 133 did not show growth, 11 were polymicrobial while 33 samples were flagged positive after 72 hours. Candida spp. grew in 34 cases, Gram negative bacilli grew in 28 cases and Gram positive cocci grew in 11 cases. In four cases, 66 hours were saved, 60 and 54 hours were saved in 18 cases each, 48 hours were saved in 27 cases, and 24 hours were saved in 6 cases. Methicillin resistant Staphylococcus aureus and Klebsiella pneumoniae were the most common isolates among Gram positive cocci and Gram negative bacilli, respectively, while C. guilliermondii was the most common Candida isolate. All Gram positive isolates were susceptible to vancomycin and linezolid. Most of the Gram negative isolates were susceptible to imipenem. CONCLUSION: This method can be employed in peripheral laboratory settings where there is no complete automation. Modification in processing blood culture can provide speedy identification and sensitivity report in blood stream infections. Time saved in reporting would play a crucial role in improving morbidity and mortality rates in neonatal septicemia.

Bacteriological profile of neonatal sepsis in a secondary care hospital in rural Tamil Nadu, Southern India.

INTRODUCTION: Neonatal sepsis is a leading cause of neonatal mortality and morbidity in the world. The objective of the current study was to detect the common causative microorganisms of neonatal sepsis and their antimicrobial resistance patterns in a rural secondary hospital in Tamil Nadu, India. MATERIALS AND METHODS: Neonates (0-28 days) admitted to this newborn care unit from October 2013 to September 2015, with a diagnosis of probable sepsis were studied. All the enrolled babies had blood cultures taken and were followed up till final outcome, which was discharge or death, irrespective of culture result. Univariate analysis was performed for factors associated with culture positivity, generating odds ratios, and confidence intervals. RESULTS: Among the 107 babies with a diagnosis of probable sepsis, 28 (26.2%) had shown bacteria in culture. The majority (94.4%) were of early-onset sepsis. The predominant organisms were Staphylococcus aureus (10/28) and Klebsiella (6/28). 100% of Gram-negative bacilli and 90% of Staphylococcus were resistant to Ampicillin. Gentamicin resistance among Gram-negative bacilli and Staphylococcus was 52.9% and 20%, respectively, while third-generation cephalosporin resistance was 31.2% and 20%, respectively. Among the neonates diagnosed as probable sepsis, idiopathic prematurity (P = 0.007) was found to have a statistically significant association with culture-positive sepsis. CONCLUSION: The culture positivity rate among the neonates with probable sepsis in the current study was 26%. An alarmingly high degree of antibiotic resistance observed calls for robust infection control practices and an urgent evaluation and development of individual and national antibiotic policies for neonatal sepsis.

The evaluation of the clinical efficacy of cefotaxime combined with gamma globulin on neonatal septicemia / 中国生化药物杂志

Objective To evaluate the clinical efficacy of cefotaxime combined with gamma globulin on neonatal septicemia. Methods The subjects of this study were selected from 88 cases of neonatal septicemia admitted in Jiangyou No.903 hospital from April 2014 to April 2017. They were randomly divided into two groups, each with 44 cases. The control group was given symptomatic treatment and cefotaxime, while the observation group symptomatic treatment, cefotaxime and gamma globulin as well. After 7days of treatment, the overall effective rates, case fatality rates, clinical symptoms (body temperature, resistance to milk, neurological symptoms), time for improvement and hospital stay were compared between the two groups. Results The overall effective rate of the observation group was 95.45％, much higher than 72.73％ of the control group (P<0.01). The observation group had much lower case fatality rate than the control group did (2.27％ vs 18.19％) (P<0.05). The time the observation group took for improvement in the condition of body temperature, resistance to milk, neurological symptoms, and hospital stay was (3.25±1.07) days, (4.93±1.96) days, (5.92±1.58) days, and (6.80±1.94) days respectively, all significantly shorter than the time the control group took (P<0.01). Conclusion The combination of cefotaxime and gamma globulin is effective in the treatment of neonatal septicemia. It can significantly reduce case fatality rate and shorten the time for clinical symptoms and hospital stay.

Change in pathogens and antimicrobial resistance in neonatal septicemia during 6 years / 中国感染控制杂志

Objective To understand the pathogens causing neonatal septicemia,as well as changing trend of anti-microbial resistance,and provide evidence for clinical anti-infection treatment.Methods Results of blood culture and antimicrobial susceptibility testing of pathogens from neonates with septicemia who were admitted to the depart-ment of neonatology of a hospital from January 2009 to December 2014 were analyzed retrospectively,distribution of pathogens and antimicrobial resistance between 2009 -2011 and 2012 -2014 were compared.Results A total of 259 strains were isolated from blood specimens,gram-positive bacteria,gram-negative bacteria,and fungi were 175 (67.57%),65 (25.10%),and 19 (7.33%)respectively.Coagulase-negative staphylococcus (CNS)was the main pathogen during 6 years,followed by Klebsiella pneumoniae (K .pneumoniae);the constituent ratio of the extend-ed-spectrumβ-lactamase (ESBLs)-producing strains increased from 10.56% to 15.38%,constituent ratio of fungi increased from 4.93% to 10.25%(P >0.05);The sensitivity of gram-positive bacteria to vancomycin,teicoplanin, and linezolid were all 100.00%,82.28%-88.33% of CNS and 75.00%-100.00% of Staphylococcus aureus were methicillin-resistant;the resistance rates of K .pneumoniae and Escherichia coli to the third-generation cephalospo-rins were 42.86% - 86.67%,to cefoperazone/sulbactam increased from 17.39% and 14.29% to 33.33% and 30.00% respectively,meropenem-and imipenem-resistant strains were not found.Resistance rate of Candida albi-can to fluconazole increased from 20.00% to 50.00%,all detected fungi remained sensitive to amphotericin B. Conclusion CNS are the major pathogens in neonatal septicemia,followed by K .pneumoniae ,constituent ratio of fungal infection has increased.Antimicrobial agents should be chosen according to blood culture and antimicrobial susceptibility testing results.

"Amber in chamber" an enigmatous right atrial mass in a neonate.

The incidence of fungal infection is increasing worldwide. Although fungal infection is common in adults, few cases have been reported in the neonatal population. We report a case of the preterm neonate of 34 weeks who developed respiratory distress on 2(nd) day and was initiated on mechanical ventilation. Treatment was instituted for sepsis, but the patient continued to deteriorate. Two-dimensional echocardiography revealed a large right atrial mass, which eventually turned out to be fungal ball. Intense surgical and medical management led to a speedy recovery of the patient. We stress on the early use of echocardiography in atypical presentation of neonatal septicemia along with routine investigations to help in early recognition of source of infection. This can be of great value in initiating definitive management and improving survival rate in such patients.

Bacteriological Profile of Neonatal Septicemia in a Tertiary Care Hospital from Western India.

Neonatal septicemia is an important cause of morbidity and mortality. The present study was undertaken to determine the bacteriological profile and antimicrobial susceptibility pattern of prevalent pathogens isolated from the blood of septicemic neonates from Neonatal Intensive Care Unit (NICU). A total of 180 blood samples of septicemic neonates were studied bacteriologically. Antimicrobial susceptibility testing was done by the Kirby Bauer disc diffusion method in accordance to Clinical Laboratory Standards Institutes (CLSI) guidelines. 26.6% (48 out of 180) cases of septicemia could be confirmed by blood culture. Of these, 66.7% cases were of early onset septicemia (EOS) and 33.3% were of late onset septicemia (LOS). Klebsiella pneumoniae was the predominant pathogen (35.4%) among the Gram-negative pathogens and Staphylococcus aureus (22.9%) was the predominant Gram-positive pathogen. 28% of K. pneumoniae and E. coli isolates were extended spectrum beta-lactamase (ESBL) producers. 18.1% of the Staphylococcus isolates were methicillin-resistant S. aureus (MRSA). Multi-drug-resistance pattern was observed with all the isolates. Ciprofloxacin and aminoglycosides were the most effective drugs against Gram-positive and Gram-negative isolates. This study highlights the predominance of Gram-negative organisms in causing neonatal sepsis and emergence of multi-drug-resistant strains in our set up.

Klebsiella Pneumoniae in Septicemic Neonates with Special Reference to Extended Spectrum ß-lactamase, AmpC, Metallo ß-lactamase Production and Multiple Drug Resistance in Tertiary Care Hospital.

BACKGROUND: ß-lactamases viz., extended spectrum ß-lactamase (ESBL), AmpC, and metallo ß-lactamase (MBL) production in Klebsiella pneumoniae has led to a serious concern about septicemic neonates in Neonatal Intensive Care Units due to high resistance against commonly used antimicrobials. PURPOSE: To study the prevalence of ESBL, AmpC, and MBL production in K. pneumoniae isolates in neonatal septicemia, to check antimicrobial susceptibility to various drugs including tigecycline; and to assess burden of multiple drug resistance (MDR). MATERIALS AND METHODS: Total 24 clinical isolates of K. pneumoniae isolated from 318 blood samples of suspected cases of neonatal septicemia were studied. Isolates were screened for ESBL, AmpC, and MBL production by Clinical and Laboratory Standards Institute (CLSI) disk method, AmpC cefoxitin screen, and imipenem, meropenem, ceftazidime disk screen respectively; and confirmation was done by CLSI phenotypic disk confirmatory test, AmpC sterile disk method, and imipenem ethylenediamine tetracetic acid double disk synergy test respectively. Antimicrobial susceptibility was determined by Kirby-Bauer's disk diffusion method. Efficacy of tigecycline was evaluated using United States Food and Drug Administration guidelines. RESULTS: Of the 24 K. pneumoniae isolates, co-production of AmpC + MBL was found in more number of isolates (67%) (P < 0.0001) compared to single enzyme production (ESBL and MBL 8% both, AmpC 12.5%). Rate of resistance for penicillins and cephalosporins was highest. Susceptibility was more for imipenem, co-trimoxazole, and meropenem. Nonsusceptibility to tigecycline was low (21%). A total of 23 (96%) isolates were MDR. CONCLUSIONS: Routine detection of ESBL, AmpC, and MBL is required in laboratories. Carbapenems should be kept as a last resort drugs. Trend of tigecycline susceptibility has been noted in the study. Continued monitoring of susceptibility pattern is necessary to detect true burden of resistance for proper management.

Clinical significance of distinguishing neonatal septicemia between early-onset and late-onset sepsis / 中华实用儿科临床杂志

Obgective To analyze the demographic data,non-specific items,pathogens and antibiotic sensitivity between the children with early-onset and late-onset sepsis,in order to guide the diagnosis and treatment of neonatal sepsis.Methods Three hundred and fifty-two cases with positive blood culture were retrospectively recruited and divided into an early-onset group and a late-onset sepsis group according to the onset of sepsis.Results Of 352 cases,144 cases (40.91％) were the early-onset children while 208 cases (59.09％) were the late-onset children,and in the late-onset group,108 cases occurred due to nosocomial infection.Most neonates of the early-onset term were term infants [107/144 cases (74.31％)],while the preterm infants [77/208 cases (37.02％)] and low birth weight infants[70/208 cases(33.65％)] accounted for the majority of the late-onset group.The asphyxia,perinatal intrauterine distress,meconium-staining amniotic fluid and premature rupture of fetal membranes ≥ 18 h occurred more frequently in the early-onset group [21/144 cases (14.58％),14/144 cases (9.72％),26/144 cases (18.06％),31/144 cases (21.53％)],respectively,while those in the late-onset group were [17/208 cases (8.17％),9/208 cases(4.33％),13/208 cases(6.25％),17/208 cases(8.17％)],respectively,there were significant differences (x2 =4.622,3.886,5.950,13.345,all P ＜ 0.05) between 2 groups.In the early-onset group abnormal temperature[72/208 cases(34.62％)vs 30/144 cases(20.83％)],vomiting or abdominal distention[109/208 cases (52.40％) vs 35/144 cases (24.31％)],lethargy [79/208 cases (37.98％) vs 38/144 cases (26.39 ％)] and umbilicalitis or skin pustule [33/208 cases (15.87 ％) vs 11 / 1 44 cases (7.64 ％)] occurred more frequently in late-onset group,and there were significant differences (x2 =7.853,8.763,5.153,5.265,all P ＜ 0.05).Besides,more cases in the late-onset group had elevated immature neutrophil vs total neutrophil count ratio [27/184 cases (14.67％)] and C-reactive protein value [76/206 cases (36.89％)],compared with those in early-onset group [9/133 cases (6.77％),38/143 cases(26.57％)],and there were significant differences (x2 =4.794,4.087,allP ＜ 0.05).Compared with early-onset group,patients in the late-onset group were more likely to suffer from suppurative meningitis [17.79％ (37/208 cases) vs 8.33％ (12/144 cases);x2 =6.348,P ＜ 0.05].In terms of pathogens,the main pathogens in the early-onset group were gram negative bacteria[39.58％ (57/144 cases),including detection of Klebisella pneumoniae in 21 cases and E.coli in 20 cases] and coagulase negative staphylococcus[32.64％ (47/144 cases)].In late-onset group,the main pathogens were gram positive bacteria [58.65％ (122/208 cases)],including detection of coagulase negative staphylococcus in 90 cases(43.27％) and E.coli [17.79％ (37/208 cases)].There was no significant difference in prognosis between 2 groups(x2 =1.187,P =0.552).Conclusions Early-onset sepsis and late onset sepsis differ in the clinical manifestation and laboratory findings.Distinguishing neonatal early-onset and late onset septicemia is of clinical significance in choosing appropriate antibiotics.

Research on the value of C reactive protein in diagnosis of neonatal septicemia / 国际检验医学杂志

Objective To study the value of C reactive protein (CRP) in the diagnosis of neonatal septicemia .Methods 60 cases of neonatal septicemia were selected as observation group ,at the same time ,60 cases of healthy newborns were selected as control group .The levels of CRP and WBC were detected ,and the blood culture was accessed .Drug sensitive test was progressed in infants with positive blood culture results .The diagnostic values of CRP ,WBC and CRP+ WBC were compared .Results In observation group ,there were 54 cases ,49 cases and 38 cases with positive results of blood culture and the detections of CRP and WBC ,respec‐tively .The accuracy of CRP+WBC was significantly higher than separate detections of CRP and WBC (P<0 .05) .The ROC AUC of CRP+WBC was 0 .852 1 ,which was higher than that of CRP and WBC .Conclusion CRP combined with WBC detection has certain clinical application value in diagnosis of neonatal septicemia .

Analysis of pathogen distribution and antibiotic resistance in 1606 blood cultures from neonates / 临床儿科杂志

Objective To determine the pathogen profile and antibiotic resistance in aerobic isolates from blood cultures of neonates. Methods All blood culture reports (n=28120) from newborns admitted to the Department of Neonatology during 2002-2012 were analyzed, and the sensitivity patterns were recorded. Results A total of 1665 bacteria were isolated from 1606 blood culture-positive samples and the positive rate of blood cultures was 5.7%(1606/28120). Gram-positive bacteria were iso-lated in 1336 cases, with Staphylococcus epidermidis (902 cases) and Staphylococcus haemolyticus (206 cases) being the com-mon bacteria. Klebsiella pneumoniae (108 cases), followed by Escherichia coli (73 cases), were the major Gram-negative bacte-ria (235 cases). The determination of the antibiotic resistance of aerobic isolates was performed in 2012. Most Gram-positive iso-lates were sensitive to vancomycin and moxifloxacin, and more than 90%were resistant to penicillin while most of Gram-nega-tive isolates were sensitive to amikacin and imipenem. Conclusions Staphylococcus epidermidis, Staphylococcus haemolyticus, Klebsiella pneumoniae and Escherichia coli remain to be the principal organisms responsible for neonatal sepsis.

Value of procalcitonin and high sensitivity C-reactive protein in early diagnosis of neonatal septicemia / 国际检验医学杂志

Objective Too investigate the application value of procalcitonin(PCT)and high sensitivity C-reactive protein(hs-CRP)in early diagnosis of neonatal septicemia and disease condition assessment.Methods 48 patients with neonatal septicemia treated in the hospital from November 2011 to May 2013 were collected.The data of PCT,hs-CRP and blood culture were recorded and performed the comparative analysis with the serum PCT,hs-CRP detection results in contemporaneous 48 neonates without septicemia.Results The serum PCT and hs-CRP was 93.75% and 10.42% in the neonates with septicemia,which were signifi-cantly higher than 79.17% and 50% in the neonates without septicemia(P <0.05),the positive rate had statistical difference be-tween the two groups.Conclusion PCT and hs-CRP have remarkable change in the early stage of neonatal sepsis,the combination detection of serum PCT and hs-CRP can be used as the indicators for early diagnosis of neonatal sepsis,moreover the sensitivity and specificity of PCT for diagnosing neonatal septicemia are higher the those of hs-CRP,their combined detection can provide fast and accurate diagnostic basis for clinic.