Neonatal thrombocytopenia and platelets transfusion.

BACKGROUND: Neonates often develop thrombocytopenia at some time during hospital stay. Platelet transfusion are frequently given to them and are likely to result in unnecessary transfusion. MATERIAL AND METHODS: Thus, we analyzed thrombocytopenia in neonates, its prevalence, and relationship if any, between clinical condition and platelet transfusion in neonates, which would have been helpful in developing guidelines and/or protocols for platelet transfusion (and reducing the donor exposure) in neonates. RESULTS: A total of 870 neonates who were admitted in Neonatal Intensive Care Unit (NICU) with various morbidities had platelets count done; of these, 146 (16.7%) neonate revealed thrombocytopenia. DISCUSSION: Low birth weight babies (P 0.009) and babies born with mother having hypertension (P 0.04) showed significant thrombocytopenia. Neonates with intrauterine growth retardation (IUGR) diagnosed during antenatal screening showed lower platelet count (P 0.022). Neonates having associated illness, such as sepsis, gastrointestinal, and respiratory problems, and on vasopressor drugs were found to be associated with low platelet count. CONCLUSION: In our study, 16.40% of thrombocytopenic neonates required platelet transfusion either alone or with other blood component during their stay in NICU.

Intravenous colistin administration in neonates.

BACKGROUND: Nosocomial infection due to multidrug-resistant Gram-negative pathogens in intensive care units is a challenge for clinicians and microbiologists, and has led to resurgence of parenteral colistin use in the last decade. Safety and efficacy data regarding intravenous colistin (colistimethate) use in neonates is sparse. We present our experience of efficacy and safety of colistimethate in the treatment of sepsis in critically sick term and preterm neonates. METHODS: The records of the neonates who received colistimethate in a neonatal intensive care unit of a tertiary care center from January 2009 to December 2009 were reviewed. RESULTS: Eighteen critically sick neonates (10 term and 8 preterm) received 21 courses of colistimethate (dose ranging from 50,000 to 75,000 IU/kg/d) for treatment of pneumonia, blood stream infections, meningitis, and empyema thoracis. The isolated pathogens in decreasing order of frequency were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonos aeruginosa, and Enterobacter. Mean duration of colistimethate was 13.1 days/course (range: 5-21 days). At least one other antibiotic was coadministered in all courses. A favorable clinical outcome occurred in 16 of 21 (76%) courses, 5 patients died due to severe sepsis with multiple organ dysfunction. Microbiologic clearance was documented in 17 courses. Increase in serum creatinine by > 0.5 mg/dL above baseline in 2 babies was associated with the presence of multiple organ dysfunction syndrome in both and coadministration of netilmicin in one. CONCLUSIONS: Colistimethate intravenous administration appears to be safe and efficacious for multidrug-resistant Gram-negative infections in neonates, including preterm and extremely low birth weight neonates.

Antimicrobial resistance of Neisseria gonorrhoeae in selected World Health Organization Southeast Asia Region countries: an overview.

BACKGROUND AND OBJECTIVES: A Gonococcal Antimicrobial Susceptibility Program (GASP) under the World Health Organization South East Asia Region (WHO SEAR) is continuing in India and neighboring countries and is being coordinated by the WHO Regional Reference Laboratory (RRL), Vardhman Mahavir Medical College, and Safdarjung Hospital, New Delhi. GOAL: The present communication describes the current status and trends of antimicrobial resistance patterns of Neisseria gonorrhoeae, isolated in different focal-point laboratories under GASP, as presented in WHO SEAR intercountry consultative meeting conducted in December 2001. STUDY: Seven laboratories from India and 1 each from Bangladesh, Sri Lanka, and Nepal presented their data for the year 2000/2001. In addition, RRL Delhi, Bangladesh, and Sri Lanka presented data for the years 1995 to 2001, 1997 to 2001, and 1996 to 2000, respectively. Either National Committee for Clinical Laboratory Standards or calibrated dichotomous sensitivity technique was used in the different laboratories for determining antimicrobial susceptibility. RESULTS: It was observed that in the Indian laboratories, penicillin resistance varied from 20% to 79%, tetracycline resistance from 0% to 45.6%, and ciprofloxacin from 10.6% to 100%. Chromosomal, as well as plasmid-mediated resistance, was observed. The strains were reported to be less sensitive to ceftriaxone in 5 out of 7 laboratories, while none reported spectinomycin resistance. The reasons for wide variation in the results could be due to geographical strain difference in different parts of this vast country. At Sri Lanka, gonococci showed resistance towards penicillin (96.8%) and ciprofloxacin (8.2%). Bangladesh reported N. gonorrhoeae with ciprofloxacin (76%), penicillin (33%), and tetracycline (50%) resistance and decreased susceptibility to ceftriaxone (1.5%). Both the laboratories did not report any spectinomycin resistance. The resistance trends in these 2 centers and the RRL, New Delhi, showed different patterns. CONCLUSION: The report indicates the necessity for continuous surveillance of antimicrobial resistance pattern in this region of WHO for establishing antimicrobial policy guidelines for management of this common but important sexually transmitted infection (STI) pathogen, known to facilitate human immunodeficiency virus (HIV) infection. It also highlights the importance of ensuring quality assurance in the techniques in order to generate uniform data.

Alarming increase in ciprofloxacin- and penicillin-resistant Neisseria gonorrhoeae isolates in New Delhi, India.

BACKGROUND: Resistance of ciprofloxacin has been reported in several regions of the world, including India. In India, ciprofloxacin is still being used as single-dose treatment for gonorrhea. GOAL: The aim of the study was to determine the antimicrobial susceptibility of Neisseria gonorrhoeae isolates from patients with acute gonococcal urethritis in New Delhi. STUDY DESIGN: By means of disc diffusion, we determined the susceptibility profiles of N gonorrhoeae isolates, determined the MICs of ciprofloxacin, penicillin, and ceftriaxone, and compared our data with previous findings. RESULTS: On the basis of MIC values, 35.3% and 52.9% of strains were found to be resistant and less sensitive, respectively, to penicillin; 67.3% and 28.2% strains were observed to be resistant and less sensitive, respectively, to ciprofloxacin. Only one isolate (5.9%) was found to be less sensitive to ceftriaxone. CONCLUSION: The significant increase in ciprofloxacin resistance in the current study indicates that resistance has developed under selective antibiotic pressure.

Clinico-mycological Study of Onychomycosis.

Onychomycosis constitutes one of the major causes of nail dystrophy and is of serious concern to the clinical because of its chronicity and recalcitrance to therapy. The clinical and mycological features were studied in 45 cases of onychomycosis. The disease was more common in adult males. Subungual hyperkeratosis (95.5%) and discolouration of the nail plate (100%) were the most consistent fmdings,observed. Among the 4 clinical types seen, distal subungual onychomycosis was the commonest. The finger nails were more commonly involved than toe nails. The culture positivity rate was observed to be 68.8% The predominant isolates obtained were T. rubrum (52.9%), T. mentagraphytes (20.1%) T. tonsurans (5.9%), Asperginus species (8.8%) and C. albicans (11.8%).