To study the profile of Candida isolates and antifungal susceptibility pattern of neonatal sepsis in a tertiary care hospital of North India.

AIMS AND OBJECTIVE: To study the profile of Candida infection and antifungal susceptibility (AFS) pattern in neonatal sepsis. MATERIALS AND METHODS: In this prospective observational study, 850 blood samples were collected and processed from neonates who were suspected clinically to have sepsis. The blood culture that showed growth of Candida was further processed for species identification. Antifungal susceptibility was done as per the National Committee for Clinical Laboratory Standards (NCCLS)/Clinical Laboratory Standards Institute (CLSI) M44-A-2 guidelines by disc diffusion method and automated vitek-2 compact system. Candidemia was diagnosed by isolation of Candida species from at least one positive blood culture containing pure growth of Candida species with supportive clinical features. RESULTS: Candida species were isolated in 32 specimens of the total 322 culture-positive cases. The most common isolate was Candida tropicalis (14/32; 43.75%) followed by Candida albicans (7/32; 21.87%) and Candida glabrata (6/32; 18.75%). The three most common neonatal risk factors for candidemia were low birth weight, prolonged use of intravenous antibiotics and presence of central venous line. Non-albicans Candida (NAC) showed good sensitivity to fluconazole as compared to Candida albicans. The fluconazole sensitivity of Candida tropicalis, Candida glabrata, and Candida parapsilosis was 93, 67, and 100%, respectively, whereas it was 57% in Candida albicans. The sensitivity to amphotericin B was 95% among all Candida isolates. All NAC were sensitive to amphotericin B, while only 72% Candida albicans were sensitive to amphotericin B. CONCLUSIONS: The incidence of neonatal sepsis secondary to NAC is increasing and has replaced Candida albicans as a major cause of neonatal fungal sepsis. Low birth weight is the most important risk factor for Candida sepsis. The resistance of Candida albicans is increasing for both fluconazole and amphotericin B when compared to NAC. Increasing antifungal resistance warrants its judicious use both for prophylaxis and treatment.

Bloodstream infections and antibiotic sensitivity pattern in intensive care unit.

Bloodstream infection remains one of the most important causes of morbidity and mortality globally, specifically among intensive care unit patients. This prospective observational study included 887 blood culture samples collected cases admitted to intensive care unit suspected of having sepsis. Samples were cultured and evaluated for antimicrobial susceptibility patterns: 202 (22.78%) blood cultures were positive and yielded microbial growth with 132 (14.88%) having mono-microbial growth. Gram-negative bacteria accounted for 45.2% cases, with Escherichia coli being the most common; Gram positives accounted for 43.9% with Staphylococci haemolyticus being most common and 10.9% were fungal isolates. Gram-negative isolates were sensitive to colistin and tigecycline and 77.3% of isolates were extended spectrum beta-lactamase (ESBL) producers. Gram-positive isolates were sensitive to tigecycline, linezolid, vancomycin and teicoplanin with 97.5% being methicillin-resistant Staphylococci (MRSA). Most of the blood culture isolates from critically ill patients in intensive care unit were multidrug-resistant, ESBL producers and MRSA which raises a serious concern about the development of serious antibiotic resistance.

Correlation of Apgar Score with Asphyxial Hepatic Injury and Mortality in Newborns: A Prospective Observational Study From India.

OBJECTIVE: The objective of this study is to determine the correlation of Apgar score with asphyxial hepatic injury and neonatal mortality in moderately and severely asphyxiated newborns. MATERIAL AND METHODS: This is a secondary analysis of our prospective observational case-controlled study. Sixteen neonates with severe birth asphyxia (five-minute Apgar ≤3) were compared with either 54 moderate asphyxia neonates (five-minute Apgar >3) or 30 normal neonates. Liver function tests were measured on postnatal days 1, 3, and 10 in the study and control groups. Neonatal mortality was observed in the study and control population. RESULTS: Correlation of Apgar score in severely asphyxiated neonates compared with normal Apgar score neonates and moderately asphyxiated neonates for deranged hepatic function showed significant correlation (odds ratio [OR] 4.88, 95% CI 3.26-5.84, P = 0.01 and OR 2.46, 95% CI 1.94-3.32, P = 0.02, respectively). There was a significant increase in serum lactate dehydrogenase (LDH) and total bilirubin on day 1 and serum LDH at age of 10th postnatal life in severely asphyxiated neonates when compared to moderately asphyxiated neonates, whereas there was a significant decrease in total bilirubin and serum albumin on day 3 in severely asphyxiated neonates. There was a significant increase in serum alanine transaminase, serum LDH, and total bilirubin on day 1, serum aspartate transaminase, serum LDH, and total bilirubin on day 3, and International Normalized Ratio on day 10 of postnatal life when severely asphyxiated neonates were compared with normal neonates. There was a significant reduction in total protein and serum albumin on day 1 and direct bilirubin on day 3 in severely asphyxiated neonates when compared with normal neonates. There was a significant increase in neonatal mortality in severely asphyxiated neonates when compared to the other two groups. Correlation of Apgar score in severely asphyxiated neonates compared with normal Apgar score neonates and moderately asphyxiated neonates for neonatal mortality showed significant correlation (odds ratio [OR] 2.23, 95% CI 1.42-3.04, P = 0.03 and OR 1.87, 95% CI 1.64-2.02, P = 0.04, respectively). CONCLUSION: The severity of hepatic dysfunction correlates well with increasing severity of asphyxia. The neonatal mortality also showed good correlation with Apgar score in our study, although we need a large multicentric trial to confirm our observations. Apgar score combined with hepatic dysfunction can be used as a prognostication marker for neonatal mortality.

Bacteriological spectrum and antimicrobial susceptibility pattern of neonatal septicaemia in a tertiary care hospital of North India.

BACKGROUND: Neonatal septicaemia is a clinical entity that is characterised by systemic signs and symptoms of infection and accompanied by bacteraemia in first 4 weeks of life and is one of the four leading causes of neonatal mortality and morbidity in India. AIM: To determine the bacterial spectrum and antimicrobial susceptibility pattern of neonatal septicaemia in a tertiary care hospital of North India. MATERIALS AND METHODS: In this prospective observational study, 850 blood samples were collected and processed from clinically suspected neonates according to standard laboratory protocol. Antimicrobial susceptibility of the isolates was done by Kirby Bauer disc diffusion method according to Clinical and Laboratory Standard Institution (CLSI) recommendations. RESULTS: Blood culture reports were positive in 322 (37.8%) cases. Early onset sepsis (EOS) was present in 61.41% and late onset sepsis (LOS) in 38.59% of cases. Gram-negative septicaemia (60.67%) was encountered more than Gram-positive (32.01%). Coagulase negative Staphylococci (17.43%) was the predominant isolate followed by, Klebsiella spp in 16.11% cases. Best overall sensitivity among Gram-negative isolates was to Colistin (89.94%), Imipenem (86.43%) and Meropenam (77.88%). Gram-positive isolates had good (97.15%) sensitivity to linezolid, (95.23%) vancomycin and (88.57%) Teicoplanin. CONCLUSION: Gram-negative organisms are the leading cause of neonatal septicaemia with Klebsiella spp being commonest. Coagulase negative Staphylococci is the predominant isolate among Gram-positive organisms. Most of the isolates are resistant to common antibiotics.

Hepatic dysfunction in asphyxiated neonates: prospective case-controlled study.

OBJECTIVE: This study was performed to determine the occurrence of hypoxic hepatitis in full-term neonates after perinatal asphyxia and to correlate between the rise in enzymes and severity of asphyxia with Apgar score and hypoxic ischemic encephalopathy (HIE) grading of the neonates. METHOD AND MATERIAL: This prospective case-controlled study was conducted in a tertiary-level hospital in India for a period of 12 months. The study group A comprised 70 newborns suffering from birth asphyxia, while 30 healthy neonates were included in group B (control). All biochemical parameters of liver function, ie, serum alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein, serum albumin, bilirubin (total and direct), and international normalized ratio (INR), were measured on postnatal days 1, 3, and 10 in both study and control groups. RESULTS: In group A, 22.8% newborns had severe (Apgar score 0-3), 47.1% had moderate (Apgar score 4-5), and 30% had mild (Apgar score 6-7) birth asphyxia at five minutes. In all, 14.28% babies were in HIE stage I, 25.73% babies were in HIE stage II, and 11.42% babies were in HIE stage III. The rest of the newborns, 48.57%, were normal. The prevalence of liver function impairment was seen in 42.85% of asphyxiated neonates. On day 1, ALT, AST, ALP, LDH, PT, and INR were significantly higher, and total protein and serum albumin were significantly lower in group A than in group B. However, ALT and AST correlated well with increasing severity of HIE score. On day 3, there was a rising trend observed in the concentration of mean LDH as HIE staging of neonates progressed from stage 0 to stage III, and among various HIE stages, the difference in LDH was statistically significant. CONCLUSION: We concluded that AST, ALT at 24 hours, and LDH at 72 hours of animation can be a utilitarian diagnostic tool to differentiate asphyxiated neonates from non-asphyxiated neonates and to discover the severity of perinatal asphyxia because of easy accessibility and feasibility of tests. The outcomes of this survey would be useful for physicians who receive neonates for whom birth details are not easily documented as most of the time the referred newborn infants lack asphyxia history either because the attendants do not know clearly the whole birth history or it was an unattended delivery, or the referring health-care professional has not been observant because of legal threats. The neurological assessment also becomes difficult and inconclusive as ventilator treatment, sedative drugs, and anticonvulsant therapy would produce an evaluation of severity of hypoxic ischemic brain disease and neurological insult difficult.