Clinical, Bacteriological Profile and Outcome of Neonatal Sepsis.

BACKGROUND: Sepsis is a major cause of morbidity and mortality among neonates in Nepal. This study was conducted to determine the clinical-bacteriological profile, their antibiotic susceptibility patterns, and clinical outcome of culture-positive neonatal sepsis. METHODS: This was a prospective study conducted at B.P Koirala Institute of Health Sciences from July 2018 to June 2019. Neonates with clinically diagnosed sepsis having blood culture positive were included in the study. Blood samples culture and antimicrobial susceptibility testing were performed with the standard microbiological method. Demographic, clinical information, and clinical outcomes were documented. RESULTS: The incidence of culture-positive sepsis was 10.3% (183/1773) of neonatal admissions. Poor feeding 85(46%) and fever 68(37%) were the common clinical features at presentation. The incidence of early-onset sepsis and late-onset sepsis were found to be 116 (63%) and 67(37%) respectively. Staphylococcus aureus was the common pathogen in both early-onset 61(49%) and late-onset 34(41%) sepsis. The incidence of multidrug-resistant cases was 41% (75/183) with 20% (15/75) extensively drug-resistant gram-negative bacilli, 36% (20/75) multidrug-resistant gram-negative bacilli, and 44% (33/75) Methicillin-resistant Staphylococcus aureus cases. In-hospital mortality rate was 12 (7%) with a higher frequency in multidrug-resistant sepsis 92% (11/12) than non- multidrug-resistant 8% (1/12). The median hospital days were longer in multidrug-resistant cases than non- multidrug-resistant [11(9-13) verses 3(2-5)]. CONCLUSIONS: The incidence of multidrug-resistant pathogens causing neonatal sepsis is high at our hospital and are associated with more in-hospital mortality and longer hospital stay. Implementation of effective preventive strategies to combat the emergence of antimicrobial resistance is immediately needed.

Pulmonary Paragonimiasis: A Case Series.

Paragonimiasis contributes to significant foodborne zoonosis worldwide. The major mode of transmission in humans is by consumption of uncooked or undercooked crabs and crayfish harbouring Paragonimus metacercariae. It begins with symptoms like fever and lower respiratory involvement from a few months to a year, mimicking those of tuberculosis and leading to diagnostic delay. Here, we report two cases of paragonimiasis during a period of nine months. Both cases presented with symptoms of productive cough with rusty sputum, chest pain, along with eosinophilia, and pleural effusion and had a history of consumption of smoked crab from the local river. The diagnosis was established by microscopic demonstration of Paragonimus ova in the sputum. They were treated with praziquantel and recovered. Indeed, it is challenging to diagnose paragonimiasis due to the lack of its specific symptoms but should be considered in the differential diagnosis of eosinophilia and pleural effusion in such lung diseases. Keywords: case reports; eosinophilia; paragonimiasis; pleural effusion.

Early-Onset Neonatal Meningitis Caused by an Unusual Pathogen-Moraxella catarrhalis.

INTRODUCTION: Moraxella catarrhalis are part of the normal flora of the human respiratory tract and are known to have low pathogenic potential. The organism is rarely reported in the literature as the causative agent of meningitis. We report the first case of early-onset neonatal meningitis associated with M. catarrhalis from Nepal. CASE REPORT: A 3-day-old baby with fever and yellowish discolouration of the body since 48 hrs was admitted to the neonatal ward. The baby developed 3 episodes of seizures in the form of uprolling of eyes on the first day of admission during phototherapy course for raised serum bilirubin. Sepsis screen was positive, and meningitis was confirmed as the cerebrospinal fluid culture grew M. catarrhalis. Cranial ultrasound scan was normal. The baby received a 21-day course of intravenous cefotaxime and amikacin. Recovery has been uneventful to date. CONCLUSION: Neonatal meningitis is a life-threatening infection. This case report presents an uncommon aetiology of neonatal meningitis which can be misidentified in the diagnostic bacteriology laboratory in resource constraints area like ours.

Pantoea agglomerans Infections in Children: Report of Two Cases.

INTRODUCTION: Pantoea agglomerans, primarily an environmental and agricultural organism has been reported as both commensal and pathogen of humans. We present two case reports of P. agglomerans infections in children that involved the meninges and bloodstream. CASE PRESENTATIONS: A 6-month-old female baby, diagnosed as congenital hydrocephalus secondary to aqueduct stenosis with ventriculoperitoneal shunt in situ, operated 14 days back was brought to the pediatric emergency with a two-day history of high fever associated with vomiting, irritability, excessive crying, and decreased feeding. Postoperative meningitis was confirmed as cerebrospinal fluid culture revealed P. agglomerans. She responded well with a 14-day intravenous (IV) course of ceftriaxone. Also, we report a case of a 3-year-old male child referred to our center with a provisional diagnosis of UTI with chickenpox for further evaluation. During his 24-hour stay at the local hospital, he had received oral antibiotics and urinary catherization. Urine culture of catheter clamp urine was sterile. P. agglomerans was grown in blood culture. He was treated successfully with IV ceftriaxone and amikacin. CONCLUSION: P. agglomerans can cause postsurgical meningitis and bloodstream infection in children. The clinical course of infection was mild and timely administration of proper antibiotic resulted in a favorable outcome.

Stenotrophomonas maltophilia causing blood stream infection in neonates and infants: a cause for concern.

Stenotrophomonas maltophilia ( S. maltophilia) is an important Gram-negative, non-fermentative, multidrug resistant (MDR) nosocomial organism. We evaluated the isolation of S. maltophilia from the seven blood culture specimens received from the Paediatric Emergency Department (PED) of BP Koirala Institute of Health Sciences (BPKIHS) over the duration of two weeks. The suspicion of a possible outbreak was raised and the hospital infection control team investigated the source and found the hand of one healthcare provider harbouring a similar organism. All six steps of hand hygiene were subsequently strictly enforced after which the same bacteria were no longer isolated. Infection control measures should be rigorously adopted for the control of such nosocomial bacteria.