Enterobacter, the most common pathogen of neonatal septicemia in Rasht, Iran

Bacterial sepsis continues to be a major cause of morbidity and mortality in newborns. Bacterial pathogens of neonatal septicemia may vary from one country to another and within a country from one hospital or region to another. Both gram-negative and gram-positive bacteria are responsible in neonatal sepsis. This study was undertaken to determine the prevalent bacterial agents of neonatal sepsis and their antimicrobial susceptibility in a teaching hospital, Rasht, from February 2008 to February 2010. This prospective study includes 611 newborns admitted with the probable diagnosis of septicemia. We studied the cases with positive blood culture, the pathogens and antibiotic resistance to different antibiotics. Among 611 hospitalized newborns, 64 [10.6%] cases had positive blood culture. The commonest pathogens were Entrobacter [78.1%] and Klebsiella [6.2%]. According to the results, low birth weight and prematurity were associated with higher risk of sepsis significantly. The most common pathogen was Enterobacter. Treatment with effective antibiotics [e.g. gentamicin, cost effective and easily available] and hygienic care in the neonatal unit are recommended to eliminate the infectious factors especially Entrobacter

Assessment of febrile neonates according to low risk criteria for serious bacterial infection

It is propounded that febrile neonates with low risk criteria [LRC] can be carefully observed without parenteral antimicrobial therapy; but yet, reliability of LRC to exclude serious bacterial infection [SBI] is uncertain. The records of all febrile term neonates, seen in the emergency room and admitted in neonatal ward of 17 Shahrivar children's hospital of Rasht, Iran from January 2004 to January 2009 were reviewed. All of them underwent full sepsis workup. The prevalence of SBI in total population and LRC positive and negative neonates were calculated A total of 202 records of previously healthy febrile neonates were evaluated. SBI was shown in 38 [18.8%]. The most common type of SBI was urinary tract infection [UTI]. Sixty-two [31%] neonates had LRC, and only one [1.6%] had SBI [UTI with E. coli]. SBI was significantly more common in neonates without LRC [26.6% versus 1.6%, P<0.001]. The negative predictive value [NPV] of LRC to exclude SBI was 98.4% [95% confidence interval: 96.7% to 100%]. These findings suggest that LRC may be relied upon to exclude SBI in febrile neonates. We propose that all febrile neonates be admitted, ill or LRC negative neonates should undergo a full sepsis work up and be administered systemic antibiotics immediately. LRC positive neonates should be under close observation