Bacteriological profile and antibiotic susceptibility pattern of neonatal septicaemia in patients of neonatal intensive care unit, by BACTEC in a tertiary care hospital, Vadodara

Background: Neonatal septicemia is the major cause of mortality and morbidity in developing countries like India. It is an ongoing major global public health challenge with major contribution from neonatal sepsis. Objective were to study the prevalent organisms and their antibiotic susceptibility pattern of neonatal septicemia in NICU by BACTEC and neonatal factors and maternal factors associated with neonatal sepsis. Methods: A cross-sectional study was carried out from December 2020 to September 2021. Blood samples were taken from the suspected cases admitted to NICU for culture and antimicrobial susceptibility test. A total of 103 blood culture-proven neonatal sepsis patients were enrolled in this study. Results: Out of 103 neonates having blood culture-proven sepsis, septicemia was most common in males (53.4%), preterm (73.4%), and low birth weight (61.2%), with vaginal mode of delivery (51.5%). Neonatal septicemia was predominantly caused by gram-positive methicillin resistant coagulase negative Staphylococci (CONS) (28.15%). Among the all-gram-positive organism, vancomycin was the most sensitive drug followed by linezolid. For the gram-negative organisms, piperacillin/ tazobactam was the most sensitive drug followed by meropenem. Turnaround time of an automated BACTEC system for reporting culture positivity along with antimicrobial susceptibility was most commonly within 3 days (55.34%). Conclusions: A high level of suspicion is needed on clinical grounds for the diagnosis of neonatal septicemia. Early onset septicemia is more common which can be curtailed by clean vaginal deliveries. Prematurity and low birth remain the major presentation for admission to NICU followed by respiratory distress syndrome. Maternal risk factors are associated with an increase in the incidence of neonatal septicemia. Septic screen markers are important in the presumptive diagnosis of sepsis in neonates along with the correlation of clinical presentation. The yield of reporting culture-proven sepsis neonates is more rapid with an automated BACTEC system as compared to conventional blood culture methods.

Microbial Profile of Neonatal Septicemia and its Antibiogram Prevalent in a Tertiary Care Hospital of Western Odisha

Introduction : A disseminated disease with positive Blood Culture during the first month of life and encompasses various systemic infections of the newborn such as septicemia, meningitis, pneumonia, arthritis, osteomyelitis and Urinary Tract Infection is defined as Neonatal Sepsis. It is one of the leading causes of morbidity and mortality amongst neonates of developing countries. Aim : To determine the microbial profile of Blood Culture-positive Septicemia cases and study their antimicrobial susceptibility pattern. Materials and Methods : Blood Culture and C-reactive Protein (CRP) estimation were done for all 220 clinically suspected neonates. All the pure Bacterial and Candida isolates were identified using standard biochemical tests. Antimicrobial susceptibility testing was done for all bacterial isolates using the Kirby-Bauer disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results : Out of 220 cases, 68.2% were culture positive. Early-onset Neonatal Septicemia (EONS) cases were 74% and Late-onset Neonatal Septicemia (LONS) 26%. The male to female ratio was 1.9:1. Bacterial cases were 66% and 34% were due to Candida. Gram-negative isolates predominated, with Klebsiella pneumonia being the most common one. In the case of Gram-positive isolates, Staphylococcus aureus was most common. The best overall sensitivity of Gram-negative isolates was to Amikacin (100%), Colistin (100%), and Imipenem (96%). Grampositive isolates reported 100% sensitivity to Vancomycin, Teicoplanin and 97.4% to Linezolid. Conclusion : Gram-negative isolates were the leading cause of Sepsis in our study. Strict antimicrobial stewardship should be implemented to prevent the emergence of multi-drug resistant strains.

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.

Incidence of Septicemia in Children Attending University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Introduction: Septicemia is an invasive infection where chemical substances released into the bloodstream causes morbidity and mortality in neonates. The developing countries carries major burden of the problem and Nigeria is not exceptional.Objective: The study was carried out to determine age/sex-related prevalence, causative agents and antimicrobial sensitivity pattern of neonatal septicemia in children at University of Port Harcourt Teaching Hospital, Nigeria.Methods: This retrospective study was carried out in the pediatric department for a period of twelve months. Blood culture test using thioglycollate broth and tryptone soya broth for isolation of microorganisms was adopted. Antimicrobial sensitivity pattern was done with disc diffusion method. The data was analyzed using descriptive statistics and Chi square for significance.Results:A total of 598 children were examined, of which 394(67.9%) children showed negative blood cultures, while 204(34.1%) children had positive bacterial cultures and 2 children (0.3%) were positive for Candida albicans. Overall, Klebsiellaspp. was the most common pathogen, accounting for (37.8%) of the total isolates, which is followed by Staphylococcus aureus(28.4%), Escherichia coli(11.8%), unclassified Coliforms (8.3%), Pseudomonasspp. (4.9%), Proteusspp. (3.4%), Enterococcusspp. (2.9%) and coagulase-negative Staphylococcus(CONS) (2.5%) respectively. Early onset neonatal sepsis (EONNS) had Klebsiella spp as the most prevalent causative agent while Staphylococcus aureus was prevalent among the late onset neonatal sepsis (LONNS). Klebsiella spp. was susceptible to spafloxacin(87.0%) followed by ofloxacin (82.0%), amoxycillin-clavulanic acid (79.0%) and ceftazidime (65.0%) among the Gram negative organisms. In the category of Gram positive organisms, Staphylococcus aureus was highly sensitive to ofloxacin (81.0%) followed by spafloxacin (79.0%) and amoxicillin-clavulanic acid (71.0%). Conclusion: The study showed Klebsiellaspp. and Staphylococcus aureus were the prevalent bacterial organisms of septicemia in children in University of Port Harcourt Teaching Hospital. Early diagnosis with use of appropriate antimicrobial treatment will effect intervention for management of the children

Incidence of meningitis in term neonates with sepsis and antibiotic sensitivity pattern: an observational study

Background: To find out the incidence of meningitis in neonatal sepsis and antibiotic sensitivity pattern in term neonates.Methods: This prospective observational cohort study was done in a tertiary care hospital located in rural South India for a period of 2 years. Blood culture and lumbar puncture were performed for all term babies with clinically suspected sepsis. Growth, if detected was followed by antibiotic sensitivity testing.Results: Of a total of 50 neonates investigated with blood culture, 32(64%) were found to be culture positive for neonatal septicemia, 16 were diagnosed to have meningitis. Meningitis was present in 4(25%) early onset sepsis cases and in 12(75%) late onset sepsis cases (p-value: 0.008). Blood culture showed growth in all of the 16 cases of meningitis, but Cerebro Spinal Fluid (CSF) culture was positive in 5 cases. The most common presenting features are lethargy, seizures, decreased acceptance of feeds, instability of temperature regulation, vomiting, respiratory distress, and apnea. The most common organism in blood culture was Coagulase Negative Staphylococcus (CONS) (20%) followed by Klebsiella spp. (16%). CONS was most sensitive to Linezolid (100%), Vancomycin (90%). Of the 8 cases of Klebsiella, 62.5% cases were sensitive to Colistin and Tigecycline, 50% to Cotrimoxazole. CSF culture was positive in 5(31.25%) cases. CONS and Enterococci spp. were the most common organisms isolated in CSF.Conclusions: Clinical manifestations of meningitis overlap with those of sepsis and are nonspecific. Significant number of neonates with sepsis have meningitis. Hence, it is necessary to rule out meningitis in neonates presented with clinical features of sepsis. CONS was the most common agent isolated in both blood and CSF culture. Routine bacterial surveillance and study of their resistance patterns must be an essential component of neonatal care which helps in implementation of a rational empirical treatment strategy.

Clinical Outcome of Neonatal Septicemia in Bangladesh

Objective: In this study our main goal is to evaluate clinicaloutcome of neonatal septicemia in Bangladesh.Methods: This cross-sectional study is conducted at Neonatalunit of the department of paediatrics, Sir Salimullah MedicalCollege and Mitford Hospital, Dhaka, From July 2005 to June2006. Among 90 clinically diagnosed septicemic neonates, 30were blood culture positive.Results: During the study, where low birth weight (60%),prematurity (53%), prolonged rupture of membrane wasdocumented in 17% of cases. 70% delivery occurred by normalvaginal route, among them 50% occurred at home and 20%occurred at hospital. 30% were delivered by LUCS. 13% caseshad H/O fever in last trimester. Lethargic and reluctant to feed,83% had respiratory distress. Jaundice was present in 60%cases, fever was present in 40% cases. Other presentationswere apnea, convulsion, abdominal distension, sclerema,vomiting, hypothermia and diarrhoea.Conclusion: From our result, we can conclude that, thepattern of organisms are changing and high incidence ofmultidrug resistance remains a major challenge to manageneonatal septicemia.

Neonatal septicemia: bacteriological profile in a tertiary level hospital in South India

Background: Early onset bacterial sepsis remains a major cause of neonatal morbidity and death. The choice of antibiotic for an infant with sepsis depends on the predominant bacterial pathogens and the antibiotic susceptibility profiles for the microorganisms causing disease in a particular geographic region. The purpose of this study was to analyze the bacteriological profile and antibiotic sensitivity pattern of neonatal septicemia in our neonatal unit.Methods: A descriptive cross sectional study carried was out at the NICU of a tertiary level hospital in South India for a period of one year.Results: Clinically suspected septicemia comprised 18.14% of total NICU admissions. Organism was isolated by blood culture in 14.9% of cases. The most common organisms causing septicemia were Coagulase negative Staphylococci, Klebsiella and Staphylococcus aureus. Gram positive isolates were most sensitive to Vancomycin (100%) while the gram negative isolates were most sensitive to Amikacin. Resistance to Crystalline Penicillin, Ampicillin  and 3rd generation cephalosporins was high.Conclusions: The most common organism isolated in septicemia was Coagulase negative staphylococcus in our NICU. Gram positive isolates were most sensitive to Vancomycin (100%) while the gram negative isolates were most sensitive to Amikacin. High resistance to commonly used antibiotics is worrisome. There should be a constant surveillance of the common microbes and their sensitivity pattern in each NICU and the antibiotic protocols should be periodically reviewed. Rational use of antibiotics and preventive measures like hand washing is the need of the hour.

Early diagnosis and evaluation of neonatal septicemia by hematological scoring system

Background: Neonatal septicemia is a major health problem. Morbidity and mortality in the neonatal period are mostly due to neonatal septicemia. Objective: The present study was undertaken to highlight the importance of hematological scoring system (HSS) in the early diagnosis and evaluation of neonatal septicemia and to correlate these hematological parameters with blood culture and C-reactive protein. Materials and Methods: This study was prospective and was done over the period of 1 year including 100 clinically suspected neonatal septicemia cases admitted in neonatal intensive care unit. Hematological parameters were measured in all cases. Culture positivity was taken as the criterion for definitive diagnosis. Specificity, sensitivity, positive predictive value, negative predictive value, and P value were calculated for each hematological parameter. Results: Of 100 clinically suspected neonates with sepsis studied, 19% were culture positive, 63.2% were male, 84.2% were term neonates, and 84.2% were low birth weight neonates (<2.5 kg). Early onset septicemia was more common (73.6%). In neonates who were delivered by spontaneous vaginal delivery (73.7%), septicemia was more common and also in neonates who were delivered in the hospital (84.2%). Klebsiella pneumoniae was the most common organism isolated (36.8%). By comparison of Rodwell’s HSS with blood culture results, it was found that the presence of likelihood of sepsis with score ≥3 was 59.25 % and with score ≥5 was 100%. With score ≤2, the likelihood of sepsis was absent (95.9%). Conclusion: HSS is useful for distinguishing the infected infants from non-infected infants. It is also useful to provide an effective guideline for making decisions regarding the proper use of antibiotics for early treatment.

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.

The rising trend of coagulase‑negative staphylococci in neonatal septicemia.

Neonatal septicemia is one of the leading causes of neonatal mortality and morbidity worldwide. Hence, the present study was undertaken to isolate the bacteria causing neonatal sepsis and determine their antibiotic susceptibility pattern. Fifty neonates suspected to have septicemia were screened for 2 months (July and August 2014). Out of 50 specimen, 15 (30%) were blood culture positive. Coagulase‑negative staphylococci was the most common isolate (10, 66.6%), with 60% (6 isolates) methicillin resistance. In view of the increasing antibiotic resistance, periodic surveillance should be conducted to control the emergence and spread of antimicrobial resistance.

Sphingomonas paucimobilis septicemia in a neonate: A rare case report.

Sphingomonas paucimobilis, a yellow‑pigmented, aerobic, glucose nonfermenting, Gram‑negative bacilli is a rare cause of human infection. It was first discovered as an infective agent in humans in 1977 and named Pseudomonas paucimobilis. It was renamed as S. paucimobilis in 1990 in accordance with phylogenetic data. S. paucimobilis is an aerobic bacterium found in soil and water; it is a rare cause of healthcare associated infections. S. paucimobilis can cause infections in healthy as well as immunocompromised individuals. At first, its colony looks like Gram‑positive bacilli colony, so by mistake it is discarded as contaminants. S. paucimobilis is an emerging pathogen and it should not be discarded as contaminants. Here, we report a case of S. paucimobilis bacteremia in a neonate who presented with respiratory distress.

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.

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 .

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.

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.

Neonatal Septicemia due to Acinetobacter species and their Antimicrobial Susceptibility Pattern.

Background and Objectives: Sepsis remains a clinical challenge in the Indian intensive care nurseries. Neonatal sepsis due to Acinetobacter species has been reported in recent years. Because of their multidrug resistance pattern, Acinetobacters pose a challenge regarding management of patients. The present study was therefore undertaken to find out the prevalence of Acinetobacter species in cases of neonatal septicemia and also to find out the antimicrobial susceptibility pattern of all Acinetobacter isolates. Methods: Eighty Acinetobacter isolates from blood culture samples from neonates with signs and symptoms of septicemia were speciated by standard biochemical tests and their antimicrobial susceptibility testing was done by Kirby Bauer Disk Diffusion (KBDD) method according to CLSI guidelines. Results: Incidence of neonatal septicemia due to Acinetobacter species was 9.18% out of total blood culture positive samples and predominant species was Acinetobacter baumanii (67.5%), followed by Acinetobacter junii (20%). Acinetobacter species showed maximum susceptibility to netilmicin (86.25%), followed by imipenem (70%). Acinetobacter junii showed greater susceptibility than Acinetobacter baumanii. Conclusion: This study indicates that neonatal sepsis due to Acinetobacter species is on the rise. Acinetobacter baumanii is multiresistant type and has direct bearing on mortality, so it highlights the importance of formulating a proper antibiotic policy in every hospital in cases of neonatal sepsis. The differences in resistant patterns among isolates emphasizes the need for differentiating A. baumanii from other Acinetobacter species by special biochemical tests.

Streptomyces septicaemia in a neonate.

Streptomyces species has been commonly reported as a cause of mycetoma. Invasive streptomyces infections are rare. We report a case of late onset neonatal septicemia caused by Streptomyces annulatus in a home delivered baby, which was identified based on morphology and biochemical characteristics. Invasive streptomyces infections may be more common than these isolated case reports.

Neonatal septicemia: Bacterial isolates & their antibiotics susceptibility patterns.

Background: Septicemia remains a significant cause of morbidity and mortality in the newborn, more so in developing countries due to delivery and postnatal follow up in an unclean environment having more chance of contamination with infective organisms. Moreover these infants are deficient in their inherent protective mechanisms, humoral and cellular immunity. The changing pattern and frequent emergence of resistant bacteria make the problem more difficult. Objectives: (1) To know the etiology of septicemia in neonates. (2) To detect the antibiotic susceptibility pattern of the isolates. Methods and Material: Blood samples were collected aseptically from 303 newborns admitted in NICU, Sir T Hospital, Bhavnagar during Jan-2006 to August-2008 with sepsis. The specimens were inoculated into brain heart infusion broth & subcultures were performed. The isolates were identified by standard biochemical tests. Antibiotic sensitivity pattern of isolates was studied by Modified Kirby Bauer Disc diffusion technique. Results: A total 140 (46.20%) organisms were isolated. These included Klebsiella (66, 47.14%), Staphylococcus aureus (35, 25%), Coagulase negative staphylococci (CONS) (5, 3.57%), E.coli (15, 10.71%), Proteus (5, 3.57%), Acinetobactor (3, 2.14%), Pseudomonas (6, 4.28%) and Candida (5, 3.57%). Majority of organisms isolated were resistant to commonly used antibiotics. Maximum sensitivity was seen by Cefoperazone/sulbactum (97%) & Piperacillin/tazobactum (98%) for Gram negative organisms & Vancomycin(100%) for Gram positive organisms. Conclusions: Multi-drug resistance organisms were isolated from septicemia in neonates. Therefore great caution is required in selection of antibiotic therapy.

Antibiotic sensitivity pattern of causative organisms of neonatal septicemia in an urban hospital of Bangladesh.

Background: The information of the sensitivity pattern of the causative organisms is very important for effective control of septicemia in neonates. OBJECTIVE: To determine the proportion and profile of pathogenic bacteria in the blood cultures of the neonates with clinically suspected septicemia and their susceptibility pattern to antimicrobial agents for developing a unified antibiotic treatment protocol. Materials and Methods: A cross-sectional retrospective study was conducted over a period of 3 year and 4 months (39 months). The study included 1000 patients admitted in the selected hospital in Bangladesh. Blood samples for culture were taken aseptically before starting antibiotic therapy. Microorganisms were isolated and identified by standard microbiological processes which include colony morphology, Gram stain, and biochemical profiles. Antimicrobial sensitivity patterns were performed by Kirby-Bauer's disc diffusion method against imipenem, ciprofloxacin, ceftazidime, chloramphenicol, netilmicin, gentamicin, ceftriaxone, aztreonam, cefotaxime, cephalexin, and ampicillin. Results: Among the patients, 633 (63.3%) were males and 367 (36.7%) were females. Blood cultures were found positive in 194 (19.4%) neonates. The organisms isolated were Pseudomonas spp. (31.4%), Klebsiella pneumoniae (23.2%), Staphylococcus aureus (12.4%), Escherichia coli (7.2%), Acinatobactor (5.7%), Gram-negative Bacilli (4.1%), Flavobacterium spp. (3.6%), Serratia spp. (5.7%), Citrobacter fruendi (3.1%), Streptococcus species (2.6%), and Enterobacter spp. (1.0%). A majority of the bacterial isolates in neonatal sepsis were found sensitive to imipenem (91.8%) and ciprofloxacin (57.2%) and resistant to commonly used antibiotics, eg. ampicillin (96.4%) and cephalexin (89.2%). Conclusion : The problem can be mitigated by careful selection and prudent use of available antibiotics.