Epidemiology of neonatal sepsis in two neonatal intensive care units in Krakow, Poland in 2016-2017 years.

BACKGROUND: Sepsis in low-birth-weight neonates remains one of the most significant causes of neonatal morbidity and mortality. Approximately 3 million newborns suffer from sepsis globally every year. The aim of this study was to compare demographic and clinical features, as well as etiology and antibiotic susceptibility, of the main pathogens related to neonatal sepsis in two neonatal intensive units during a two-year period. METHODS: We observed early-onset (EO-BSI) and late-onset bloodstream infections (LO-BSI) cases in two high-reference neonatal intensive care units (NICU) over a 24-month period (2016-2017). Samples of patients' blood were tested for the presence of the microorganisms. All bacterial isolates were tested for susceptibility to antibiotics. RESULTS: The majority of sepsis cases weighed above 1000 g and were born by cesarean section. About 10% of the EO-BSI group died. There were differences in the EO-BSI /LO-BSI ratio in the compared wards due to differences among the admitted children. The most common pathogens isolated from blood were coagulase-negative staphylococci (CoNS) were represented by two dominating species: S. epidermidis and S. haemolyticus, followed by Klebsiella spp. strains and E.coli, which were mostly found in EO-BSI cases. No single S. agalactiae (GBS) strain was isolated. The majority of CoNS strains were resistant to methicillin, half were resistant to aminoglycosides, and one-third were resistant to macrolides and lincosamides. Half of the Gram-negative rods were resistant to beta-lactams. CONCLUSIONS: The epidemiology of sepsis in two observed NICUs is comparable to data obtained from other studies with a predominance of methicillin-resistant CoNS in LO-BSI and beta-lactam resistant E. coli in EO-BSI. It is of importance that the campaign for controlling GBS carriage in pregnant women in Poland resulted in the disappearance of GBS as a cause of sepsis. Unfortunately, there are no such measures to control E.coli related sepsis.

Antibiotic consumption in laboratory confirmed vs. non-confirmed bloodstream infections among very low birth weight neonates in Poland.

BACKGROUND: Newborns are a population in which antibiotic consumption is extremely high. Targeted antibiotic therapy should help to reduce antibiotics consumption. The aim of this study was an assessment of antibiotic usage in bloodstream infections treatment in the Polish Neonatology Surveillance Network (PNSN) and determining the possibility of applying this kind of data in infection control, especially for the evaluation of standard methods of microbiological diagnostics. METHODS: Data were collected between 01.01.2009 and 31.12.2013 in five teaching NICUs from the PNSN. The duration of treatment in days (DOT) and the defined daily doses (DDD) were used for the assessment of antibiotics consumption. RESULTS: The median DOT for a single case of BSI amounted to 8.0 days; whereas the median consumption expressed in DDD was 0.130. In the case of laboratory confirmed BSI, median DOT was 8 days, and consumption-0.120 DDD. Median length of therapy was shorter for unconfirmed cases: 7 days, while the consumption of antibiotics was higher-0.140 DDD (p < 0.0001). High consumption of glycopeptides expressed in DOTs was observed in studied population, taking into account etiology of infection. CONCLUSIONS: Even application of classical methods of microbiological diagnostics significantly reduces the consumption of antibiotics expressed by DDD. However, the high consumption of glycopeptides indicates the necessity of applying rapid diagnostic assays. Nevertheless, the assessment of antibiotic consumption in neonatal units represents a methodological challenge and requires the use of different measurement tools.

Infections and risk-adjusted length of stay and hospital mortality in Polish Neonatology Intensive Care Units.

BACKGROUND: The objectives of this study were to analyze the impact of infections on prolonging hospital stay with consideration of underlying risk factors and determining the mortality rates and its association with infections. METHODS: An electronic database developed from a continuous prospective targeted infection surveillance program was used in the study. Data were collected from 2009 to 2012 in five Polish tertiary academic neonatal intensive care units (NICUs). The length of stay (LOS) of 2,003 very low birth weight (VLBW) neonates was calculated as the sum of the number of days since birth until death or until reaching a weight of 1,800g. RESULTS: The median LOS for neonates with infections was twice as high as for neonates without infection. LOS was significantly affected by the overall general condition of the neonate, as expressed by both gestational age and birth weight as well as by the Clinical Risk Index for Babies (CRIB) score; another independent factor was presence of at least one infection. Risk of in-hospital mortality was significantly increased by male sex and vaginal birth and was lower among breastfed neonates. Deaths were significantly more frequent in neonates without infection. CONCLUSIONS: The general condition of VLBW infants statistically increase both their risk of mortality and LOS; this is in contrast to the presence of infection, which significantly prolonged LOS only.

Pentoxyfylline in and prevention and treatment of chronic lung disease.

The anti-inflammatory effects of pentoxfylline are associated with a number of clinical benefits. These include reduction in mortality in patients who have undergone bone marrow transplants or suffer peritonitis. In infants with sepsis, a reduction in mortality has also been associated with pentoxyfylline administration. The anti-inflammatory effects of pentoxyfylline, as well as its bronchodilator, diuretic and respiratory muscle stimulant effects suggest it may have a useful role in BPD. Interim analysis of a prophylactic trial suggests pentoxyfylline may reduce treatment requirements after the neonatal period and that, in established BPD, pentoxyfylline and dexamethasone may be of similar efficacy.

Effect of the immunomodulating agent, pentoxifylline, in the treatment of sepsis in prematurely delivered infants: a placebo-controlled, double-blind trial.

OBJECTIVE: To evaluate the influence of the methylxanthine derivative, pentoxifylline, on plasma levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, and IL-6 in prematurely delivered infants with generalized bacterial infections and to assess the effect of this immunomodulating drug on the clinical outcome in newborns with sepsis. DESIGN: A prospective, randomized, double-blind trial. SETTING: The neonatal intensive therapy units in university teaching hospitals. PATIENTS: One hundred patients with sepsis admitted during a 1.5-yr period. INTERVENTIONS: Patients were randomly assigned to receive pentoxifylline (pentoxifylline group) in a dose of 5 mg/kg/hr for 6 hrs on 6 successive days or an identically presented placebo (placebo group). MEASUREMENTS AND MAIN RESULTS: Only infants with sepsis confirmed by positive blood culture were recruited into the study. There were no significant differences at randomization between the pentoxifylline and placebo groups with regard to the birth weight, gestational age, gender, Apgar score, hypotension, neutropenia, thrombocytopenia, metabolic acidosis, plasma levels of cytokines, and occurrence of shock. Plasma levels of TNF, IL-1, and IL-6 were evaluated before and after the drug or placebo administration on the first, third, and sixth days of therapy. Cytokines were determined by immunoenzymetric test EASIA (TNF) and Endogen Interleukin-Elisa (IL-1, IL-6). The frequency of gram-negative sepsis was similar in both groups (37.5% and 36.8%). Pentoxifylline significantly diminished plasma TNF levels (p = .009) but had no effect on plasma IL-1 levels. Mean plasma IL-6 levels, which were measured in the pentoxifylline group on the 6th day of the study, were significantly lower compared with respective data obtained in the placebo group. Only 1 of 40 infants with sepsis in the pentoxifylline group died, whereas 6 of 38 infants in the placebo group did not survive (p = .046). An increased incidence of disordered peripheral circulation and metabolic acidosis (p = .048), anuria or oliguria (p = .03), disseminated intravascular coagulation (p = .043), and the occurrence of clinical symptoms of necrotizing enterocolitis (p = .025) was observed in the course of sepsis in infants in the placebo group. CONCLUSION: Pentoxifylline significantly affects the synthesis of TNF and IL-6 as well as reduces the mortality rate in premature infants with sepsis. The dosage and schedule of drug administration in this study attenuated the severity of the clinical course of sepsis in this group of patients.

Stability of local anesthetics in heparinized blood, plasma and sulfuric acid.

BACKGROUND: This study was undertaken to investigate the stability of local anesthetics in different media. METHODS: 60 patients with axillary plexus block, using prilocaine, mepivacaine or lidocaine 1%, or with lumbar epidural catheter-anesthesia, using bupivacaine 0.5%, were investigated. Stability was evaluated in heparinized whole blood for 24 h at +4 degrees C, in plasma for 8 week at -25 degrees C and in sulfuric acid for 6 months at -25 degrees C. RESULTS: Mean recovery rates were between 96.4% and 102.6% in all local anesthetics and media. No statistical significance became obvious for differences between recovery rates and initial values. CONCLUSION: Stability of prilocaine, mepivacaine, lidocaine and bupivacaine can be expected when samples are stored as heparinized whole blood for 24 h at +4 degrees C, plasma for 8 weeks at -25 degrees C, and after preparation into sulfuric acid for 6 months at -25 degrees C.

[Evaluation of treatment results for anemia of prematurity treated with various doses of human recombinant erythropoietin]. / Ocena wyników leczenia niedokrwistosci wczesniaków z zastosowaniem róznych dawek rekombinowanej ludzkiej erytropoetyny.

We evaluated the results of administering recombinant human erythropoietin (rHuEPO) and iron in 19 randomly selected premature infants, who had no infections, did receive oxygen support or aminophylline. rHuEPO was administered intravenously from days to 37 (biweekly) in a dose of 100 U/kg (group I) or 400 U/kg (group II). Also, infants in both groups were supplemented with 10 mg/kg/week of iron intravenously. Seven of 19 infants did not receive either rHuEPO or iron (group III). Infants of all groups had similar birth weights, gestational age and hematocrit, RBC count as well as total and fetal hemoglobin concentrations in blood obtained within the first hour of life. However, infants treated with 400 U/kg of rHuEPO required a significantly (p < 0.04) lower volume of packed erythrocytes in comparison to untreated infants, both between days 7 and 37 of life (18.6 ml vs 46.8 ml; p < 0.04) and between day 7 of life and the day of discharge (35.8 ml vs 94.2 ml; p < 0.04). No difference in neutrophil count, fetal hemoglobin concentration and no toxicity were observed in infants treated with rHuEPO in comparison to untreated prematures.

Pentoxifylline treatment of sepsis of premature infants: preliminary clinical observations.

Pentoxifylline (Trental, 5 mg/kg/h for 6 h) was administered to 17 premature infants with sepsis, on 3 successive days. A statistically significant decrease in mortality rate (P < 0.04) was observed in comparison to a retrospectively analysed group of 13 septic infants, who were treated in a comparative way but without the use of a pentoxifylline infusion. The suggestion that pentoxifylline may be an effective drug in the treatment of Gram-negative sepsis in premature infants should be tested in a double-blind, randomized study.

[The modification of ciliary motility by salbutamol: a comparative study on subjects: oral vs inhalation administration]. / Die Beeinflussung der Zilienmotilität durch Salbutamol: Eine vergleichende Untersuchung an Probanden: orale vs inhalative Applikation.

15 healthy adults received for 3 days twice daily 8 mg salbutamol orally. Ciliary beat frequency was measured before, on the day of drug administration, 1 and 3 days after the beginning of the treatment, by means of nasal brush biopsy. In the same subjects ciliary beat frequency was determined before and 10 minutes following to the inhalation of 2.5 mg salbutamol with 2 ml of 0.9% saline. Findings suggest that by orally administered salbutamol a positive effect on ciliary beat frequency is yielded. The increase of frequency is more distinct in patients suffering from bronchial hyperreactivity. There was no statistically significant effect after inhalative administration of the drug.

A model of experimental atherosclerosis in pigs. Part III. Electroretinography and the diameter of retinal vessels.

Domestic pigs were fed with high lipid diet (HLD) for 24 weeks. Electroretinographic studies and the measurement of the diameter of retinal arterioles were investigated before and after the administration of HLD. The most significant change produced by HLD was negativization of electroretinogram. At the same time the diameter of retinal arterioles was significantly decreased.