Risk factors of multidrug-resistant organisms neonatal sepsis in Surabaya tertiary referral hospital: a single-center study.

BACKGROUND: Bacterial organisms causing neonatal sepsis have developed increased resistance to commonly used antibiotics. Antimicrobial resistance is a major global health problem. The spread of Multidrug-Resistant Organisms (MDROs) is associated with higher morbidity and mortality rates. This study aimed to determine the risk factors for developing MDRO neonatal sepsis in the Neonatal Intensive Care Unit (NICU), dr. Ramelan Navy Central Hospital, in 2020-2022. METHODS: A cross-sectional study was performed on 113 eligible neonates. Patients whose blood cultures were positive for bacterial growth and diagnosed with sepsis were selected as the study sample. Univariate and multivariate analysis with multiple logistic regression were performed to find the associated risk factors for developing multidrug-resistant organism neonatal sepsis. A p-value of < 0.05 was considered significant. RESULTS: Multidrug-resistant organisms were the predominant aetiology of neonatal sepsis (91/113, 80.5%). The significant risk factors for developing MDRO neonatal sepsis were lower birth weight (OR: 1.607, 95% CI: 1.003 - 2.576, p-value: 0.049), history of premature rupture of the membrane (ProM) ≥ 18 (OR: 3.333, 95% CI: 2.047 - 5.428, p-value < 0.001), meconium-stained amniotic fluid (OR: 2.37, 95% CI: 1.512 - 3.717, p-value < 0.001), longer hospital stays (OR: 5.067, 95% CI: 2.912 - 8.815, p-value < 0.001), lower Apgar scores (OR: 2.25, 95% CI: 1.442 - 3.512, p-value < 0.001), and the use of respiratory support devices, such as invasive ventilation (OR: 2.687, 95% CI: 1.514 - 4.771, p-value < 0.001), and non-invasive ventilation (OR: 2, 95% CI: 1.097 - 3.645, p-value: 0.024). CONCLUSIONS: Our study determined various risk factors for multidrug-resistance organism neonatal sepsis and underscored the need to improve infection control practices to reduce the existing burden of drug-resistant sepsis. Low-birth-weight, a maternal history of premature rupture of the membrane lasting more than 18 hours, meconium-stained amniotic fluid, longer hospital stays, a low Apgar score, and the use of ventilators were the risk factors for developing drug-resistant neonatal sepsis.

Microbial Pattern of Neonatal Sepsis in the Neonatal Intensive Care Unit of dr. Ramelan Navy Central Hospital.

Background: The morbidity and mortality rates from neonatal sepsis remain high. However, there is limited information about the microbial pattern of neonatal sepsis in Indonesia. Microbial patterns can give an overview of the hygiene of an environment and act as a determinant for choosing definitive antibiotic treatment in neonatal sepsis patients. The organisms that cause neonatal sepsis differ from unit to unit and from time to time within the same unit. Objectives: This study is aimed at discovering the microbial pattern of neonatal sepsis in the Neonatal Intensive Care Unit (NICU), dr. Ramelan Navy Central Hospital, in 2021-2022. Methods: This is a retrospective, cross-sectional study that takes secondary data from the NICU and clinical microbiology department of dr. Ramelan Navy Central Hospital. Data that met the inclusion and exclusion criteria available between January 1, 2021, and December 31, 2022, were collected. Patients whose blood cultures were positive for bacterial growth and diagnosed with sepsis were selected as the study sample. Results: Out of 174 samples, 93 (53.4%) were found positive for bacterial infection and diagnosed as neonatal sepsis. Gram-negative isolates (96.8%) were predominant. Sixty-point-two percent of Klebsiella pneumoniae XDR, 19.4% of Klebsiella pneumoniae ESBL, and 8.6% of Burkholderia cepacia XDR were identified. The gram-positive isolates found in this study were only 3 samples (3.2%). Two-point-one percent of MRSA and 1.1% of Staphylococcus haemolyticus MDR were identified. Conclusion: The most common microorganisms causing neonatal sepsis in our NICU were gram-negative bacteria, particularly Klebsiella pneumoniae XDR. Following the recommended infection control procedures, practicing good hand hygiene, and having access to basic supplies and equipment are important to prevent and reduce the incidence of sepsis.

Successful resection of delayed management rupture midline encephalocele: A case report.

INTRODUCTION AND IMPORTANCE: Encephalocele is an NTD that affects one in every 10,000 live births. A ruptured encephalocele is advised to be operated on as soon as possible, preferably within 48 h. Signs and symptoms of infection should be considered when performing corrective surgery. CASE PRESENTATION: We present the case of an 8-day-old baby who had a ruptured midline frontoparietal encephalocele as a result of delayed corrective surgery. The mass on the patient's head measured approximately 7 × 6 × 5 cm with a leakage of clear and yellowish fluids. The head CT scan revealed a multi-enhancement mass, pedunculated with an ill-defined border protruding from the anterior fontanelle. CLINICAL DISCUSSION: The patient underwent an emergency corrective surgery. Excision was performed completely. The defect was covered with a double-layer closure technique in a watertight manner. The patient's postoperative recovery was uneventful. CONCLUSION: An encephalocele can only be resolved through corrective surgery. In our case, the ruptured midline encephalocele was easily resolved with an emergency corrective surgery. Closure of the defect soon after birth is advised, especially if no layer of skin protects the encephalocele.

Escherichia coli extended spectrum beta-lactamase meningitis in 3 months infant with subdural abscess and communicating hydrocephalus: A case report.

INTRODUCTION AND IMPORTANCE: Escherichia coli ESBL as the etiology of meningitis is rarely found and frequently missed in infants. Escherichia coli found in the environment is an indication of fecal contamination. CASE PRESENTATION: A 3-month-old infant presented with focal seizures without fever, accompanied by positive meningeal sign and bulging large fontanelle. Laboratory examination found an increase in inflammation marker. A head CT scan showed hydrocephalus and subdural cysts. CLINICAL DISCUSSION: The patient underwent a burr hole drainage. Subdural abscesses with yellowish pus and hydrocephalus were found during the operation. Escherichia coli ESBL growth from the pus culture. This patient diagnosed as meningitis, subdural abscess and communicating hydrocephalus. Evacuation of the subdural abscess by burr hole drainage, meropenem treatment, and shunt was placed in this case. CONCLUSION: We suggest the source of infection in this patient related to poor hygiene practices prior to formula preparation. Early diagnosis and treatment are essential to prevent morbidity and mortality.