A preterm infant with intractable metabolic acidosis: a devastating presentation of Chryseobacterium meningosepticum meningitis (original) (raw)
Global Journal of Pediatrics & Neonatal Care, 2019
Background: Sepsis is still a leading cause of neonatal morbidity and mortality especially when caused by Gram-negative bacteria. The causative organisms and their susceptibility to antibiotics vary among units. Empiric antibiotic therapy is based on the likely pathogens and their susceptibility pattern in a NICU. This study aims to identify, in a cohort of neonates diagnosed with Gram-negative sepsis, the bacteriological profile and the antibiotic susceptibilities as well as to evaluate the appropriateness of the empirical antibiotic coverage. Material and methods: In this retrospective observational study, all Gram-negative pathogens isolated in the blood culture of neonates admitted to the neonatal unit in a tertiary referral hospital between January 2011and December 2015 were analyzed. Demographic data, causative organisms, antibiotic susceptibility, empiric therapy and outcomes were collected and analyzed. Results: Of the 2732 neonates admitted to NICU, 80 infants (2.9%) had a blood culture-proven sepsis with a Gram-negative pathogen. Klebsiella pneumonia was the commonest causative organism. Sensitivity to gentamicin and meropenem were 95% and 99% respectively. Mortality, necrotizing enterocolitis, periventricular leukomalacia, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity was more prevalent in affected infants. Conclusion: In our unit, neonatal sepsis caused by gram-negative organisms was highly sensitive to aminoglycosides. Almost all cases Gramnegative sepsis were adequately covered by carbapenem.
Iris Publishers LLC, 2018
Bacillus cereus is a Gram-positive spore-forming, motile and rod-shaped bacterium that produces tissue destructive toxins and it is commonly found in the environment. As a human pathogen, it is known for self-limited acute gastroenteritis after food poisoning. But it is also a rare cause of neonatal sepsis, highly aggressive and often fatal. Herein, we describe a case of Bacillus cereus bacteremia and meningoencephalitis in a 4-day-old female twin-preterm neonate. The neonate in only 12 hours after the initial clinical deterioration developed irreversible brain damage and fell to coma. The infant died on her sixth day of life due to cardiorespiratory deterioration and brain stem, central arrest. This case report aims to highlight the importance of clinical suspicion, early diagnosis and effective treatment.
Neonatal Group A Streptococcus Meningitis. Case Report and Literature Review
SN Comprehensive Clinical Medicine
Group A streptococci (GAS) have previously accounted for a large portion of invasive neonatal infections, but differences in the access to medical care and in the antibiotic used over the last half century has significantly reduced such cases. A literature review reveals 17 neonatal GAS meningitis reports with positive CSF cultures since 1967, characterized by high morbidity and mortality. We present a case of a 10-day old well-appearing neonate diagnosed with GAS meningitis, exhibiting an excellent response to antimicrobial therapy. Epidemiological investigation revealed her mother as the likely source of postnatal transmission of GAS with an emm1.0 subtype. GAS meningitis is a rare cause of neonatal meningitis associated with high morbidity and mortality warranting further research assessing potential risk factors, modes of transmission, and therapeutic protocols. Keywords Neonatal meningitis. Neonatal sepsis. Group a streptococci. Streptococcus pyogenes Abbreviations CDC Centers for disease control and prevention CSF Cerebrospinal fluid GAS Group a streptococcus SIADH Syndrome of inappropriate antidiuretic hormone secretion This article is part of the Topical Collection on Medicine
Risk Factors and Microbiological Outcome in Neonatal Sepsis
Journal of Biomedical and Allied Research, 2023
Infection is the predominant cause of neonatal deaths universally. Neonatal deaths (30-50%) every year is caused due to sepsis. Due to nosocomial infections and their associated morbidities, cost and mortality, betterment of neonatal outcomes is complicated as hospitals in developing countries are at major risk for the transmission of infection. The present study aimed to analyse sepsis risk factors and microbiological outcome in the NICU and post-natal ward. The study diagnosed the affected neonates as earliest possible so that suitable antibiotic treatment can be done without adding to the burden of antibiotic resistance. In this study, 94% of babies with neonatal sepsis were discharged and 6% of babies succumbed to the illness. Low birth weight between 1500-2500 grams was noted as an important contributing factor to sepsis in babies. PROM was found to be greater than 18 hours in (46%) of cases. Klebsiella pneumoniae was the common pathogen amongst gram negative bacteria in the present study and thus was the common cause of septicemia in neonates, and Coagulase negative Staphylococcus and Staphylococcus aureus were common bacteria among the gram-positive bacteria. A higher mortality rate in cases of late onset sepsis was observed and was explained probably due to prolonged NICU stay, multiple interventions such as mechanical ventilation, umbilical venous catheterization, and central lines.
Novel Approaches to the Prevention and Therapy of Neonatal Bacterial Sepsis
Clinics in Perinatology, 1997
Bacterial sepsis remains a serious problem in the newborn nursery, with the incidence varying from 1 to 10 cases per 1000 live births, with even higher rates in low-birth-weight neonates. 94 a In spite of all the advances in prevention and treatment, sepsis continues to be a significant cause of death in the neonatal period, with mortality rates as high as 30% to 50%. 60 • 85 The neonates' increased risk of developing sepsis or an adverse outcome following this infection can, in part, be explained by their compromised immune systems. After residing in a relatively sterile environment, neonates may be challenged with multiple, potentially infectious bacteria during and after birth. These pathogens most likely enter the infant through the conjunctiva, respiratory, or gastrointestinal systems, or the skin. If there is maternal bacteremia, however, the neonate's bloodstream may be seeded directly through the placenta. 113 Initially, the neonate's barriers to bacterial infections are compromised. Production of secretory IgA is absent in the first few days of life, leaving gastrointestinal and respiratory epithelium potentially vulnerable. 85 • 113 The skin in the newborn, especially in the preterm infant, is immature and has increased permeability. This is due, in part, to both impaired production of free fatty acid and the alkaline pH of the skin. 113 Additionally, breaks in the skin's integrity, or the implementation of instrumentation and surgical procedures, may foster access to potential pathogens. In fact, a recent study reported that preservativefree topical ointment (Aquaphor [Beirsdorf, Inc, Norwalk, CT]) decreased bacterial colonization and positive blood and cerebrospinal fluid (CSF) cultures in premature infants of less than 33 weeks' gestation during the first 2 weeks of life. 78 The umbilical cord, because of its proximity to the circulatory system,
2011
Objective: To analyse the Gram-negative bacteriological profile of nosocomial sepsis and antibiotic susceptibility patterns. Methods: Neonates clinically diagnosed with sepsis and whose blood cultures tested positive for Gram-negative microorganisms from 2002 to 2008, retrospectively. Results: 143 cases of neonatal sepsis caused by Gram-negative microorganisms were identified. Eighty-one percent (n=116) of these had nosocomial sepsis. In nosocomial sepsis, the most common isolated Gram-negative microorganism was Serratia marcescens (16.4%). Levofloxacin (97.4%), meropenem (97.1%), imipenem (95.6%), ciprofloxacin (95.4%) and amikacin (94.8) were the most sensitive antibiotics to Gram-negative micro-organisms. Sepsis-related mortality rate was 16% (n=23) in nosocomial sepsis caused by Gramnegative microorganisms. Conclusions: Carbapenem seems to be the best option for nosocomial sepsis caused by Gram-negative micro-organisms in our neonatal intensive care unit. Every unit must evaluate causative agents and antimicrobial susceptibilities in order to select the appropriate empirical therapy for nosocomial sepsis.