Neonatal Septicaemia in Finland 1981–85

ABSTRACT. A survey of blood culture-confirmed neonatal septicaemia was carried out in seven delivery hospitals in 1981–85, for a second successive five-year period. The total number of cases was 377, to compare with 410 in the previous five-year period. Group B streptococcus (GBS) was throughout the major pathogen (29%), followed by Staphylococcus aureus (15%) and Escherichia coli (14%), while Staphylococcus epidermidis (10%) has emerged as a significant new causative agent. Septicaemia with very early onset was predominant: 49% of the cases had onset within the first 24 hours; in the majority the symptoms were present from birth. GBS was responsible for 49% of the cases detected in the first 24 hours of life. The overall mortality was 20% as compared to 23% in the previous five-year period, whereas in the very early onset septicaemia mortality was now 18%, down from the preceding 30%. Despite the modest progress, GBS septicaemia with very early onset remains a significant problem, and effective preventive measures are needed.     

Neonatal Septicaemia—Incidence, Etiology and Outcome A 6-year Analysis

Grauel, E. L., Halle, E., Bollmann, R., Buchholz, P. and Buttenberg, S. (Department of Neonatology, Pediatric Clinic and Institute of Medical Microbiology, University-Hospital (Charité), Berlin, GDR). Neonatal septicaemia—incidence, etiology and outcome. A 6-year analysis. Acta Paediatr Scand Suppl 360: 113, 1989.
Between 1983 and 1988 we observed altogether 222 cases of neonatal septicemia and/or meningitis in our Department of Neonatology. The incidence was 8.46 per 1000 liveborn infants. The case fatality rate amounted to 45.9 Yo. The most frequently isolated causative agents were Escherichia coli (23,4 %) followed by group B Streptococci (16.7%), Staphylococcus aureus (9.9%), Klebsiella pneumoniae species (8.8%), Serratia marcescens (7.9 %), Pseudomonas aeruginosa and coagulase-negative Staphy-lococci each 5.9%. The report includes information about serotypes of Escherichia coli, group B Streptococci and plasmid patterns of Serratia marcescens. The latter was responsible for an outbreak of septicemia and meningitis with high mortality. The changing infection pattern reflects changes in the newborn population, especially in the patient structure of the neonatal intensive care unit, changes in the antibiotic policy and organizational problems.     

Severe skin loss after meningococcal septicaemia: complications in treatment

Meningococcal septicaemia can lead to purpura fulminans with subsequent full thickness skin loss and deep muscle damage. The case reports on two infants who recovered from such a severe episode are used to describe post-septicaemic procedures and complications encountered in nursing care, psychological support and rehabilitation, with the main focus on surgery. Skin grafting is complicated by contaminated and contracting wound areas. Extensive tissue necrosis required leg amputations. Cultured keratinocytes in one of the patients were found to be too vulnerable. It has still to be proven whether more radical early-stage fasciotomies can limit skin and muscle necrosis. Patients with meningococcal septicaemia are subject to a high number of complications that are optimally treated in a burns unit. These patients require up-to-date knowledge of constantly evolving treatment possibilities and a high-level collaboration of all medical fields involved.     

Adhesion molecules (E-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1)) in sera from patients with Staphylococcus aureus bacteraemia with or without endocarditis

The aim of this prospective study was to evaluate if patients with endocarditis display a more extensive endothelial activation than those with bacteraemia but without endocarditis. Sixty-five patients with blood culture-verified Staphylococcus aureus bacteraemia were included and serum samples collected on admission were analysed by enzyme immunoassays. Elevated serum concentrations of adhesion molecules were found in most of the patients with S. aureus bacteraemia. Patients with endocarditis (n = 15) showed significantly higher serum E-selectin (median 156 ng/ml) and VCAM-1 (median 1745 ng/ml) concentrations compared with those with S. aureus bacteraemia but without endocarditis (80 ng/ml and 1172 ng/ml, respectively; P = 0.01 and P = 0.003). No significant difference was found between the groups concerning ICAM-1 (median 451 ng/ml versus 522 ng/ml). In addition, serum tumour necrosis factor-alpha (TNF-alpha) concentrations were significantly correlated (P < 0.002) to serum levels of E-selectin, ICAM-1 and VCAM-1.     

Flumazenil as a diagnostic tool in the differential diagnosis of coma in a critically ill patient

The purpose of this report is to describe the use of flumazenil as a diagnostic aid in the differential diagnosis of coma in a patient with an inadvertent overdose of benzodiazepines. We report a patient with suspected septic encephalopathy whose level of consciousness markedly improved following flumazenil administration. Subsequent analysis revealed the presence of benzodiazepines and their metabolites in the blood and urine although the patient had not received benzodiazepines for over two weeks. The critically ill patient with multiorgan failure may have considerable derangement of benzodiazepine metabolism; therefore, if an obtunded patient’s level of consciousness improves following flumazenil administration, benzodiazepine intoxication must be considered.     

Repeating blood cultures during hospital stay: practice pattern at a teaching hospital and a proposal for guidelines

Guidelines for blood culture (BC) address the appropriate frequency, number and volume, but no guidelines exist for repeating BCs. The pattern of repeated BCs was studied in all patients hospitalised in December 2001 to determine the extent of and reasons for repeating cultures. BC was repeated in 127 (31.6%) of 405 adults with an initial BC during the study period. All patients with available records (n = 96; 75.6%) were included. The average patient age was 62.2 +/- 15.9 years. In total, 295 BC sets (one to four BCs/set) were obtained, comprising 96 initial and 199 repeats (one to nine repeats/patient). Sixty-nine (34.7%) repeats were taken within 24 h, and 89 (44.7%) within 2-4 days. The most common reason (32.2%) was persistent fever. The result of repeated cultures was: no growth (83.4%), same pathogen (9.1%), new pathogen (2.5%) or contamination (5.0%). Thus, BC repeats accounted for one-third of all BCs handled in the laboratory, with little additional yield. Guidelines for repeating BCs may decrease unnecessary testing.     

Iatrogenic Cushing's syndrome due to topical steroid abuse in a child with Psoriasis presenting as septicaemia

Psoriasis vulgaris is a chronic inflammatory disorder that affects the skin and joints. Mild disease is treated with topical corticosteroids (CS) which forms the first line of treatment for localized disease. While it is well established that prolonged use of oral or parenteral corticosteroids can lead to iatrogenic Cushing's syndrome and suppression of hypothalamic pituitary axis; development of these complications secondary to use of topical CS is rarely described. Since steroids have anti‐inflammatory properties, their prolonged use can lead to increased susceptibility to develop bacterial and fungal infections. We hereby report a 11‐year‐old female with psoriasis who presented with septicaemia and features of iatrogenic Cushing's syndrome due to treatment with topical corticosteroids for 2 years. Presentation of ICS as septicemia due to topical steroid use in this age group or in a psoriatic patient has not been described in the literature so far. Patient also developed hypertension and osteopenia, which are known adverse effects of corticosteroids; but occur rarely due to topical corticosteroids.     

Bacteriological spectrum and antimicrobial susceptibility pattern of neonatal septicaemia in a tertiary care hospital of North India

Background: Neonatal septicaemia is a clinical entity that is characterised by systemic signs and symptoms of infection and accompanied by bacteraemia in first 4 weeks of life and is one of the four leading causes of neonatal mortality and morbidity in India.

Aim: To determine the bacterial spectrum and antimicrobial susceptibility pattern of neonatal septicaemia in a tertiary care hospital of North India.

Materials and methods: In this prospective observational study, 850 blood samples were collected and processed from clinically suspected neonates according to standard laboratory protocol. Antimicrobial susceptibility of the isolates was done by Kirby Bauer disc diffusion method according to Clinical and Laboratory Standard Institution (CLSI) recommendations.

Results: Blood culture reports were positive in 322 (37.8%) cases. Early onset sepsis (EOS) was present in 61.41% and late onset sepsis (LOS) in 38.59% of cases. Gram-negative septicaemia (60.67%) was encountered more than Gram-positive (32.01%). Coagulase negative Staphylococci (17.43%) was the predominant isolate followed by, Klebsiella spp in 16.11% cases. Best overall sensitivity among Gram-negative isolates was to Colistin (89.94%), Imipenem (86.43%) and Meropenam (77.88%). Gram-positive isolates had good (97.15%) sensitivity to linezolid, (95.23%) vancomycin and (88.57%) Teicoplanin.

Conclusion: Gram-negative organisms are the leading cause of neonatal septicaemia with Klebsiella spp being commonest. Coagulase negative Staphylococci is the predominant isolate among Gram-positive organisms. Most of the isolates are resistant to common antibiotics.     

Improving Village Animal Health Worker participation in national disease surveillance systems: A case study from Cambodia

Para‐veterinary systems have arisen in numerous developing countries to address the low capacity of national veterinary services in meeting livestock health demands of mainly smallholder farmers. In Cambodia, the village animal health worker (VAHW) system was established in the early 1990s, involving short training programmes to equip VAHWs to provide basic animal health services for smallholder farmers, particularly the vaccination of cattle for haemorrhagic septicaemia (HS). However, there are increasing expectations that VAHWs provide village level disease surveillance information to the national veterinary services, despite their low‐level disease diagnostic skills. To identify opportunities to improve the disease reporting system in Cambodia, a closed‐ended cross‐sectional study of VAHWs (n = 80) from two provinces was conducted in 2015, examining their contact frequency with district and provincial animal health authorities. Ordinal logistic regression was used to determine factors associated with increased frequency of VAHW contact with the district animal health authorities responsible for national disease reporting. Positive associations between income generated from VAHW activities (p = .01) and the frequency of visiting farmers (p < .0001), with more frequent contacts with district animal health authorities, were identified. High levels of inappropriate use of antibiotics, with almost 90% of VAHW reporting they use antibiotics to treat FMD‐affected animals, were reported. Although further research to increase the rates of reporting at the smallholder farmer and VAHW levels is required, increased emphasis on complying with the World Organisation for Animal Health's competency guidelines for veterinary paraprofessionals may be required if they are expected to contribute to national animal disease surveillance systems.     

Septicaemia in a population‐based HIV clinical cohort in rural Uganda, 1996–2007: incidence,aetiology, antimicrobial drug resistance and impact of antiretroviral therapy

Objectives To describe the incidence and aetiology of septicaemia, and antimicrobial drug resistance in HIV‐infected and uninfected individuals, and the impact of antiretroviral therapy (ART) on septicaemia. Methods Between 1996 and 2007, we followed up a rural population–based cohort of HIV‐infected and uninfected participants. The aetiology and incidence of septicaemia, and antimicrobial drug resistances were determined. ART became available in 2004, and its impact on the incidence of septicaemia was examined. Results The overall septicaemia incidence (per 1000 pyrs) was 32.4 (95% CI 26.2–40.6) but was only 2.6 (95% CI 1.3–6.2) in HIV‐negative patients and 67.1 (95% CI 53.4–85.4) in HIV‐positive patients not on ART. Among those on ART, the overall incidence was 71.5 (95% CI 47.1–114.3), although it was 121.4 (95%CI 77.9–200.4) in the first year on ART and 37.4 (95%CI 18.9–85.2) in the subsequent period. Septicaemia incidence was significantly associated with lower CD4 counts. The commonest isolates were Streptococcus pneumoniae (SPN, n = 68) and Non‐typhi salmonellae (NTS, n = 42). Most SPN isolates were susceptible to ceftriaxone and erythromycin, while resistance to cotrimoxazole and penicillin was common. All NTS isolates were susceptible to ciprofloxacin, but resistance to cotrimoxazole and chloramphenicol was common. Conclusions Septicaemia incidence was higher in HIV‐infected than in HIV‐uninfected participants, and it remained high for some time among those who started ART. Starting ART earlier at higher CD4 counts is likely to lead to lower septicaemia incidence. Both SPN and NTS, the commonest isolates, were resistant to most commonly available antimicrobials. Blood culture laboratory surveillance systems to monitor antibiotic susceptibility and inform treatment guidelines are needed in Africa.