Research Article
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Clinical and Laboratory Evaluation of Culture-Proven Neonatal Sepsis in Premature Infants

Year 2018, Volume: 4 Issue: 1, 664 - 679, 15.04.2018
https://doi.org/10.30569/adiyamansaglik.407704

Abstract

Aim:
In
this study, who were followed up with diagnosis of sepsis in neonatal intensive
care unit in terms of underlying facilitating factors, causative pathogen,
clinical course and mortality.

Material
and methods:
114 cases of sepsis with proven-blood
culture were included in the study. Early onset neonatal sepsis (ENS), which
grew in the blood culture sample within the first 72 hours after birth, and late
onset neonatal sepsis (LNS), which grew in the blood culture sample after 72
hours. Platelet values <150x109/L were defined as
thrombocytopenia, and those with ≥150x109/L were defined as normal
platelet counts. C-reactive protein (CRP) levels >10 mg/dl were divided into
two groups as high level and ≤10 mg/dl as middle-low level.

Results:
30.7%
of the cases were ENS and 69.3% were LNS. In ENS, group B streptococcus was the
most frequently isolated agent in blood culture, whereas Klebsiella pneumoniae
was the most frequently isolated agent in LNS. When the ENS and LNS were
compared between gram positive and gram negative groups, mean platelet values
were significantly higher in the gram positive group and mean CRP values were
significantly higher in the gram negative group. Thrombocytopenia in ENS was
seen in only three cases, whereas high CRP values were seen in only one case.

In
LNS group, the incidence of  patients
with thrombocytopenia and high CRP levels were significantly higher in gram
negative-candida groups than in gram positive group.







 Conclusion:
Gram negative neonatal sepsis is a major problem in neonatal intensive care
units. In preterm babies with LNS, thrombocytopenia and high CRP levels are
more frequent in those who was detected 
gram negative agent-candida than those who was detected  gram positive agent in blood cultures.

References

  • CJ Baker, et al. Maternal Antibody at Delivery Protects Neonates From Early Onset Group B Streptococcal Disease. J Infect Dis 2014;209:781–8.
  • Raimondi F, et al. Neonatal sepsis: a difficult diagnostic challenge. Clin Biochem 2011;44:463-4.
  • Liu L, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012;379:2151–61.
  • Oncel MY, et al. Mean platelet volume in neonatal sepsis. J Clin Lab Anal 2012;26:493-6.
  • Simonsen K, et al. Early-onset neonatal sepsis. Clin Microbiol Rev 2014;27(1):21-47.
  • Klinger G, et al. Epidemiology and risk factors for early onset sepsis among very low birth weight infants. Am J Obstet Gynecol 2009;201:38.e1-6.
  • Jiang JH, et al. Neonatal sepsis in the neonatal Intensive Care Unit: Characteristics of early versus late onset. J Microbiol Immunol Infect 2004;37:301-6.
  • Kaufman D, et al. Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev 2004;17:638-80.
  • Berrington JE, et al. The neonatal bowel microbiome in health and infection. Curr Opin Infect Dis 2014;27:236–43.
  • Cetinkaya M, et al. Lower vitamin D levels are associated with increased risk of early-onset neonatal sepsis in term infants. J Perinatol 2015;35: 39–45.
  • Stewart CJ, et al. Bacterial and fungal viability in the preterm gut: NEC and sepsis. Arch Dis Child Fetal Neonatal Ed 2013;98:298–303.
  • Stewart CJ, et al. Cesarean or vaginal birth does not impact the longitudinal development of the gut microbiome in a cohort of exclusively preterm infants. Front Microbiol 2017;8:1008.
  • Greenberg RG, et al. Late-onset Sepsis in Extremely Premature Infants: 2000–2011. Pediatr Infect Dis J 2017;36(8):774-9.
  • Paolucci M, et al. How can the microbiologist help in diagnosing neonatal sepsis? Int J Pediatr 2012;2012:120-34.
  • Hofer N, et al. An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology 2012;102:25–36.
  • Nandyal SS, et al. Study of thrombocytopenia in neonatal intensive care unit. Indian J Pathol Oncol 2016;3(1);55-9.
  • Bhat S, et al. Incidence of thrombocytopenia and changes in various platelet parameters, in blood culture positive neonatal sepsis. Int J Pediatr 2015;3(4.1):757-66.
  • MY Lai, et al. Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein (≦10 mg/L). BMC Infect Dis 2015;15:320.
  • AL Shane, et al. Neonatal sepsis. Lancet 2017;390:1770–80.
  • Bizzarro MJ, et al. Neonatal sepsis 2004–2013: the rise and fall of coagulase-negative staphylococci. J Pediatr 2015;166:1193–9.
  • Özdemir AA, ve ark. Neonatal Sepsisli Olguların Retrospektif Değerlendirilmesi ve Etkenlerin Antibiyotik Direnci. Ş.E.E.A.H. Tıp Bülteni 2016;50(4):319-24.
  • Sağlam D, ve ark. Kayseri Eğitim Araştırma Hastanesi yenidoğan yoğun bakım ünitelerinde kan kültürlerinden izole edilen mikroorganizmaların dağılımı. Abant Med J 2015;4(3):255-60.
  • Kara H, ve ark. Yenidoğan yoğun bakım ünitesindeki kültür ile kanıtlanmış sepsisli hastaların değerlendirilmesi. Dicle Tıp Dergisi 2015;42(3):355-60.
  • Hakan N, ve ark. Klebsiella Sepsisinin Klinik Özellikleri ve Antibiyotik Duyarlılık Paterni: Üçüncü Düzey Bir Yenidoğan Yoğun Bakım Ünitesindeki 8 Yıllık Deneyimlerimiz. Jinekoloji - Obstetrik ve Neonatoloji Tıp Dergisi 2017;14(3):110–3.
  • Ali Abdel Rahim KA, et al. Prevalence of Extended Spectrum β-lactamase-Producing Klebsiella pneumoniae in Clinical Isolates. Jundishapur J Microbiol 2014;7:e17114.
  • Ree IMC, et al. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS One 2017;12:e0185581.
  • Zhang X, et al. Clinical characteristics of neonatal fungal sepsis in neonatal intensive care unit. Beijing Da Xue Xue Bao Yi Xue Ban 2017;49:789-93.

Prematüre Bebeklerde Kültürle Kanıtlı Neonatal Sepsisin Klinik ve Laboratuvar Değerlendirmesi

Year 2018, Volume: 4 Issue: 1, 664 - 679, 15.04.2018
https://doi.org/10.30569/adiyamansaglik.407704

Abstract

Amaç:
Bu
çalışmada yenidoğan yoğun bakım kliniğimizde sepsis tanısıyla takip edilen
prematüre bebeklerin altta yatan kolaylaştırıcı faktörler, etken patojen,
klinik seyir ve mortalite yönünden araştırılması amaçlanmıştır.

Gereç
ve Yöntemler:
Kan kültürü kanıtlı 114 sepsisli olgu
çalışmaya dahil edildi. Doğumdan sonra ilk 72 saat içerisinde kan kültürü
örneğinde üreme olanlar erken başlangıçlı neonatal sepsis (ENS), 72. saatten
sonra kan kültürü örneğinde üreme olanlar ise geç başlangıçlı neonatal sepsis (GNS)
grubuna dahil edildi. Platelet değeri <150x109/L olanlar trombositopeni,
≥150x109/L olanlar ise normal trombosit sayısı olarak tanımlandı. C-reaktif
protein (CRP) değerleri >10 mg/dl olanlar yüksek düzey, ≤10 mg/dl olanlar
ise orta-düşük düzey olmak üzere iki gruba ayrılıp değerlendirildi.

Bulgular:
Olguların
% 30.7’si ENS, % 69.3’ü de GNS idi. ENS’de kan kültüründe en sık grup B streptokok izole edilirken GNS’de
en sık Klebsiella pneumoniae izole
edilmişti. ENS ve GNS gram pozitif ve gram negatif gruplar arasında
karşılaştırma yapıldığında ortalama platelet değerleri anlamlı olarak gram
pozitif grupta daha yüksek bulunurken ortalama CRP değerleri gram negatif
grupta anlamlı olarak daha yüksekti. ENS’de trombositopeni sadece üç olguda
görülürken, yüksek CRP değerleri sadece bir olguda görüldü. GNS’de
trombositopenili ve yüksek CRP değerli olgular gram negatif-candida grubunda
gram pozitiflere göre anlamlı olarak daha sık bulunmaktaydı.







Sonuç:
Gram
negatif neonatal sepsis, yenidoğan yoğun bakım ünitelerinde önemli bir sorun
oluşturmaktadır. Prematüre bebeklerde GNS’de trombositopeni ve yüksek CRP
değerleri kan kültüründe gram negatif patojen tespit edilenlerde gram pozitif
patojen tespit edilenlere göre daha sık karşımıza çıkmaktadır. 

References

  • CJ Baker, et al. Maternal Antibody at Delivery Protects Neonates From Early Onset Group B Streptococcal Disease. J Infect Dis 2014;209:781–8.
  • Raimondi F, et al. Neonatal sepsis: a difficult diagnostic challenge. Clin Biochem 2011;44:463-4.
  • Liu L, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012;379:2151–61.
  • Oncel MY, et al. Mean platelet volume in neonatal sepsis. J Clin Lab Anal 2012;26:493-6.
  • Simonsen K, et al. Early-onset neonatal sepsis. Clin Microbiol Rev 2014;27(1):21-47.
  • Klinger G, et al. Epidemiology and risk factors for early onset sepsis among very low birth weight infants. Am J Obstet Gynecol 2009;201:38.e1-6.
  • Jiang JH, et al. Neonatal sepsis in the neonatal Intensive Care Unit: Characteristics of early versus late onset. J Microbiol Immunol Infect 2004;37:301-6.
  • Kaufman D, et al. Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev 2004;17:638-80.
  • Berrington JE, et al. The neonatal bowel microbiome in health and infection. Curr Opin Infect Dis 2014;27:236–43.
  • Cetinkaya M, et al. Lower vitamin D levels are associated with increased risk of early-onset neonatal sepsis in term infants. J Perinatol 2015;35: 39–45.
  • Stewart CJ, et al. Bacterial and fungal viability in the preterm gut: NEC and sepsis. Arch Dis Child Fetal Neonatal Ed 2013;98:298–303.
  • Stewart CJ, et al. Cesarean or vaginal birth does not impact the longitudinal development of the gut microbiome in a cohort of exclusively preterm infants. Front Microbiol 2017;8:1008.
  • Greenberg RG, et al. Late-onset Sepsis in Extremely Premature Infants: 2000–2011. Pediatr Infect Dis J 2017;36(8):774-9.
  • Paolucci M, et al. How can the microbiologist help in diagnosing neonatal sepsis? Int J Pediatr 2012;2012:120-34.
  • Hofer N, et al. An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology 2012;102:25–36.
  • Nandyal SS, et al. Study of thrombocytopenia in neonatal intensive care unit. Indian J Pathol Oncol 2016;3(1);55-9.
  • Bhat S, et al. Incidence of thrombocytopenia and changes in various platelet parameters, in blood culture positive neonatal sepsis. Int J Pediatr 2015;3(4.1):757-66.
  • MY Lai, et al. Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein (≦10 mg/L). BMC Infect Dis 2015;15:320.
  • AL Shane, et al. Neonatal sepsis. Lancet 2017;390:1770–80.
  • Bizzarro MJ, et al. Neonatal sepsis 2004–2013: the rise and fall of coagulase-negative staphylococci. J Pediatr 2015;166:1193–9.
  • Özdemir AA, ve ark. Neonatal Sepsisli Olguların Retrospektif Değerlendirilmesi ve Etkenlerin Antibiyotik Direnci. Ş.E.E.A.H. Tıp Bülteni 2016;50(4):319-24.
  • Sağlam D, ve ark. Kayseri Eğitim Araştırma Hastanesi yenidoğan yoğun bakım ünitelerinde kan kültürlerinden izole edilen mikroorganizmaların dağılımı. Abant Med J 2015;4(3):255-60.
  • Kara H, ve ark. Yenidoğan yoğun bakım ünitesindeki kültür ile kanıtlanmış sepsisli hastaların değerlendirilmesi. Dicle Tıp Dergisi 2015;42(3):355-60.
  • Hakan N, ve ark. Klebsiella Sepsisinin Klinik Özellikleri ve Antibiyotik Duyarlılık Paterni: Üçüncü Düzey Bir Yenidoğan Yoğun Bakım Ünitesindeki 8 Yıllık Deneyimlerimiz. Jinekoloji - Obstetrik ve Neonatoloji Tıp Dergisi 2017;14(3):110–3.
  • Ali Abdel Rahim KA, et al. Prevalence of Extended Spectrum β-lactamase-Producing Klebsiella pneumoniae in Clinical Isolates. Jundishapur J Microbiol 2014;7:e17114.
  • Ree IMC, et al. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS One 2017;12:e0185581.
  • Zhang X, et al. Clinical characteristics of neonatal fungal sepsis in neonatal intensive care unit. Beijing Da Xue Xue Bao Yi Xue Ban 2017;49:789-93.
There are 27 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Article
Authors

Halil Kazanasmaz 0000-0003-4671-4028

Hüseyin Gümüş 0000-0002-9326-2194

Publication Date April 15, 2018
Submission Date March 20, 2018
Acceptance Date March 28, 2018
Published in Issue Year 2018 Volume: 4 Issue: 1

Cite

AMA Kazanasmaz H, Gümüş H. Prematüre Bebeklerde Kültürle Kanıtlı Neonatal Sepsisin Klinik ve Laboratuvar Değerlendirmesi. ADYÜ Sağlık Bilimleri Derg. April 2018;4(1):664-679. doi:10.30569/adiyamansaglik.407704