Current-proven neonatal sepsis in Indonesian tertiary neonatal intensive care unit: a hematological and microbiological profile
,
Abstract
Background and Objectives: Neonatal sepsis is the third leading cause of neonatal death in the world. The patterns of pathogens causing neonatal sepsis varies in many countries. This study was aimed to identify hematological and microbiological profile of culture-proven neonatal sepsis in Indonesian tertiary neonatal intensive care unit (NICU).
Materials and Methods: Hospital based cross-sectional study was conducted in all inborn neonates that were suspected sepsis neonatal over a period of six months from April to September 2019. Complete blood count, c-reactive protein (CRP) and blood culture were examined before antibiotic administration. Statistical analysis were calculated based on Chi-Square’s Test and Mann-Whitney U test and p <0.05 considered significant.
Results: One hundred four inborn neonates admitted to NICU and diagnosed with suspected neonatal sepsis were recruited. Culture-proven neonatal sepsis were confirmed in 52 (50%) neonates, 13 (25%) in early-onset neonatal sepsis (EONS) and 39 (75%) in late-onset neonatal sepsis (LONS). The most common abnormal hematological profile were anemia and thrombocytopenia, with amount of 61.5% and 75%, respectively. High CRP only detected in 36.4% and only 18.5% experienced leukopenia. Gram negative bacteria responsible in 75% from total isolated pathogens. Klebsiella pneumoniae accounted for 48.1% followed by coagulase negative staphylococci (CONS) for 17.3% and Enterobacter cloacae for 11.5%.
Conclusion: Anemia and thrombocytopenia were the top two hematological profile of culture-proven neonatal sepsis. Most causes of culture-proven neonatal sepsis were Gram negative bacteria and the dominant pathogen was K. pneumoniae.
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15. Al-Matary A, Heena H, AlSarheed AS, Ouda W, AlShahrani DA, Wani TA, et al. Characteristics of neonatal sepsis at a tertiary care hospital in Saudi Arabia. J Infect Public Health 2019;12:666-672.
16. Li X, Ding X, Shi P, Zhu Y, Huang Y, Li Q, et al. Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children’s hospital, 2013 to 2017. Medicine (Baltimore) 2019;98(12):e14686.
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18. Guo J, Luo Y, Wu Y, Lai W, Mu X. Clinical characteristic and pathogen spectrum of neonatal sepsis in Guangzhou city from June 2011 to June 2017. Med Sci Monit 2019;25:2296-2304.
19. Olivier F, Bertelle V, Shah PS, Drolet C, Piedboeuf B. Association between birth route and late-onset sepsis in very preterm neonates. J Perinatol 2016;36:1083-1087.
20. Kan B, Razzaghian H, Lavoie PM. An immunological perspective on neonatal sepsis. Trends Mol Med 2016;22:290-302.
21. Sherman MP. New concepts of microbial translocation in the neonatal intestine: mechanisms and prevention. Clin Perinatol 2010;37:565-579.
22. Hematyar M, Najibpour R, Bayesh S, Hojjat A, Farshad A. Assessing the role of clinical manifestations and laboratory findings in neonatal sepsis. Arch Pediatr Infect Dis 2017;5(1):e29985.
23. Piagnerelli M, Boudjeltia KZ, Gulbis B, Vanhaeverbeek M, Vincent J-L. Anemia in sepsis: the importance of red blood cell membrane changes. Transfus Altern Transfus Med 2007;9:143-149.
24. Bateman RM, Sharpe MD, Singer M, Ellis CG. The Effect of sepsis on the erythrocyte. Int J Mol Sci 2017;18:1932.
25. Gomella TL (2013). Postdelivery antibiotics. 3In: neonatology : management, procedures, on-call problems, disesase and drugs. Ed, Gomella TL, Cunningham MD, Eyal FG. Mc Graw Hill, 7th ed. New York, pp. 492-501.
26. Newman TB, Puopolo KM, Wi S, Draper D, Escobar GJ. Interpreting complete blood counts soon after birth in newborns at risk for sepsis. Pediatrics 2010;126:903-909.
27. Ree IMC, Fustolo-Gunnink SF, Bekker V, Fijnvandraat KJ, Steggerda SJ, Lopriore E. Thrombocytopenia in neonatal sepsis:incidence, severity and risk factors. PLoS One 2017;12(10):e0185581.
28. Odabasi IO, Bulbul A. Review neonatal sepsis. Sisli Etfal Hastan Tip Bul 2020;54:142-158.
29. Xu L, Li Q, Mo Z, You P. Diagnostic value of c-reactive protein in neonatal sepsis: a meta-analysis. Eur J Inflamm 2016;14:100-108.
30. Hasibuan BS. Comparison of microbial pattern in early and late onset neonatal sepsis in referral center Haji Adam Malik hospital Medan Indonesia. IOP Conf Ser Earth Environ Sci 2018;125:012053.
31. Wilar R. Diagnostic value of eosinopenia and neutrophil to lymphocyte ratio on early onset neonatal sepsis. Korean J Pediatr 2019;62:217-223.
32. Gao K, Fu J, Guan X, Zhu S, Zeng L, Xu X, et al. Incidence, bacterial profiles, and antimicrobial resistance of culture-proven neonatal sepsis in south China. Infect Drug Resist 2019;12:3797-3805.
33. Akbas AMI. Pola Kuman dan Uji sensitivitas antibiotik pada bakteremia neonatus prematur di RSUD Dr. Soetomo Tahun 2015 [Internet]. Surabaya: universitas Airlangga; 2017 [updated 2017 Dec 20; cited 2021 May 6]. available from: http://repository.unair.ac.id/68582/
34. Kuntaman K, Santoso S, Wahjono H, Mertaniasih NM, Lestari ES, Farida H, et al. The sensitivity pattern of extended spectrum beta lactamase-producing bacteria against six antibiotics that routinely used in clinical setting. J Indon Med Assoc 2011;61:482-486.
35. Hilliard NJ, Schelonka RL, Waites KB. Bacillus cereus bacteremia in a preterm neonate. J Clin Microbiol 2003;41:3441-3444.
36. Decousser JW, Ramarao N, Duport C, Dorval M, Bourgeois-Nicolaos N, Guinebretière MH, et al. Bacillus cereus and severe intestinal infections in preterm neonates: putative role of pooled breast milk. Am J Infect Control 2013;41:918-921.
2. Bany-Mohammed F (2013). Sepsis. in:neonatology: management, procedures, on-call problems, disesase and drugs. Ed, Gomella TL, Cunningham MD, Eyal FG. Mc Graw Hill, 7th ed. New York, pp. 865-874.
3. Polin RA, Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics 2012;129:1006-1015.
4. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the sustainable development goals. Lancet 2016;388:3027-3035.
5. Hug L, Alexander M, You D, Alkema L, UN Inter-agency Group for Child Mortality Estimation. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health 2019;7(6):e710-e720.
6. Haque KN. Definitions of bloodstream infection in the newborn. Pediatr Crit Care Med 2005;6(3 Suppl):S45-49.
7. Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed 2015;100:F257-263.
8. The Clinical Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. 25th ed. Pennsylvania: Clinical and Laboratory Standards Institute; 2015.
9. Sorsa A. Epidemiology of neonatal sepsis and associated factors implicated: observational study at neonatal intensive care unit of Arsi university teaching and referral hospital, south east Ethiopia. Ethiop J Health Sci 2019;29:333-342.
10. Arowosegbe AO, Ojo DA, Dedeke IO, Shittu OB, Akingbade OA. Neonatal sepsis in a Nigerian tertiary hospital: clinical features, clinical outcome, aetiology and antibiotic susceptibility pattern. S Afr J Infect Dis 2017;32:127-131.
11. Mahallei M, Rezaee MA, Mehramuz B, Beheshtirooy S, Abdinia B. Clinical symptoms, laboratory, and microbial patterns of suspected neonatal sepsis cases in a children’s referral hospital in northwestern Iran. Medicine (Baltimore) 2018;97(25):e10630.
12. Schurz H, Salie M, Tromp G, Hoal EG, Kinnear CJ, Möller M. The X chromosome and sex-specific effects in infectious disease susceptibility. Hum Genomics 2019;13:2.
13. Kosyreva AM. The sex differences of morphology and immunology of SIRS of newborn Wistar rats. Int Sch Res Notices 2014;2014:190749.
14. Belachew A, Tewabe T. Neonatal sepsis and its association with birth weight and gestational age among admitted neonates in Ethiopia: systematic review and meta-analysis. BMC Pediatr 2020;20:55.
15. Al-Matary A, Heena H, AlSarheed AS, Ouda W, AlShahrani DA, Wani TA, et al. Characteristics of neonatal sepsis at a tertiary care hospital in Saudi Arabia. J Infect Public Health 2019;12:666-672.
16. Li X, Ding X, Shi P, Zhu Y, Huang Y, Li Q, et al. Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children’s hospital, 2013 to 2017. Medicine (Baltimore) 2019;98(12):e14686.
17. Bandyopadhyay T, Kumar A, Saili A, Randhawa VS. Distribution, antimicrobial resistance and predictors of mortality in neonatal sepsis. J Neonatal Perinatal Med 2018;11:145-153.
18. Guo J, Luo Y, Wu Y, Lai W, Mu X. Clinical characteristic and pathogen spectrum of neonatal sepsis in Guangzhou city from June 2011 to June 2017. Med Sci Monit 2019;25:2296-2304.
19. Olivier F, Bertelle V, Shah PS, Drolet C, Piedboeuf B. Association between birth route and late-onset sepsis in very preterm neonates. J Perinatol 2016;36:1083-1087.
20. Kan B, Razzaghian H, Lavoie PM. An immunological perspective on neonatal sepsis. Trends Mol Med 2016;22:290-302.
21. Sherman MP. New concepts of microbial translocation in the neonatal intestine: mechanisms and prevention. Clin Perinatol 2010;37:565-579.
22. Hematyar M, Najibpour R, Bayesh S, Hojjat A, Farshad A. Assessing the role of clinical manifestations and laboratory findings in neonatal sepsis. Arch Pediatr Infect Dis 2017;5(1):e29985.
23. Piagnerelli M, Boudjeltia KZ, Gulbis B, Vanhaeverbeek M, Vincent J-L. Anemia in sepsis: the importance of red blood cell membrane changes. Transfus Altern Transfus Med 2007;9:143-149.
24. Bateman RM, Sharpe MD, Singer M, Ellis CG. The Effect of sepsis on the erythrocyte. Int J Mol Sci 2017;18:1932.
25. Gomella TL (2013). Postdelivery antibiotics. 3In: neonatology : management, procedures, on-call problems, disesase and drugs. Ed, Gomella TL, Cunningham MD, Eyal FG. Mc Graw Hill, 7th ed. New York, pp. 492-501.
26. Newman TB, Puopolo KM, Wi S, Draper D, Escobar GJ. Interpreting complete blood counts soon after birth in newborns at risk for sepsis. Pediatrics 2010;126:903-909.
27. Ree IMC, Fustolo-Gunnink SF, Bekker V, Fijnvandraat KJ, Steggerda SJ, Lopriore E. Thrombocytopenia in neonatal sepsis:incidence, severity and risk factors. PLoS One 2017;12(10):e0185581.
28. Odabasi IO, Bulbul A. Review neonatal sepsis. Sisli Etfal Hastan Tip Bul 2020;54:142-158.
29. Xu L, Li Q, Mo Z, You P. Diagnostic value of c-reactive protein in neonatal sepsis: a meta-analysis. Eur J Inflamm 2016;14:100-108.
30. Hasibuan BS. Comparison of microbial pattern in early and late onset neonatal sepsis in referral center Haji Adam Malik hospital Medan Indonesia. IOP Conf Ser Earth Environ Sci 2018;125:012053.
31. Wilar R. Diagnostic value of eosinopenia and neutrophil to lymphocyte ratio on early onset neonatal sepsis. Korean J Pediatr 2019;62:217-223.
32. Gao K, Fu J, Guan X, Zhu S, Zeng L, Xu X, et al. Incidence, bacterial profiles, and antimicrobial resistance of culture-proven neonatal sepsis in south China. Infect Drug Resist 2019;12:3797-3805.
33. Akbas AMI. Pola Kuman dan Uji sensitivitas antibiotik pada bakteremia neonatus prematur di RSUD Dr. Soetomo Tahun 2015 [Internet]. Surabaya: universitas Airlangga; 2017 [updated 2017 Dec 20; cited 2021 May 6]. available from: http://repository.unair.ac.id/68582/
34. Kuntaman K, Santoso S, Wahjono H, Mertaniasih NM, Lestari ES, Farida H, et al. The sensitivity pattern of extended spectrum beta lactamase-producing bacteria against six antibiotics that routinely used in clinical setting. J Indon Med Assoc 2011;61:482-486.
35. Hilliard NJ, Schelonka RL, Waites KB. Bacillus cereus bacteremia in a preterm neonate. J Clin Microbiol 2003;41:3441-3444.
36. Decousser JW, Ramarao N, Duport C, Dorval M, Bourgeois-Nicolaos N, Guinebretière MH, et al. Bacillus cereus and severe intestinal infections in preterm neonates: putative role of pooled breast milk. Am J Infect Control 2013;41:918-921.
| Files | ||
| Issue | Vol 13 No 3 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v13i3.6386 | |
| Keywords | ||
| Neonatal sepsis; Bacteremia; Blood culture; Gram negative bacteria; Klebsiella | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Utomo M, Sumitro K, Etika R, Widodo A. Current-proven neonatal sepsis in Indonesian tertiary neonatal intensive care unit: a hematological and microbiological profile. Iran J Microbiol. 2021;13(3):266-273.
