Current Pediatric Research

Abstract

Background: Neonatal septicemia is a major cause of morbidity and mortality worldwide. We analyzed the spectrum of pathogens causing neonatal septicemia in various Arabic countries as Iraq. Materials and Methods: The study was conducted in the Neonatal Care Unit (NCU) at Al-Elwiya maternity teaching hospital, a total of (50) neonate admitted to NICU during the period January 2021 to June 2021. The case records were reviewed and information regarding gestational age, and medical history of the mother, bacterial isolate isolated from newborn and management procedures were collected. Blood cultures were used to establish the diagnosis of bacterial infection as well as (25) control group without neonatal septicemia (healthy). Results: Current study appeared 30 (60%) males and 20 (40%) females, so about 31 (62%) in age (>7) day compare to age group (7-28 and 28 ≤) day as (22%, 16%) respectively, so the early onset sepsis (58%)more than late onset sepsis (42%), and most common pathogens were gram negative bacilli causing both early onset septicemia and late onset sepsis as percentage (28%, 34%) respectively compare to gram positive bacteria (30%, 8%), also most common pathogenic organisms were E. coli 13 cases (26%), both Klebsiella and Pseudomonas species 7 cases (14%), Staphylococcus epidermedis (11 cases or 22%) in both early and late onset neonatal septicemia. Results of current study showed, 36 cases (72%)were delivered at hospital and 14 (28%) at home, about to residency are a urban was 31 cases (62%) and 29 cases (58%) rural, also education of mothers as primary school (27%, 54%) compare to control (11%, 44%) and secondary school as (8%, 16%) compare to control (10%, 40%), whilst the mother as housewife and employer as (44%, 40%) respectively compare to control. Conclusion: Current study appeared the males with septicemia more than females so about 31 (62%) in age >7 day compare to age group (7-28 and 28 ≤) day as (62%, 22%) respectively, early onset sepsis more than late onset sepsis. So most common pathogens were gram-negative bacilli causing both early-onset septicemia and late onset sepsis, as well as most common pathogenic organisms were E. coli, followed both Klebsiella and Pseudomonas species. Socio demographic characteristics play important role in neonatal septicemia.

Keywords

Risk factors, Neonatal bacterial septicemia, Al-Elwiya maternity teaching hospital, Iraq

Introduction

NeonatalSepticemia(NNS) (both early and late onset sepsis) is an important common cause ofmortalityandmorbidityamong Iraqineonates, the incidence of neonatal septicemia is 1-4 per 1000 live births in developed countries while in developing countries, the incidence of neonatal septicemia is about 3.5-4.3 cases per 1000 live births [1,2]. Newborns receiving care in the Neonatal Intensive Care Unit (NICU) are at increasing risk of hospital acquired infections, which is the most important cause of morbidity and mortality among hospitalized newborns [3].

Neonatal septicemia was defined as the pure growth of a single potentially pathogenic organism from the blood of a baby who was clinically septic according to defined criteria [4,5]. The neonatal deaths in Asia account for over 60% of the estimated global total of neonatal deaths; however, the average rates are lower, mainly because of the high fertility rate and large population [6]. Neonatal infection is a clinical syndrome found in infants who are 28 days or younger and manifested by systemic signs of infection and isolation of a bacterial pathogen from the bloodstream [7]. The pathogens responsible of neonatal septicemia has also changed dramatically, since the mid-20th century the infectious agents that cause neonatal septicemia have changed from Escherichia coliand Staphylococcus aureus which were the most common bacterial pathogens among neonates in the United States for decades to Group B Streptococcus (GBS) as the most common gram-positive organism that caused early-onset septicemia [8].

Materials and Methods

The study was conducted in the Neonatal Care Unit (NCU) at Al-Elwiya maternity teaching hospital, a total of (50) neonate admitted to NICU during the period January 2021 to June 2021. The case records were reviewed and information regarding birth weight of the neonate, gestational age, and medical history of the mother, bacterial isolate isolated from newborn and management procedures were collected. Blood cultures were used to establish the diagnosis of bacterial infection as well as (25) control group without neonatal septicemia (healthy).

Statistical analysis

The data analyzed using Statistical Package for Social Sciences (SPSS) version 22. The data presented as mean, standard deviation and ranges. P value less than 0.05 was considered statistically significant.

Results

The total number of newborns who were included in the study was 50 were diagnosed as septicemia (cases) and the other 25 without neonatal septicemia (control). Table 1 showed 30 (60%) males and 20 (40%) females, so about 31 (62%) in age (>7) day compare to age group (7-28 and 28 ≤) day as (22%, 16%) respectively, so the early onset Sepsis (58%) more than late onset sepsis (42%).

Table 1. Distribution of neonatal septicemia according to gender, age and classification of septicemia.

The most common pathogens were gram negative bacilli causing both early onset septicemia and late onset sepsis as percentage (28%, 34%) respectively compare to gram positive bacteria (30%, 8%), these results are shown in Table 2.

Table 2. Distribution of bacterial isolate isolated from neonatal septicemia as early and late onset sepsis according to gram stain.

The most common pathogenic organisms were E. coli (13 cases–26%), both Klebsiella and Pseudomonas species 7 cases (14%), Staphylococcus epidermedis (11 cases or 22%), Staphylococcus hemolyticus 6 cases (12%), as well as Enterococcus species 3 cases (6%) in both early and late onset neonatal septicemia.

Table 3. Types of bacterial isolate in early and late onset neonatal septicemia.

Results in Table 4 showed, 36 cases (72%)were delivered at hospital and 14 (28%) at home, about to residency area urban was 31 cases (62%) and 29 cases (58%) rural, also education of mothers as primary school (27%, 54%) compare to control (11%, 44%) and secondary school as (8%, 16%) compare to control (10%, 40%), whilst the mother as housewife and employer as (44%, 40)% respectively compare to control.

Table 4. Relationship between sociodemographic characteristics and neonatal septicemia.

Discussion

In Current study, males were found to have a higher incidence of septicemia compared to female. Other researchers in Iraq [9], Nigeria [10], Ethiopia [11], reported similar findings. Whereas Omoregie et al. found no significant sex difference in the incidence of bacterial septicemia [12]. The most common pathogens were gram negative bacilli causing both early-onset septicemia and late onset sepsis as percentage (28%, 34%) respectively compare to gram positive bacteria (30%, 8%) Gram negative bacteria is more common in EOS and LOS with predominant of E. coli in two categories [13]. Similar results were obtained by many previous studies in Dubai [14] (Koutouby), Saudi Arabia [15] and Mexico [16]. All these studies showed a higher incidence of gram negative micro-organisms among neonates with septicemia who died compared to those who survived. Revealed that Gram negative organism is most common and represented by E. coli, Klebsiella, Salmonella and Pseudomonas [17]. While Gram positive bacteria, CoNS, Staph. aureus, Strep. pyogenes and Strep. pneumoniae are most commonly isolated [18].

The source of infection for EOS is highly associated with the organisms that are carried in the maternal genital tract leading to vertical transmission, while LOS is typically caused by either nosocomial (hospital-acquired) or community-acquired sources [19]. The most common pathogenic organisms were E. coli 13 cases (26%), both Klebsiella and Pseudomonas species 7 cases (14%), in Baghdad teaching hospital/medical city, Ibraheem, 2011 was found (similar to current study ) that E. coli was the most common bacteria isolated in 19 (23.7%), followed by Klebsiellapneumoniae 16 (20%) [20].

Results of Hoffman explain the organisms most frequently involved in early-onset neonatal septicemia of term and preterm infants together are GBS andEscherichia coli, which account for approximately 70% of infections combined. Additional pathogens to consider, which account for the remaining minority of cases, are other streptococci [21]. The most common pathogen reported causing early onset sepsis were gram-negative bacilli responsible for 54% of early septicemia. Coagulase-negative Staphylococcus was the next most common, either due to rapid early postnatal acquisition of the organism or as blood culture contaminants followed by Staphylococcus aureus. This pattern of organisms is similar to that observed by other investigators [22-24]. The mortality was higher in neonates whose blood culture, as well as the education mothers, housewife and rural of residency area were more prone to septicemia than other neonates [25,26].

Conclusion

Males with septicemia more than females, so about 31 (62%) in age (>7) day compare to age group (7-28 and 28 ≤) day as (62%, 22%) respectively. Early onset sepsis more than late onset sepsis. The most common pathogens were gram negative bacilli causing both early-onset septicemia and late onset sepsis. The most common pathogenic organisms were E. coli, followed both Klebsiella and Pseudomonas species. Socio demographic characteristics play important role in neonatal septicemia.

References

1. Threaf MF, Tektook NK, Pirko EY. Immunological biomarkers for the early diagnosis of Iraqi neonatal bacterial septicemia (early and late onset). Biochemical and Cellular Archives 2018; 18(2): 2547-2551.
2. Yang YN, Tseng HI, Yang SN, et al. A strategy for reduction of antibiotic use in new patients admitted to a neonatal intensive care unit. Pediatr Neonatol 2012; 53(4): 245-51.
3. Nagata E, Brito A, Matsuo T. Nosocomial infections in a neonatal intensive care unit: incidence and risk factors. Am J Infect Control 2002; 30(1): 26-31.
4. Isaacs D, Barfield CP, Grimwood K, et al. Systemic bacterial and fungal infections in infants in Australian neonatal unit . Med J Aust 1995; 162(4): 198-201.
5. https://www.elsevier.com/books/remington-and-kleins-infectious-diseases-of-the-fetus-and-newborn-infant/wilson/978-0-323-24147-2
6. Ayaz A, Saleem S. Neonatal mortality and prevalence of practices for newborn care in a squatter settlement of Karachi, Pakistan: a cross-sectional study. PLoS ONE 2010; 5(11).
7. Gershon AA, Hotez PJ, Katz SL. “Septicemia in the newborn,” in Krugman's infectious diseases of children. (11th edn.) USA, Philadelphia, Mosby, 2004; p: 545.
8. Den Hoogen AV, Gerards LJ, Verboon-Maciolek MA, et al. Long-term trends in the epidemiology of neonatal septicemia and antibiotic susceptibility of causative agents. Neonatology 2010; 97(1):22-8.
9. Jumah DS, Hassan MK. Predictors of mortality outcome in neonatal sepsis. Med J Basrah Univ 2007; 25(1): 11–8
10. Gabrehiwot A, Lakew W, Moges F, et al. Bacterial profile and drug susceptibility pattern of neonatal septicemia in Gondar University Hospital, Gondar North West Ethiopia Der. Pharmacia Lettre 2012; 4(6): 1811-1816.
11. Makuolu AO, Jiya N, Adesiyun OO. Neonatal septicaemia in Ilorin: Bacterial pathogens and antibiotic sensitivity pattern. Afr J Med Sci 2002; 31(2): 127-130.
12. Omoregie R, Egbe CA, Ogefere HO, et al. Effects of gender and seasonal variation on the prevalence of bacterial septicaemia among young children in Benin City, Nigeria Libyan J. Med 2009; 4(3): 107–9.
13. Tareef FR, Assad MA, Abood ASA et al. bacterial profile and antimicrobial susceptibility in neonatal sepses Al - Alwyia Pediatric Teaching Hospital in Baghdad. Al-Kindy College Medical Journal 2017; 13(2): 21-25.
14. Koutouby A, Habibullah J. Neonatal septicemia in Dubai United Arab Emirates. J Trop Pediatr 1995; 41: 177-180.
15. Asindi A, Bilal N, AL-shehri M, et al. Neonatal septicemia. Saudi Med J 1999; 20(12): 942-946.
16. Rodriguez M, Canadiani C, Garcia J, et al. Morbidity and mortality from neonatal septicemia in a tertiary care level hospital. Saludpublica Mex 2003; 45(2): 90-95.
17. Vergnano S, Sharland M, Kazembe P, et al. Neonatal septicemia: An international perspective. Arch Dis Child Fetal Neonatal Ed 2005; 90(3): 220–224.
18. Karthikeyan G, Premkumar K. Neonatal septicemia: Staphylococcus aureus as the predominant pathogen. Indian J Pediatr 2001; 68(8): 715-717.
19. Shane AL, Sanchez, PJ, Stoll BJ. Neonatal sepsis. Lancet 2017; 390: 1770–1780.
20. Ibraheem MF. Neonatal bacterial septicemia: Risk factors, clinical features And short term outcome. J Fac Med Baghdad 2011; 53(3): 261- 264.
21. Hoffman JA, Mason EO, Schutze GE, et al. Streptococcus pneumoniae infections in the neonate.Pediatrics2003; 112(5): 1095–1102.
22. Sankar MJ, Agarwal R, Deorari Ak, et al. Septicemia in the newborn. Indian J Pediatr 2008; 75(3): 261-66.
23. Okolo AA, Omene JA. Changing pattern of neonatal septicemia in an African city. Ann Troppediatr 1985; 5(3): 122-26.
24. Orsin D, Vergnano S, Anthony C. Serious bacterial infections in newborn infant in developing countries. Curr Opin Infec Dis 2004; 17(3): 217-24.
25. Simonsen KA, Anderson-Berry AL, Delair SF, et al. Early-onset neonatal septicemia. Clin Microbiol Rev 2014; 27(1): 21-47.
26. Behrman RE, Kleigman RM, Stanton Bf, et al. Infections of the neonatal infant. In: Nelson textbook of pediatrics.. (19th edn) Philadelphia: Saunders. 2011; p: 633.