Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal.
Centre for Tropical Medicine and Global Health, Medical Sciences Division, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
BMC Infect Dis. 2021 Jun 9;21(1):546. doi: 10.1186/s12879-021-06261-x.
Sepsis is an overwhelming and life-threatening response to bacteria in bloodstream and a major cause of neonatal morbidity and mortality. Understanding the etiology and potential risk factors for neonatal sepsis is urgently required, particularly in low-income countries where burden of infection is high and its epidemiology is poorly understood.
A prospective observational cohort study was conducted between April 2016 and October 2017 in a level three NICU at a tertiary care hospital in Nepal to determine the bacterial etiology and potential risk factors for neonatal sepsis.
Among 142 NICU admitted neonates, 15% (21/142) and 32% (46/142) developed blood culture-positive and -negative neonatal sepsis respectively. Klebsiella pneumoniae (34%, 15/44) and Enterobacter spp. (25%, 11/44) were the most common isolates. The antimicrobial resistance of isolates to ampicillin (100%, 43/43), cefotaxime (74%, 31/42) and ampicillin-sulbactam (55%, 21/38) were the highest. Bla (53%, 18/34) and bla (46%, 13/28) were the commonest ESBL and carbapenemase genes respectively. In univariate logistic regression, the odds of sepsis increased with each additional day of use of invasive procedures such as mechanical ventilation (OR 1.086, 95% CI 1.008-1.170), umbilical artery catheter (OR 1.375, 95% CI 1.049-1.803), intravenous cannula (OR 1.140, 95% CI 1.062-1.225); blood transfusion events (OR 3.084, 95% CI 1.407-6.760); NICU stay (OR 1.109, 95% CI 1.040-1.182) and failure to breast feed (OR 1.130, 95% CI 1.060-1.205). Sepsis odds also increased with leukopenia (OR 1.790, 95% CI 1.04-3.082), increase in C-reactive protein (OR 1.028, 95% CI 1.016-1.040) and decrease in platelets count (OR 0.992, 95% CI 0.989-0.994). In multivariate analysis, increase in IV cannula insertion days (OR 1.147, 95% CI 1.039-1.267) and CRP level (OR 1.028, 95% CI 1.008-1.049) increased the odds of sepsis.
Our study indicated various nosocomial risk factors and underscored the need to improve local infection control measures so as to reduce the existing burden of sepsis. We have highlighted certain sepsis associated laboratory parameters along with identification of antimicrobial resistance genes, which can guide for early and better therapeutic management of sepsis. These findings could be extrapolated to other low-income settings within the region.
败血症是一种由血流中的细菌引起的压倒性的、危及生命的反应，是新生儿发病率和死亡率的主要原因。了解新生儿败血症的病因和潜在危险因素迫在眉睫，特别是在感染负担高且流行病学了解甚少的低收入国家。
2016 年 4 月至 2017 年 10 月，在尼泊尔一家三级护理医院的 NICU 进行了一项前瞻性观察队列研究，以确定新生儿败血症的细菌病因和潜在危险因素。
在 142 名入住 NICU 的新生儿中，分别有 15%（21/142）和 32%（46/142）发生血培养阳性和阴性的新生儿败血症。肺炎克雷伯菌（34%，15/44）和肠杆菌属（25%，11/44）是最常见的分离株。分离株对氨苄西林（100%，43/43）、头孢噻肟（74%，31/42）和氨苄西林-舒巴坦（55%，21/38）的抗菌耐药率最高。bla（53%，18/34）和 bla（46%，13/28）分别是最常见的 ESBL 和碳青霉烯酶基因。在单变量逻辑回归中，败血症的发生几率随着机械通气（OR 1.086，95%CI 1.008-1.170）、脐动脉导管（OR 1.375，95%CI 1.049-1.803）、静脉置管（OR 1.140，95%CI 1.062-1.225）等侵入性操作的使用天数增加而增加；输血事件（OR 3.084，95%CI 1.407-6.760）；NICU 住院时间（OR 1.109，95%CI 1.040-1.182）和未能母乳喂养（OR 1.130，95%CI 1.060-1.205）而增加。败血症的几率也随着白细胞减少症（OR 1.790，95%CI 1.04-3.082）、C 反应蛋白升高（OR 1.028，95%CI 1.016-1.040）和血小板计数下降（OR 0.992，95%CI 0.989-0.994）而增加。在多变量分析中，静脉置管天数增加（OR 1.147，95%CI 1.039-1.267）和 CRP 水平升高（OR 1.028，95%CI 1.008-1.049）都会增加败血症的发生几率。
我们的研究表明了各种医院获得性危险因素，并强调需要改善当地感染控制措施，以降低现有的败血症负担。我们已经强调了与败血症相关的某些实验室参数以及鉴定抗菌药物耐药基因，这可以指导败血症的早期和更好的治疗管理。这些发现可以推广到该地区其他低收入国家。
