DOI: 10.5005/jp-journals-10081-1258 |
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Balachander B, Muktineni G, Rao S. Comparison of Profile and Sensitivity Patterns of Organism Causing Neonatal Sepsis between a Tertiary Care Neonatal Unit and DeNIS Study. Pediatr Inf Dis 2020; 2 (4):127-129.
Background: Infection is an important cause of mortality and morbidity in neonates. The rise in multidrug-resistant as reported by the Delhi Neonatal Infection Study (DeNIS) is alarmingly high. The aim of our study was to compare the results of the DeNIS with a single-center data from southern part of India Materials and methods: This is a prospective observational study conducted between January 2016 and December 2017 in a tertiary care neonatal unit. Infants with blood culture positive sepsis were included in the study. The data were compared to the DeNIS study. A p value of <0.05 was considered significant. Results: The commonest organism identified in our study was CONS (40%) followed by Klebsiella, E. coli, Candida, and non-fermenting gram-negative bacilli. The DeNIS collaboration identified Acinetobacter to be the commonest cause. Methicillin resistance prevailed in 70% of CONS and 50% Staphylococcus aureus isolates in our study compared to 61% and 38% in the DeNIS. In the gram-negative organism, MDR was 66% for Acinetobacter, 15% for E. coli, and 44% for Klebsiella. In the DeNIS, the rates of resistance were 82%, 54%, and 38% for Acinetobacter, E. coli, and Klebsiella, respectively. The mortality in MDRO was 26.9% compared to 15.7% in Denis. Conclusion: Our findings conclude that the incidence of sepsis was similar to the DeNIS study, and antimicrobial resistance and the mortality secondary to the same is high. Unlike the DeNIS collaboration, the incidence of Acinetobacter was lower in our center. A nation-wide multicentric study on the profile of infection in neonates and antibiotic sensitivity is the need of the hour.
Background: Studies on prevalence of acute respiratory tract infections (ARTIs) exclusively on the infant population in India, and their association with mode of delivery are lacking. Aims and objectives: To assess the incidence of ARTIs in infants aged <12 months and to delineate its association with the mode of delivery (cesarean and vaginal). We also evaluated the antibiotic use for management of ARTIs in the study population. Study design: This single-center retrospective analysis was carried out in a private hospital (Cloudnine Hospitals) in Karnataka, India, over a period of 12 years from 2007 to July 2019. Participants: The study included 51,850 infants up to 1 year of age who were outpatients or admitted to the hospital with infections. Intervention: In this retrospective study, infection type, mode of delivery, and antibiotic use were recorded. Outcomes: Both upper and lower respiratory tract infections (URTI and LRTI) were observed. Mode of delivery recorded included both cesarean and vaginal, and some infants received antibiotics for ARTI treatment. Results: Higher prevalence of cesarean mode of delivery (71%) was recorded, which was associated with a higher incidence of ARTIs, compared to vaginal delivery (5,648 vs 2,420). Among the ARTI patients, antibiotics were prescribed to 2,635 (21.7%) infants. The commonly prescribed antibiotics were penicillin-type and aminoglycoside antibiotics. Conclusion: The incidence of ARTIs in infants was 23.4%, with URTIs being more prevalent than LRTIs. The prevalence of cesarean delivery was found to be highest and was associated with a higher incidence of ARTIs. Use of antibiotics was observed in 21.7% of infants with ARTIs.
Neutropenia can result from failure, infiltration, or suppression of the bone marrow due to nonmalignant disorders, cancers, chemotherapy, radiation, or a combination of these. Febrile neutropenia (FN) is a hemato-oncological emergency and is an important cause of death in immunocompromised children. Prompt and stepwise management of FN helps to minimize the morbidity and mortality considerably. In resource-constraint countries, additional challenges can be encountered during the treatment of fever in neutropenic patients. In India, many children with FN are initially treated at regional centers and later referred to tertiary units if needed. Pediatricians should hence be familiar with the treatment algorithm and specific issues related to the management of FN.
Nutritionally acquired immune deficiency syndrome (NAIDS) is a significant disadvantage to children with malnutrition. The role of nutrients in immunity and markers of inflammation in infections are highlighted. The complex interaction between malnutrition, infection, and immunity are elucidated. A brief note on the “ABCDEFG approach” for comprehensive assessment and nutrient supplementation for optimum intervention is included.
Respiratory syncytial virus (RSV) is one of most common cause of lower respiratory tract infection in infants less than 2 years of age and sometimes in elderly people. Bronchiolitis is the common presentation. Severe infection is seen in high-risk infants and preterm infants. More than 90% of mortality due to RSV infection occurs in developing countries. At present, no specific drug is available for treatment. Prevention of RSV infection can be done by giving palivizumab, which is a monoclonal antibody developed against RSV fusion protein. Phase 3 clinical trials are done with nanoparticle RSV protein F vaccine for pregnant mothers to protect the infant through transplacental transfer of RSV antibodies. Clinical trials are going on for live attenuated RSV vaccine, vector-based vaccines, chimeric vaccine, and subunit vaccine.
Isolated renal mucormycosis (IRM) is a life-threatening and extremely rare entity in immunocompetent children. Unfortunately, the diagnosis of mucormycosis using clinical and laboratory parameters can be difficult leading to high mortality. We report a case of IRM in a 3-year-old immunocompetent child who was successfully managed with amphotericin B and nephrectomy. A high index of suspicion, early diagnosis, and aggressive treatment with antifungal and surgery is critical for a favorable outcome.
Antibiotics have revolutionized the practice of medicine and antibiotic stewardship programs are being put in place so that the benefits of this revolution are not offset by its rampant and unscientific use. The antimicrobial stewardship program is in its infancy. It has much scope for growth and a tremendous potential for promoting evidence-based therapy for infectious disease. An attempt is made in this article to put together strategies for its effective implementation in healthcare facilities.
Mycoplasma pneumoniae contributes to 30–40% of community-acquired pneumonia in children and has the potential to cause clusters and outbreaks in closed settings. Early diagnosis helps in appropriate management of the case and also reduces long-term complications associated with extrapulmonary disease. Molecular testing and specific serology remain the backbone of laboratory diagnosis for Mycoplasma pneumoniae.