A seven-year review of neonatal sepsis due to multidrug resistant Pseudomonasaeruginosa in a regional NICU

Abstract number: 1134_04_155

Sadownik B., Behrendt J., Karpe J., Wasek-Buko M., Godula-Stuglik U.

Objectives and methods:  

Analysis of epidemiology, clinical symptoms, laboratory findings and outcome of neonatal septicemia due to Pseudomonasaeruginosa in tertiary regional NICU. Retrospective chart review of preterm and full-term neonates diagnosed with this sepsis between January 1997 and December 2003.

Material:  

Among 549 septic neonates 47 ( 8.6%) had Pseudomonasaeruginosa in blood culture. Early-onset septicemia (<=3 day of life) in 4 (8.5%) and late-onset in 43 (91.5%) neonates were diagnosed. Prematurity in 87%, intrauterine hypotrophy in 21%, severe birth asphyxia in 24%, very low birth weight (<=1500g) in 58%, extremely low birth weight (<=1000g) in 30% and male sex in 51% of cases were found. In all neonates with late-onset Pseudomonasaeruginosa sepsis the endotracheal intubation and total parenteral nutrition in first week of life were applied.

Results:  

Most frequent clinical symptoms included bilateral pneumonia (96%), septic shock (66%), urinary tract infection (43%), DIC (40%), purulent meningitis (21%) and necrotizing enterocolitis (21%). Metabolic acidosis (83%) and significant increase of serum CRP concentration (92%) as biochemical disorders were most often stated. Thrombocytopenia in 58%, marked decrease of AT III activity in 51% and neutropenia in 19% of cases were found. Pseudomonasaeruginosa isolated from blood were resistant to gentamycin in 100%, to amikacin, tobramycin, ciprofloxacin, imipenem/clastatin, meropenem and cefepim in 75%, to ceftazidim, piperacillin, ticarcillin/clavulanic acid in 50%. All strains were sensitive to colimycin and piperacillin/tazobactam. In 36% septic mechanically ventilated neonates Pseudomonasaeruginosa in tracheobronchial aspirates were also isolated. Mortality rate was 34%. All 16 neonates who died had low birth weight (including 9 with birthweight less than 1000g) and late-onset sepsis. Nine of them suffered from others significant diseases such as bronchopulmonary dysplasia, necrotizing enterocolitis, congenital defects and/or severe intracranial hemorrhages.

Conclusion:  

Multidrug resistant Pseudomonasaeruginosa is potentially important pathogen in the etiology of severe neonatal sepsis, especially late-onset with bad prognosis.