Clinical features of neonatal sepsis caused by resistant Gram-negative bacteria.
BACKGROUND
Clinical features and outcomes of neonatal sepsis caused by resistant Gram-negative bacteria are not well described in Jordan. The aim of the present study was therefore to describe microbiology and clinical features, laboratory findings and outcomes of early- and late-onset Gram-negative neonatal sepsis.


METHODS
All patients with Gram-negative bacteremia between July 2003 and June 2005 were retrospectively included. Resistance profiles, clinical features and outcomes of early and late-onset neonatal sepsis were compared.


RESULTS
A total of 79 patients (after excluding all nine cases of Gram-positive bloodstream infection (BSI) were identified as having Gram-negative BSI (25 had early-onset and 54 had late-onset neonatal sepsis). Respiratory distress, metabolic acidosis and requirement of ventilation were found in 74.7%, 40.5%, and 58.2%, respectively. Hypotension was found in 22.9% of patients. Klebsiella pneumoniae was responsible for 43 cases (54.4.2%). Klebsiella pneumoniae resistance rates to ampicillin and ceftazidime were 100% and 50%, respectively. Mortality rate was 30.9%. Forty-eight percent of deaths occurred within 3 days of sepsis. Meningitis was diagnosed in five cases. Elevated C-reactive protein (CRP) and thrombocytopenia were seen in 28% and 24% of infants with early-onset sepsis, respectively, and in 79.6%, 59.3% of infants with late-onset sepsis respectively.


CONCLUSIONS
Both early- and late-onset neonatal sepsis are caused by highly resistant Gram-negative bacteria. Mortality of sepsis is high. Elevated CRP and thrombocytopenia is seen more commonly in late-onset neonatal sepsis.
Khassawneh
Mohammad
M
Department of Pediatrics, Jordan University of Science and Technology, PO Box 126, Aidone, Irbid 21166, Jordan. deema321@yahoo.com
Khader
Yousef
Y
Abuqtaish
Nadeen
N
D017668:Age of Onset; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002097:C-Reactive Protein / Q000032:analysis; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007597:Jordan / Q000453:epidemiology; D007710:Klebsiella Infections; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D013921:Thrombocytopenia / Q000453:epidemiology
D002097:C-Reactive Protein