Evaluation of sepsis case in Aydın Adnan Menderes University Faculty of Medicine newborn intensive care unit and determination of antibiotic sensitivity

AIM: Neonatal sepsis is a systemic syndrome of bacterial, viral or fungal origin, which presents with hemodynamic changes and various clinical symptoms, and causes significant morbidity and mortality. In case of delay in treatment, it causes significant comorbidity and mortality. In our study, the laboratory tests of the babies who were hospitalized in the Neonatal Intensive Care Unit of Aydın Adnan Menderes University Faculty of Medicine and diagnosed with neonatal sepsis by detecting growth in the blood culture, the factors detected in the blood culture and the antibiotic susceptibility of these agents, and the retrospective determination of the European Medicines Agency (EMA) criteria. It was aimed to investigate the predictive value in neonatal sepsis. MATERIALS AND METHODS: In this retrospective study, babies who were hospitalized in Aydın Adnan Menderes University, Department of Pediatrics, Neonatal Intensive Care Unit between January 2014 and December 2019 and whose blood culture had a growth were included. Demographic characteristics, clinical and laboratory findings, blood, urine and cerebrospinal fluid culture results of the cases and mothers were obtained retrospectively from the hospital archive system. RESULTS: Neonatal sepsis and contamination rates by years; Sepsis 8.6%, contamination 18.2% in 2014, sepsis 9.9% in 2015, contamination 18.3%, sepsis 8.2% in 2016, contamination 14.9%, sepsis 7.8% in 2017, 16.2%, in 2018 sepsis 8.1%, contamination 11.1%, in 2019 sepsis 10.2%, contamination 8.9%. 59.5% of babies were male, mean birth weight was 1613.61+/-812.62 g (485-4410), mean birth week was 31.13+/-4.54 (22-41) weeks, 149 (%78,4) was delivery by C/S. The fifth minute Apgar score of 22 infants (11.5%) was found to be <7. Eight (3.8%) infants had EBNS, 183 (86.3%) infants had EBNS, and 21 (9.9%) infants had EBNS. TPN was used during sepsis in 200 (94.3%) infants, and a history of catheterization was present in 76 (36.8%) infants at the time of diagnosis. Fifteen (7.9%) infants died due to sepsis. While the mean age of the mothers was 29.64+/-6.67, 18.4% of them were over 35 years old. When the clinical and laboratory findings of the infants during sepsis were examined according to the EMA sepsis scoring, the presence of at least two clinical and at least two laboratory findings in 177 (83.5%) attacks met the diagnosis of clinical sepsis; clinical sepsis diagnosis could not be met in 35 (16.5%) attacks because the criteria could not be met. According to the EMA sepsis scoring, respiratory problems (82.1%) were most common in infants during the diagnosis of sepsis, followed by cardiovascular system findings (67%), followed by non-specific symptoms such as restlessness, lethargy, and hypotonicity (62.3%); gastrointestinal system findings (45.3%), body temperature changes (22.6%), and skin and subcutaneous lesions (9.4%) were followed. When the clinical findings of EMA sepsis scoring are examined in detail, the two most frequently observed criteria are increase in oxygen demand [155 sepsis attacks (73.1%)], increase in ventilation need [138 attacks (65.1%)], while the most common laboratory findings are acute phase. increased reactants [(145 sepsis attacks (68.4%) elevated CRP (>15 mg/dl), 163 sepsis attacks (76.9%) elevated procalcitonin levels (≥2 ng/ml)] and immature/total neutrophil ratio increased (>0.2) [151 attacks (71.2%)]. Fungal growth was observed in eight episodes (3.8%). Among coagulase-negative staphylococci, S.epidermidis (35.8%) was the most common. After CNS, Klebsiella spp. [23 attacks (10.8%)], Serratia spp. [ten attacks (4.7%)], Candida spp. [eight attacks (3.8%)] were seen most. It was seen that the causative agent was MRCNS in 122 of 137 attacks in which CNS was detected, and S.epidermidis in 67 of MRCNS. All 155 sepsis attacks due to gram-positive agents were found to be susceptible to vancomycin. When CNS with methicillin resistance are examined; Tetracycline resistance was observed in 20, co-trimoxazole resistance in eight, and clindamycin resistance in 75. When methicillin-susceptible Gram-positive agents were examined, penicillin resistance was observed in eight cases. When the antibiograms of Klebsiella strains are examined; It was observed that 7 of 16 attacks with K.pneumoniae were ESBL positive, and all K.oxytoca strains were ESBL negative. While meropenem was found to be sensitive in 47 of 49 Gram-negative sepsis attacks, it was observed to be resistant in two attacks. One of these meropenem resistant agents was B.cepacia and the other was A.baumannii. Panresistant enterobactericea was not detected in our study. In cases who died from sepsis, six (40%) Gram-positive, eight (53.3%) Gram-negative, one (6.7%) fungal growths were the causative agents. Serratia marcescens grew in three (20%) of these patients, S. epidermidis in three (20%), and other agents in the remaining nine. All of the deaths due to Gram-positive agents were below 30 weeks of gestation and were ADDA. CONCLUSION: In our study, gram-positive bacteria (most common CNS and S.epidermidis) were found to be the most common sepsis agents, followed by Klebsiella spp. is following. It was observed that the contamination rates decreased from 18.2% to 8.9%. When EMA sepsis scoring was examined retrospectively, it was predicted that it could be used as a diagnostic criterion because it was found to be positive in 83.5% of proven neonatal sepsis cases. In our study, it is observed that Gram-negative agents have increased over the years, while the changes in the agents have been shown over the years. Knowing the factors that cause neonatal sepsis and the change in antibiotic susceptibility over time will both facilitate the selection of the appropriate empirical antibiotic therapy by providing the recognition of the hospital flora and will guide the clinician in terms of cost-effectiveness. Key words: Neonate, sepsis, EMA criteria, antibiotic resistance, contamination