الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Neonatal sepsis is the most serious problem in NICUs, and it had been attributed to
several maternal and neonatal risk factors. It may be classified according to the time of
onset into EOS and LOS. Its clinical diagnosis is complicated as early signs of infection
are nonspecific.
Blood culture remains the mainstay for detection of BSI pathogens, however, the
proper interpretation of its results may be challenging. The primary factors that
significantly influence the sensitivity, specificity and interpretation of blood cultures are
number and volume of blood specimens, dilution of blood to culture medium, skin
disinfection, timing of collection and transportation of blood culture.
Contamination of blood cultures usually originates from the environment or the
patient’s skin, which lead to misuse of antibiotics, longer hospital stays and related
morbidities. Clinical and laboratory data, associated risk factors, identity of the isolated
organism, number of positive cultures, growth time had been proposed to differentiate
contamination from true sepsis. Best sampling practices should be implemented to reduce
blood culture contamination rates.
The present study aimed to:
1. Isolate and identify the causative agents of sepsis from blood samples of neonates
with determination of their antimicrobial susceptibility patterns.
Summary, Conclusion and Recommenations
82
2. Provide an education program for NICU staff concerning the best sampling
practices.
3. Implement best practice procedure in sampling to reduce blood culture
contamination in NICU.
4. Compare the difference in contamination rates before and after implementation of
the best sampling practices.
This cross-sectional intervention study was conducted over a period of 8 months
from May to December 2018. The study included three phases; the pre and post
intervention phases enrolled 266 suspected neonatal sepsis cases admitted to NICU. The
intervention phase was conducted on 85 HCWs at NICU of Elraml Pediatric Hospital in
Alexandria.
- Pre-intervention phase: 133 blood cultures were collected before implementation
of best sampling practices and identification of isolates was performed. Clinical
criteria and laboratory data combined with associated risk factors were used to
differentiate the contaminated cultures from clinically significant ones.
- Intervention phase: Implementation of best sampling practices during a period of
one month.
- Post-intervention: 133 blood samples were collected after implementation of best
sampling practices. Checklists for proper blood culture sampling were provided
with each bottle and fulfilled by the infection control team.
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The results of the present study revealed that:
1. Thirty-three neonates (pre and post-intervention) had been diagnosed as proven
sepsis. 33 bacterial isolates from proven sepsis cases showed 23 (69.70%) gram
negative and 10 (30.30%) gram positive bacteria.
2. K. pneumoniae was the predominant isolate in the pre or post-intervention
samples (36.86% versus 28.58%, respectively), followed by S. aureus (31.58%
versus 21.44%, respectively).
3. The majority (63.64%) of proven sepsis cases had LOS, while 36.36% had EOS.
K. pneumoniae was the most frequent isolate in LOS and S. aureus in EOS.
4. Fifty-three CoNS contaminants were isolated from the pre and post-intervention
blood cultures. The most common CoNS spp. in the pre-intervention period were S.
epidermidis and S. saprophyticus (31.25% each), while S. saprophyticus (57.14%)
and S. epidermidis (28.57%) were observed in the post-intervention period.
5. There was a decrease in blood culture contamination rate from 24.06% (32 out of
133) to 15.79% (21 out of 133) after implementation of best sampling practices
for one month.
6. Proven sepsis was significantly related to two risk factors (CVC application and
C.S) and was significantly related to CRP positivity (96.97%), thrombocytopenia
(75.76%), leukocytosis (45.45%), and anemia (24.24%).
7. All gram-negative isolates were resistant to ampicillin and amoxicillin-
clavulanate, while they showed the high susceptibility to imipenem and
meropenem (100%).
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84
8. High MDR percentages were recorded among gram-negative isolates, K.
pneumoniae (36.36%), A. baumannii (66.7%), K. oxytoca, E. coli, and P.
aeruginosa (100% each).
9. All S. aureus isolates were MRSA, but they were sensitive to vancomycin and
linezolid.
It can be concluded from the present study that:
1. The most predominant causative agent of neonatal sepsis is K. pneumoniae.
2. High percentages of multi drug resistant gram negative bacteria (MDR-GNB) in
neonatal sepsis.
3. S. epidermidis is responsible for 3.03% of proven neonatal sepsis cases.
4. Implementation of best sampling practices significantly reduced blood culture
contamination rate.
from the results of the present study, the following recommendations are suggested:
1. Use of collaborative criteria (clinical and laboratory data, risk factors, and identity
of the isolated organism) to discriminate between contaminants and true pathogens
in blood culture results.
2. Implementation of best sampling practices with continuous monitoring and
education programs should be maintained until achieving the accepted
contamination rate benchmark.
3. Updating the empirical antibiotic regimen in NICUs at local health care facilities,
according to the current resistance pattern.