1Early neonatal sepsis at tertiary care teaching hospital作者：Muhammad Javed, Abdul Majid Memon【摘要 】 Objective:To study organisms in cases of early neonatal sepsis, and sensitivity patterns of these isolates. Methods: All pregnant mothers admitted from Jan 2006 Dec 2006 were registered. Neonates delivered at the hospital were examined upto 72 hours of birth, with special emphasis on the signs and symptoms of suspected sepsis. Neonates with no maternal or neonatal risk factor were included in the study, blood examination and appropriate cultures were taken. Antibiotics as cephatexime and amikacin were started on empirical bases until final cultures report was received. In cases of negative cultures, antibiotics were stopped. Other wise it continued according to culture and sensitivity for 10 to 14 days. Results: Among these 257 cases, 113 neonates full filled our criteria. Staph aureus being the commonest organism in our study (59.29%) followed by Klebsiella pneumoniae (19.47%) and Entrococci (19.47%). These findings are not consistent with other studies in the 2country.Conclusion: Neonatal sepsis is a major cause of mortality and morbidity. Choice of antibiotic should depend on the local studies from time to time. 【关键词】 Neonatal sepsis; Isolates; SensitivityINTRODUCTIONGlobally 5 million children die every year, and 1.6 million neonates die due to sepsis in under developed countries. Pakistan is among one of the highest countries in Eastern Mediterranean region with high neonatal mortality13. 60% of neonatal deaths take place in the first week of life. Sepsis is one of the commonest causes of this high neonatal mortality rate46. There are number of risk factors for this high neonatal mortality due to sepsis.Neonatal sepsis is defined as early neonatal sepsis from birth to 72 hours of life, and late neonatal sepsis after 72 hours of birth, Organisms in cases of early neonatal sepsis are usually transmitted by the mother (vertical transmission), and in cases of late neonatal sepsis from the environment 3(nosocominal).Maternal factors include chorioamnionitis, infections at the time of labour, prolong rupture of membranes over 18 hours, and repeated vaginal examinations at the time of labour. Neonatal factors are pre maturity, low birth weight, and meconium aspiration.Sign and symptoms of the sepsis are often nonspecific. Babies response to stimuli, the colour of umbilicus, respiratory rates and abnormal heart rate, particularly bradycardia, are the important parameters.We studied the organisms and sensitivity patterns in blood culture proven cases of early neonatal sepsis at Hamdard University Hospital.MATERIALS AND METHODSAll mothers admitted from Jan 2007Dec 2007 were registered on a pre designed Performa, by the House Officers/Resident Medical Officers of Hamdard College of 4Medicine & Dentistry/Hamdard University Hospital. Neonates of all mothers delivered at the hospital were examined, first immediately at birth and then daily until mother was discharged in two to three days.Special emphasis was given on the signs and symptoms of suspected as babies response to stimuli, the colour of umbilicus, respiratory rates and abnormal heart rate, particularly bradycardia. Neonates with suspected sepsis and with no maternal risk factors as maternal infection, fever, mother using antibiotics before delivery, prolong labour, premature rupture of membranes and signs of chorioamnionitis were excluded. Neonates with prematurity, congenital and chromosomal anomalies were also excluded from the study, blood examination and cultures were collected by the house officers. Special instructions were given to avoid skin contamination at the time of collection. Antibiotics as cephatexime and amikacin were started on empirical bases until final cultures report were received. In cases of negative cultures, antibiotics were stopped. Other wise it continued according to culture and sensitivity for 10 to 14 days.RESULTS5Total numbers of deliveries at Hamdard university hospital from Jan 2006 to Dec 2006 were 950. And 257/950 (27.05%) had proven sepsis. There were 113 neonates meeting our criteria, Positive blood cultures in our study were 43.96%. These figures are different from study by Rehana Akhtar, Aslam haider6 and Nadeem Haider and Sajjid Maqbool7. Staph aureus is the commonest organism in our study (67, 59.29%) followed by Klebsiella (22, 19.47%) and Entrococci (22, 19.47%), which is not consistent with other studies of Karachi and Lahore8,9 showing Staph. aureus as major organism10.Escherichia coli (E. coli), which is the commonest organism in other international and national studies, is only present in 2 cases in our study(1.77%). And no case had Pseudomonas.Where as Klebsiella and Entrococci were isolated in 39.8% of cases, Staph aureus was resistant to ampicillin, cloxicillin and third generation in 20% cases, and sensitive to vancomycin in 100% cases. Entococci was resistant to 6am