Clinical Scorecard: Bacteriological Characteristics of Early-Onset Compared to Late-Onset Neonatal Sepsis in a Tertiary Care Facility in Nepal
At a Glance
Category
Detail
Condition
Neonatal sepsis (infection within first 28 days of life involving bloodstream)
Key Mechanisms
Bacterial bloodstream infection causing systemic infections; early-onset (<72h) linked to maternal/perinatal factors, late-onset (>72h to 28 days) linked to nosocomial or community infections
Target Population
Neonates from birth to 28 days admitted to NICU and neonatal wards
Care Setting
Tertiary care hospital neonatal intensive care unit and neonatal wards
Key Highlights
Neonatal sepsis classified as Early-Onset Neonatal Sepsis (EONS) within 72 hours and Late-Onset Neonatal Sepsis (LONS) after 72 hours up to 28 days.
Common causative bacteria for EONS include Escherichia coli and Group B Streptococci; LONS commonly involves Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Coagulase-negative Staphylococci (CoNS), and Group B Streptococci.
Risk factors for EONS include maternal infections, low birth weight, prematurity, prolonged rupture of membranes, and perinatal asphyxia; LONS risk factors include poor hygiene, unclean cord care, bottle feeding, and traditional umbilical cord substances.
Guideline-Based Recommendations
Diagnosis
Blood culture using aseptic techniques with incubation in BacT/ALERT system for seven days.
Identification of isolates by gram staining, catalase, coagulase, oxidase tests, and biochemical tests following ASM protocols.
Use of C-reactive protein (CRP) as an acute-phase reactant for monitoring infection onset, noting low specificity.
Management
Antibiotic susceptibility testing via Kirby-Bauer disc diffusion method on Muller Hinton Agar following CLSI M100:2019 guidelines.
Detection of multidrug-resistant organisms (MDR) defined as resistance to at least one agent in three or more antimicrobial categories.
Screening for MRSA and MR-CoNS using cefoxitin disc diffusion with defined zone inhibition cutoffs.
Detection of extended-spectrum beta-lactamase (ESBL) producers using ceftriaxone disc diffusion.
Monitoring & Follow-up
Serial CRP measurements to monitor infection progression, recognizing potential false positives in non-infectious inflammation.
Repeat cultures to exclude contaminants and confirm true pathogens.
Risks
Unhygienic cord care increases sepsis risk nearly threefold.
Use of traditional substances on umbilical cord increases risk of LONS by 2.8 times compared to antiseptic care.
Nosocomial and community-acquired infections contribute to LONS.
Patient & Prescribing Data
Neonates admitted from birth to 28 days with suspected sepsis in a tertiary care setting in Nepal.
Antibiotic therapy guided by culture and sensitivity results; awareness of multidrug resistance and MRSA/MR-CoNS prevalence is critical for effective treatment.
Clinical Best Practices
Employ strict aseptic technique during blood sample collection to minimize contamination.
Use standardized microbiological protocols for bacterial identification and antibiotic susceptibility testing.
Incorporate CRP testing as adjunctive monitoring but interpret cautiously due to low specificity.
Implement infection control measures to reduce nosocomial infections contributing to LONS.
Educate caregivers on hygienic cord care and avoidance of traditional harmful substances to reduce sepsis risk.
