Krisztina Mader

Outbreak of septicaemic cases caused by Acinetobacter ursingii in a neonatal intensive care unit

Neonatal infections may be caused by various microorganisms, but as far as we are aware, Acinetobacter ursingii has not yet been reported in connection with nosocomial infections of premature infants. During 2 months, 3 premature babies were treated with nosocomial infection caused by A. ursingii at the same ward, and on the basis of molecular typing results the same strain was responsible for all of these cases. Traditional biochemical methods and automatic identification systems failed to identify this bacterium on the species level, and only 16S rDNA sequencing gave acceptable species identifications. The isolated strains proved to be susceptible to all of the tested antimicrobials, including ampicillin/sulbactam, doxycyclin, netilmicin, ciprofloxacin, piperacillin/tazobactam, ceftazidime, imipenem, meropenem, trimethoprim/sulfametoxazole, gentamicin, tobramycin, amikacin, and levofloxacin according to the CLSI standard. In spite of the environmental screening, the source of the infection could not be clarified. One of 3 neonates died, the others recovered and were discharged home after several months of hospitalization.

Chryseobacterium gleum – a novel bacterium species detected in neonatal respiratory tract infections

Abstract We report three patients with early neonatal infections. All patients had respiratory tract involvement with increased inflammation markers. Chryseobacterium gleum was cultured from the stomach content aspirated on arrival at the Neonatal intensive Care Unit and it was identified with the help of a Microflex™ MALDI Biotyper mass spectrometer (Bruker-Daltonik, Fremont, CA). Recovery could be achieved with ciprofloxacin treatment. We consider our cases a possible new clinical presentation of a rare human pathogen.

Lesions requiring wound management in a central tertiary neonatal intensive care unit

BackgroundMost of the skin disorders that occur in neonatal intensive care units are due in part to the immaturity and vulnerability of the neonatal skin. Various iatrogenic diagnostic and therapeutic procedures are also conducive to iatrogenic damage. This study was to review the neonates admitted to our neonatal intensive care unit who needed wound management, and to assess the most common skin injuries and wounds, and their aetiology.MethodsData were extracted from medical records of neonates who needed wound management in our Neonatal Intensive Care Unit between January 31, 2012 and January 31, 2013. Information about gestational age, sex, birth weight, area of involvement, wound aetiology, and therapy were collected.ResultsAmong the 211 neonates observed, wound management was required in 10 cases of diaper dermatitis, 7 epidermal stripping, 6 extravasation injuries, 5 pressure ulcers, 1 surgical wound and infection, 1 thermal burn, and 5 other lesions.ConclusionsInternational guidelines in neonatal wound care practice are not available, and further research concerns are clearly needed. Dressings and antiseptic agents should be chosen with great care for application to neonates, with particular attention to the prevention of adverse events in this sensitive population. Team work among dermatologists, neonatologists and nurses is crucial for the successful treatment of neonates.

Successful elimination of extended-spectrum beta-lactamase (ESBL)-producing nosocomial bacteria at a neonatal intensive care unit

BackgroundExtended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are highly dangerous to neonates. At our Neonatal Intensive Care Unit (NICU), the presence of these bacteria became so threatening in 2011 that immediate intervention was required.MethodsThis study was conducted during a nearly two-year period consisting of three phases: retrospective (9 months), educational (3 months) and prospective (9 months). Based on retrospective data analysis, a complex management plan was devised involving the introduction of the INSURE protocol, changes to the antibiotic regimen, microbiological screening at short intervals, progressive feeding, a safer bathing protocol, staff hand hygiene training and continuous monitoring of the number of newly infected and newly colonized patients. During these intervals, a total of 355 patients were monitored.ResultsBoth ESBL-producing Enterobacter cloaceae and Klebsiella pneumoniae were found (in both patients and environmental samples). In the prospective period a significant reduction could be seen in the average number of both colonized (26/167 patients; P=0.029) and infected (3/167 patients; P=0.033) patients compared to data from the retrospective period regarding colonized (72/188 patients) and infected (9/188 patients) patients. There was a decrease in the average number of patient-days (from 343.72 to 292.44 days per months), though this difference is not significant (P=0.058). During the prospective period, indirect hand hygiene compliance showed a significant increase (from the previous 26.02 to 33.6 hand hygiene procedures per patient per hospital day, P<0.001).ConclusionColonizations and infections were rolled back successfully in a multi-step effort that required an interdisciplinary approach.

Overview of Dermatologic Disorders of Neonates in a Central Regional Intensive Care Unit in Hungary

The immaturity and vulnerability of the skin and epidermal barrier function and the frequent iatrogenic complications following diagnostic and therapeutic procedures are often associated with skin manifestations in infants in neonatal intensive care units (NICUs). The aim of the current study was to investigate dermatologic disorders in neonates in our NICU. A prospective cohort study was conducted in the NICU at the Department of Pediatrics at the University of Szeged between January 2012 and January 2013. All full‐ and preterm infants hospitalized in the NICU underwent whole‐body skin examinations and all dermatologic disorders and treatment modalities were recorded. Eighty‐nine dermatologic conditions were detected in 64 of the 211 neonates admitted to the NICU. A wide variety of clinical symptoms accompanied these conditions in these preterm and severely ill full‐term infants. A considerable proportion of the disorders that were seen resulted from the immaturity of the skin and various iatrogenic complications. Dermatologic disorders are frequent in neonates requiring intensive care. Prevention, early detection, and optimal treatment of these disorders with modern, standardized skin care management strategies can result in significant improvements in barrier function and in the integrity of the skin, increasing the overall efficacy of neonatal intensive care.

Successful Postoperative Treatment of a Lumbosacral Ulcer in a Neonate after Myelomeningocele

Wound care in neonates demands special awareness of the anatomical and physiological characteristics of their skin, and the danger of adverse mechanical and toxicological events. Here, we present the case of a full-term neonate born with myelomeningocele. Following the closing surgery on the 3rd day of postuterine life, the operated region became inflamed, the sutures opened and a necrotic discharging ulcer developed. Besides parenteral antibiotic treatment based on the microbiological findings, intelligent hydrofiber dressings were applied to the wound with regard to the special characteristics of wound care in neonates. After 72 days, the ulcer had healed with a small residual scar, and the infant is currently demonstrating normal physical and mental development.

PO-0765 Introduction Of Insure Therapy – Experiences And Limitations

Background and aims Respiratory Distress Syndrome is the most frequent cause of respiratory insufficiency in premature infants. The essentials of INSURE therapy are INtubation after noticing the condition of RDS, SURfactant therapy and Extubation to non-invasive respiration. At our ward INSURE therapy was introduced in 2012. Patients and methods We analysed our patients who received INSURE therapy during the 21-month-long period from July 1. 2012 until March 31. 2014. INSURE therapy was considered effective, if the patient did not require invasive ventilation within 1 week. During the examined period 398 patients were admitted to our 18-bed tertiary Neonatal Intensive Care Unit. INSURE therapy was applied in the case of 82 prematures (gestational age: 29 ± 3 weeks, birthweight 1358 ± 404 g; mean±SD). Results A surfactant (Curosurf ®) dose of 168 ± 39 mg/kg was administered. There was no need for repeated intubation in 57 cases, in 13 cases a second dose was surfactant was also necessary. In 21/82 cases INSURE was not successful. In the unsuccessful group patients were not significantly younger and smaller. Procalcitonin levels at the age of one day were significantly higher the group of unsuccessful cases. III-IV Gr. IVH occurred in 6/82 necrotizing enterocolitis in 7/82 and bronchopulmonary dysplasia in 7/82 cases. Complications were more frequent in those cases whose INSURE therapy was unsuccessful. Conclusions The introduction of INSURE-therapy grossly decreased the need for invasive respiratory support. High procalcitonin levels and clinical manifestations of early neonatal infections as well as low birth weight negatively influenced the success of INSURE-therapy.