Neonatal sepsis is a clinical syndrome of bacteremia and systemic infection in infants under 4 weeks of age. It is classified as early onset (less than 72 hours) or late onset (more than 72 hours). Early onset sepsis is usually acquired from the mother during birth and has a sudden and fulminant presentation, while late onset sepsis is often acquired in the NICU from healthcare exposures and other infants. Blood culture is the gold standard for diagnosis but has low sensitivity, while urine and CSF cultures may also be obtained depending on the clinical scenario. Proper collection and handling of specimens is important for optimizing diagnostic yield.
This presentation aims at discussion of the pathophysiology , clinical presentation and management of the different types of intracranial bleeds in a neonate. Special emphasis has been laid on intraventricular hemorrhage. The germinal matrix bleed in a preterm is discussed in depth along with the various evidence based management protocols available. Radiological diagnosis of IVH in a preterm / term baby will be discussed in the upcoming presentations.
This presentation aims at discussion of the pathophysiology , clinical presentation and management of the different types of intracranial bleeds in a neonate. Special emphasis has been laid on intraventricular hemorrhage. The germinal matrix bleed in a preterm is discussed in depth along with the various evidence based management protocols available. Radiological diagnosis of IVH in a preterm / term baby will be discussed in the upcoming presentations.
what is community acquired pneumonia(CAP),what is the prevalence of (CAP) ,what are the risk factors and what are the causative agents ,what are the clinical presentations ,how to diagnose it,what are the needed investigations ,what is the management ,what are the procedures to decrease the incidence,
An important condition that is usually misdiagnosed. It's therefore important that healthcare practitioners understand this condition and this is what this presentation will help them with.
This presentation reviews some general fever related pearls before segueing into a review of fever workup in neonates, children 3-36 months, and then fever of unknown origin in older children.
what is community acquired pneumonia(CAP),what is the prevalence of (CAP) ,what are the risk factors and what are the causative agents ,what are the clinical presentations ,how to diagnose it,what are the needed investigations ,what is the management ,what are the procedures to decrease the incidence,
An important condition that is usually misdiagnosed. It's therefore important that healthcare practitioners understand this condition and this is what this presentation will help them with.
This presentation reviews some general fever related pearls before segueing into a review of fever workup in neonates, children 3-36 months, and then fever of unknown origin in older children.
Neonatal sepsis is the cause of substantial morbidity and mortality. Precise estimates of neonatal sepsis burden vary by
setting. Differing estimates of disease burden have been reported from high-income countries compared with reports
from low-income and middle-income countries. The clinical manifestations range from subclinical infection to severe
manifestations of focal or systemic disease. The source of the pathogen might be attributed to an in-utero infection,
acquisition from maternal flora, or postnatal acquisition from the hospital or community. The timing of exposure,
inoculum size, immune status of the infant, and virulence of the causative agent influence the clinical expression of
neonatal sepsis. Immunological immaturity of the neonate might result in an impaired response to infectious agents.
This is especially evident in premature infants whose prolonged stays in hospital and need for invasive procedures
place them at increased risk for hospital-acquired infections. Clinically, there is often little difference between sepsis
that is caused by an identified pathogen and sepsis that is caused by an unknown pathogen. Culture-independent
diagnostics, the use of sepsis prediction scores, judicious antimicrobial use, and the development of preventive
measures including maternal vaccines are ongoing efforts designed to reduce the burden of neonatal sepsis
Austin Clinical Microbiology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Microbiology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all the areas of Clinical Microbiology. Austin Clinical Microbiology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of microbiology.
Austin Clinical Microbiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Neonatal sepsis (sepsis on new born) with case presentationJOEL RAJAN U
Newborn sepsis is a severe infection in an infant younger than 28 days old. A newborn may become infected before, during, or after birth. Newborn sepsis can be hard to diagnose. Early diagnosis and treatment are the best ways to stop sepsis.
Bio-Oxfort(Brazil)introduce the Populational Screening Test for HIV,SIfillis,Hepatites B&C for all Goverments and Lab wourlwide using Elisa filter paper(especially on difficult and rural areas).The Focus is to prevent and diagnosy those deaseas on time to be trat it and them reduce the % of mortality!
Hello Guys,
This presentation talks about diagnosis and management of Antenatally detected hydronephrosis. We have discussed evidence based fetal hydronephrosis management including - antenatal followup schedule, fetal interventions, postnatal screening and follow up proforma, MCU, Functional renal scans, prophylactic antibiotics and available surgical management options.
This presentation is an overview of congenital cyanotic heart diseases, with a special discussion on Tetralogy of Fallot. We discuss the pathophysiology, clinical manifestations as well as the most updated management options for treating this condition. The topic ends with a few important complications seen in TOF patients. Hope you find it useful.
You can follow us on: Facebook page 'Neonatohub' (online academic platform) OR visit our YouTube channel 'Neonatohub' for more paediatric and neonatology presentations.
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
This presentation is a simplified version of the various types of cardiac arrythmias seen in pediatric age groups. We have discussed supraventricular tachycarsias and prolonged QT syndrome in details here. Hope everyone finds it useful.
Hello guys,
Todays presentation aims at discussing the most common syndromic causes of short stature - Turners syndrome and Downs syndrome. We have discussed the Genetics, Phenotype and co-morbidities with their individual management strategies. I hope you find it uselful too.
This presentation discusses cranial hemorrhage in a newborn baby. We have included extracranial and intracranial bleed discussion in neonates. Intraventricular hemorrhage (IVH) is further discussed in details in terms of pathophysiology, management strategies and clinical studies related to it.
Hope this presentation is helpful for the knowledge and practice of medical students, pediatricians and neonatologists and helps in practical management of your NICU babies as well.
This presentation aims at helping the pediatric trainees and practitioners to brush up their knowledge in Immunization. The schedule is based on the Universal Immunisation Programme. I have tried to cover as much as possible in terms of individual vaccines and hope it is beneficial to the reader.
This presentation aims at helping the pediatric trainees and practitioners to brush up their knowledge in Immunization. The schedule is based on the Universal Immunisation Programme. I have tried to cover as much as possible in terms of individual vaccines and hope it is beneficial to the reader.
This presentation is a part 2/4 of series of presentation on Paediatric immunization.This presentation aims at helping the pediatric trainees and practitioners to brush up their knowledge in Immunization. The schedule is based on the Universal Immunisation Programme. I have tried to cover as much as possible in terms of individual vaccines and hope it is beneficial to the reader.
This presentation aims at helping the pediatric trainees and practitioners to brush up their knowledge in Immunization. The schedule is based on the Universal Immunisation Programme. I have tried to cover as much as possible in terms of individual vaccines and hope it is beneficial to the reader.
This presentation is aimed at giving the basic information of a neonate classification on basis of gestational age and the birth weight. Prematurity has been discussed in details. I have also included the growth charts that can be used for growth monitoring in term as well as preterm babies.
** This presentation is available in a video lecture format at my youtube channel - NeonatoHub. Do watch it for further understanding of the topic & subscribe to the channel.
Hello guys, bringing to you the concept of golden hour of neonatology. As in trauma, the first hour of neonatal life is most precious and this ppt is an attempt to highlight a few key aspects of this resuscitative strategy in premature infants.
This presentation deals with the basic physics of human ventillation. I have made an effort to clarify most of the venti lingo , so as to make way for further discussions on ventilator use. Hope it turns out to be helpful for you. Thank you.
Respiratory physiology & Respiratory Distress syndrome in a newborn.Sonali Paradhi Mhatre
Hi guys, This ppt shows the pathophysiology of pulmonary surfactant in newborn and respiratory distress syndrome. Main focus is towards management of RDS esp. exogenous surfactant administration. Your comments are welcome. Thank you.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Microbiological testing in neonatal intensive unit.
1.
2. Neonatal Sepsis
Overall incidence = 1-5 per 1000 live births.
Incidence much higher for VLBW babies :
Early onset sepsis rate = 2%
Late onset sepsis rate = 36%
The mortality rate is high (13 – 25%) ; higher rates seen in
VLBW babies and in those with early fulminant sepsis.
Data from National Institute of child health and Human Development Neonatal research network
(NICHD-NRN)
3. Neonatal Sepsis
Neonatal sepsis is defined as a clinical syndrome of
bacteremia with systemic signs and symptoms of infection
in the first 4 weeks of life.
Neonatal sepsis is classified into 2 types depending on the
onset of symptoms.
Early onset sepsis
( < 72 Hrs)
Late onset sepsis
( > 72 Hrs)
4. Early onset sepsis
Presents in the first 72 hrs of life and is usually a
multisystem fulminant illness with prominent respiratory
symptoms.
Organism is acquired during antepartum or intrapartum
period from the maternal genital tract.
Primary sites of colonization includes skin, nasopharynx,
oropharynx, conjunctiva and umbilical cord.
5. Early onset sepsis
Early onset disease is characterized by a sudden onset
and fulminant course that can rapidly progress to septic
shock and death.
Organisms most commonly implicated are :
o B- streptococcus (GBS)
o E. Coli
o Staphylocoocus
o Enterococci
o Others like Listeria monocytogenes, Haemophilus influenza,
Streptococcus pneumoniae.
6. Early onset sepsis
Early onset disease is characterized by a sudden onset
and fulminant course that can rapidly progress to septic
shock and death.
Organisms most commonly implicated are :
o B- streptococcus (GBS)
o E. Coli
o Staphylocoocus
o Enterococci
o Others like Listeria monocytogenes, Haemophilus influenza,
Streptococcus pneumoniae.
7. Late onset sepsis
Late onset sepsis is often more insiduous but can be
fulminant at times.
In addition to bacteremia these infants may have an
identifiable focus, most often meningitis,in addition to
sepsis.
Bacteria responsible for LOS and meningitis include those
acquired after birth from human contact or from
contaminated equipment / environment (nosocomial).
8. Late onset sepsis
The pathogenesis is related to the underlying illness and
debilitation of the infant (esp Preterm, VLBW), the flora in NICU,
degree of asepsis performed during invasive NICU procedures,
breaks in skin and mucosal barrier,etc.
Organisms most commonly implicated are :
o Coagulase negative staphylocci esp. staph epididermis
o Gram negative rods (eg. Klebsiella, proteus, Pseudomonas)
o Staphylococcus aureus.
o GBS
o Fungal microorganisms.
9. Late onset sepsis
The pathogenesis is related to the underlying illness and
debilitation of the infant (esp Preterm, VLBW), the flora in NICU,
degree of asepsis performed during invasive NICU procedures,
breaks in skin and mucosal barrier,etc.
Organisms most commonly implicated are :
o Coagulase negative staphylocci esp. staph epididermis
o Gram negative rods (eg. Klebsiella, proteus, Pseudomonas)
o Staphylococcus aureus.
o GBS
o Fungal microorganisms.
10. Why Microbiology discussion
…???
Information derived from the results of the various
microbiological tests in a NICU setup have an impact on :
Diagnosis of infectious diseases.
Choice of antibiotics.
Antibiotic duration.
Antibiotic policy formulation.
Infection Control measures.
11. Medical microbiology
Microbes are tiny organisms—
too tiny to see without a
microscope, yet they are
abundant on Earth.
A pathogen or infectious agent
is a biological agent that causes
disease or illness to its host.
These include Bacteria, viruses,
fungi, protozoa.
12.
13. Blood culture
The isolation of microorganisms from blood is the GOLD STANDARD
used to diagnose sepsis in the newborn infant.
Despite this fact, Blood culture examination suffers from the
disadvantages of low sensitivity and reporting delay of 24 to 72 h.
The diagnostic capabilities of blood culture systems have improved over
the last decade with the advent of automated continuous blood culture
monitoring systems.
Although they can save time, subcultures are required for specific
biochemical or other assays, ultimately needed for pathogen
identification.
24. How much….???
The optimal recovery of bacteria and fungi from blood depends on culturing an
adequate volume of blood.
The optimal volume of blood to be obtained from neonates have not been
defined by certainity, however available data indicates that the yield of
pathogens also increases in direct proportion to the volume of blood
cultured.
Weight of
patient
Patients total
blood volume
(ml)
Recommended volume for
culture (ml)
Total volume for
culture (ml)
% of patients
blood volume
Culture no. 1 Culture no. 2
≤1 kg 60 – 99 2 - 2 4
1.1 - 2 100 - 200 2 2 4 4
2.1 – 12.7 > 200 4 2 6 3Adapted from Kellogg et al. Frequency of low level bacteremia in children from birth to 15 yrs.J. clinical microbiology 2000;38:2181-2185.
25. How many….???
There is limited information to guide the practitioner on the
optimal number of blood cultures that should be obtained
when evaluating an infant for suspected neonatal sepsis.
The decreased sampling in neonates is attributed to :
o The small circulating blood volume,
o Potential for increased transfusion requirements,
o Technical difficulties &
o The rapid deterioration of newborns in the setting of
neonatal sepsis.
26. How many….???
Sarkar, bhagat, et al. (2008) studied the usefulness of 2 site
culture in the initial evaluation of neonatal sepsis.
This study strongly indicated that a single site blood culture
with blood volume ≥1ml should be sufficient to document
“true” Gram positive, gram negative or fungal sepsis in
neonates.
An Aerobic bottle should be used for collection of culture of
a neonate.
27. When….???
In contrast with extensive adult data on the periodicity of bacteremia
in a variety of clinical scenarios, neonatal setting is characterised by
a lack of data on timing of blood cultures.
Practically the optimum time to culture for a neonatal suspected
bacteremia is “ As Early As Possible” in the course of septic
episode.
Ideally to be obtained prior to the administration of antimicrobial
therapy.
If already on antibiotics, blood culture to be taken immediately
before administering the next dose.
28. How to read..??
Interpreting the positive results depends on the clinical
presentation, how the culture was taken, the organisms grown,
and the time taken for the blood culture to become positive.
Some organisms like N. meningitidis, Candida albicans are nearly
always significant, even in a well looking child.
Cultures positive with potential pathogens that may also be
contaminants (eg. CoNS) are difficult to interpret and require
clinical correlation for diagnosis.
29. How to read..??
Rate of contamination are found to be highest in neonates.
Cultures drawn through indwelling intravenous devices are more
likely to be contaminated and need an additional peripheral
culture sample.
Positive blood cultures with higher colony counts and flagging
positive within 48 hrs of being drawn have been associated with
an increase likelihood of significance.
Prior antibiotic use may decrease the sensitivity of the test further.
30. Key Points….!!
Important procedures to improve the sensitivity and
specificity of blood cultures include :
Proper technique is most critical because it takes only
one organism to contaminate a collection.
Proper skin disinfection before collection,
Culturing early in the septic episode.
Taking an appropriate volume of blood per culture.
If collecting through an existing intravenous device, ensuring
that a peripheral culture is also collected.
Wherever practical, more than one bottle per episode. (This
is not always feasible in a very tiny infant.)
31.
32. Fluids sent for culture from NICU :
Urine
Cerebrospinal
Fluid
Pleural fluid
33. Fluids sent for culture from NICU :
Urine
Cerebrospinal
Fluid
Pleural fluid
42. Label the bottle correctly &
provide relevant clinical data of
the patient.
43. Urine culture
Urine culture is essential for
confirmation and appropriate therapy
for urinary tract infection in infants.
(according to a study from the
University of Southern California (USC),
Los Angeles. 2012)
Infants with late onset sepsis tend to
have higher positive results in urine
culture.
In an older infant , a urine sample
collected by aseptic technique (urinary
catheter or suprapubic bladder
aspiration) is an important part of the
sepsis workup.
44. Urine culture
The frequency of positive urine cultures in infants with early onset sepsis is
relatively low, and it is rare to find bacteriuria in infants with negative blood
culture reports.
In this era of widespread intrapartum antibiotic use in mother, positive urine
cultures may be obscured because of the excretion of antibiotics in the
urine of the newborn infant.
It is generally not recommended to obtain urine culture specimens in the
first 72 hrs of life , because the low yield from urine culture.
Studies have also shown that urine culture collected by bag specimen method
was effective in detecting urinary tract infection only after the 7th day of life.
(falcao mc., Urinary tract infection in full-term newborn infants: value of urine culture by bag specimen
collection.2000)
45. Urine culture interpretation
The colony forming units (CFU) corrosponds to the number of viable bacteria
per ml of urine & is the standard used for the interpretation on urine culture
sample.
A true infection in the absence of prior antibiotic therapy the number of
bacteria is likely to be at least 10000 or more.
Any growth in a sample collected by suprapubic aspiration is considered
significant.
Significant Bacteruria is the numbers of bacteria (≥104
CFU/ml) greater than
those likely to result from contamination from the urethral meatus and its
environs.(ADULT)
Contaminated specimens present with colony counts <10000 and mixed flora.
Gram positive (eg streptococci), fungus and fastidious organisms often are
significant even at lower numbers.
.
46. Key points…!!!
Prompt plating of the urine sample for culture is important, because
if urine sits at room temperature for more than 60 mins, overgrowth
of minor contaminants can suggest a UTI, when urine may not be
infected.
Refrigeration is a reliable method of storing the urine until it can be
cultured.
Multiple (≥3) species of gram negative bacteria - contamination.
Single organism identification with CFU less than 10000 with clinical
significant UTI – warrants treatment.
54. CSF Culture
The incidence of meningitis in neonatal
sepsis varies from 0.3 – 3%.
The clinical features of septicaemia and
meningitis often overlap , thus it is quite
possible to have meningitis with sepsis.
In early onset sepsis, CSF examination
is recommended in presence of a
positive blood culture + signs of sepsis.
In late onset sepsis, lumbar puncture is
advocated in every baby before starting
antibiotics.
55. CSF Culture
Neonatal meningitis frequently occurs in the absence of bacteremia and in the
presence of normal CSF parameters. No single CSF value can reliably exclude the
presence of meningitis in neonates.
The CSF culture is critical to establishing the diagnosis of neonatal meningitis.
Antibiotic treatment prior to lumbar puncture can decrease the sensitivity of culture,
especially when given intravenously or intramuscularly.
Common Organisms implicated in Neonatal meningitis are : Group B Streptococci,
Escherichia coli, Listeria monocytogenes, Others are Enterobacteriaceae:
Salmonella spp., Citrobacter spp.
In Infants, these are : Neisseria meningitidis, Haemophilus influenzae,
Streptococcus pneumonia.
• (Garges et al; Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid
parameters. Peds 2006 Apr;117(4):1094-100.)
56. Key points…!!!
• Cultures done on blood agar and chocolate agar remain the gold
standards for diagnosing bacterial meningitis.
• CSF must be processed within 1 hour of collection.
• Do not refrigerate.
• All media should be incubated for 3 days, with daily inspections.
• Blood culture should be done with csf culture. Bacterial meningitis is
often associated with bacteraemia and the causative organism is
sometimes isolated from blood when csf culture is negative.
• Prior treatment is no excuse for not doing an LP!
.
57.
58. ET tube tip
culture
Strict Handwashing
Sterilium + Gloves
Keep sterile scissors and
culture tube ready prior to
extubation.
Tip of the ET tube has to
be cut directly into the
collection tube.
Label the sample
carefully.
Provide clinically
relevant data
59. UVC / PICC line
tip culture
Strict Handwashing
Sterilium + Gloves
Keep sterile scissors and
culture tube ready prior to
extubation.
Tip of the ET tube has to
be cut directly into the
collection tube.
Label the sample
carefully.
Provide clinically
relevant data
60. Swab collections
Strict Handwashing
Sterilium + Gloves
Keep sterile
swab & the
culture tube
ready.
Label the sample carefully.
Provide clinically relevant data
Gently swipe the swab over
the desired site for
discharge collection.
Put the swab in culture tube
61. NICU swabs
• Neonatology is a high-risk specialty for
infection
• Effective infection prevention and
control is central to providing high
quality health care for patients and a
safe working environment for those
that work in healthcare settings.
• Bio-aerosols are airborne particles that
are living (bacteria, viruses and fungi)
or originate from living organisms.
62. NICU swabs
Deepali Danave; Bio-aerosols in Neonatal Intensive Care Units in a District Hospital.
Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2015; 3(5E):2132-2134
63. NICU swabs – surface monitoring
1. Surface monitoring
• Contact surfaces (warmers,incubators) , floors, walls, and other equipment
should be tested on a regular basis.
• Surface Swabs - used for irregular surfaces
Surface monitoring should be performed at conclusion of aseptic processing (to
minimise risk of contaminating critical surfaces during production)
2. Air monitoring
• Settle plates exposed for 30-60 minutes (longer may result in agar drying
out) and replaced for duration of filling.
• Media should be capable of growing a range of bacteria and moulds (e.g.
Soybean Casein Digest Agar (SCDA)/Trypticase Soy Agar (TSA).
64. NICU swabs
3. Water monitoring
• Microbiological quality testing of water is very important.
• Feed water, pre-treatment, purified and water for injection (WFI) should be
tested.
• Water should also be tested for presence of coliforms and/or pseudomonads if
appropriate (may cause biofilm)
• Water used for parenterals should be properly assessed.
4. Compressed Air/Nitrogen/CO2
• Should be periodically tested.
5. Personnel should be periodically tested with surprise audits.
65. BACTEC
An improvement in the
sensitivity and rapidity of
bacterial recovery in blood
cultures has been achieved
with the more recent
automated machines,
including the BACTEC.
Bactec is an automatizated
method to detect the
presence of bacteria in
human blood.
66. BACTEC
The blood is put on a bottle and is
incubated at a certain temperature. The
machine is able to detect the growth of
bacteria in the bottle and alerts the
microbiologist.
The BACTEC cannot identify the
bacteria present in blood, therefore the
microbiologist makes a culture of
the positive bottles.
BACTEC has the advantage that
microbiologist only harvests the
positive samples of blood, making a
quick discard of negative samples with
gaining of time and saving costs.
67. VITEK
• The VITEK® 2 system is a fast,
accurate microbial identification, and
antibiotic susceptibility testing modality.
• The innovative VITEK® 2 microbial
identification system includes an
expanded identification database, the
most automated platform available,
rapid results, improved confidence, with
minimal training time.
• The VITEK® 2 system next-generation
platform provides greater automation
while increasing safety and eliminating
repetitive manual operations.