NEONATAL INFECTIONS

ROLE OF DIAGNOSTIC MICROBIOLOGY

Nosocomial infections on neonatal intensive care units (NICUs) have been a recognized cause
for concern for many years. It is the endeavor of the doctors caring for these , infants and neonates to
identify and treat such infections as early as possible in an effort to reduce morbidity and mortality to a
minimum. Effective strategies to prevent nosocomial infections (NI) among neonates in neonatal
intensive care unit (NICU) require a comprehensive study of epidemiology, risk factors and outcomes.
A high percentage of babies on NICU become colonized with Gram-negative bacilli (GNB) with
increasing length of stay on the unit. Those babies that remain on NICU for prolonged periods, and who
become colonized, tend to be the most premature and sickest infants, and therefore are most at risk of
becoming septic, with increased morality and morbidity,
Neonatal infection are a grave threat to many who necessitates to be kept for life support services, at
times many continue to die in spite of best clinical care, and blame goes on to who is responsible for the
matters, I am of the certain opinion it really rests on the staff and clinical care Doctors who work
continuously to maintain the hygiene and aseptic standards, Microbiology department can monitor
nature of the bacterial flora and exaggerated isolation of common and uncommon bacterial and fungal
flora, Timely reporting remain the mainstay in bringing in greater coordination and accountability. Many
in the Developing countries still dependent on surface cultures from multiple areas of the intensive care
areas, The use of surface cultures in predicting the organisms responsible for sepsis is inefficient and
not cost-effective. There is some evidence that endotracheal aspirate cultures in ventilated neonates
may be helpful in identifying the pathogens responsible for perinatal pneumonia. (Ref 1) Major studies
have proved that use, and misuse and prolonged use of Antibiotics have created major multidrug
resistant strain, which continue to infect even the marginally infected patients, and in neonates
Antibiotics are the most prescribed medications in neonatal intensive care units (NICUs) in the United
States When used appropriately, antibiotics are life-saving, but their overuse in NICUs has been
associated with an increased risk for infection due to multidrug resistant organisms, invasive
candidiasis, narcotizing enterocolitis, late-onset sepsis and even death, For this reason, pediatric
infectious disease specialists and neonatologists have urged development of antibiotic stewardship
programs aimed at reducing overall antibiotic consumption and curtailing their unnecessary use in
NICUs Before such programs can be designed and implemented successfully, prospective surveillance
is needed to inform how and why antibiotics are being used locally Thus, antibiotic stewardship in the
NICU will require a thorough understanding of the clinical decisions driving their use, Currently, data
regarding why and how antibiotics are used in the NICU is limited to retrospective observational data
suggesting that inappropriate or unnecessary antibiotic use may be common, To understand the
realities of deaths in neonatology units is contributed by , prolonged or excessive antibiotic therapy has
been associated with a variety of adverse outcome , Stewardship efforts to minimize unnecessary
therapy are needed urgently, but must be informed by appropriate prospective surveillance of antibiotic
use. "Ruled-out" sepsis evaluations, pneumonia and "culture-negative" sepsis courses are high-yield
targets for antibiotic stewardship interventions; culture-proven infections account for a small fraction of
antibiotic use. Focusing on timely discontinuation of therapy once infection is ruled out as well as
evaluating the safe, minimum duration of therapy for common clinical scenarios will help to reduce
antibiotic use in the NICU and avoid the adverse outcomes associated with their use. While routine
prospective surveillance is time-consuming and may not be practical for all centers, prospective audit
with feedback and interventions is a keystone of good antibiotic stewardship and should be a focus in
the NICU
Does the surveillance help? Is a great question of importance to microbiologists and hospital
administrators, when the matters go wrong the physicians insist on that Microbiologists should collect
the specimens for surveillance I have lived with many conflicts, the clinicians asking the Microbiologists
to collect the specimens who many times stretched with diagnostic procedures, However, the most
effective strategy and the risks and benefits associated with surveillance in the NICU population have
not been fully evaluated. In addition, surveillance is associated with financial costs as well as staff and
patient-related costs, Nursing time is required to collect surveillance cultures, maintenance of contact

precautions requires the use of gowns and gloves and laboratory personnel and equipment are needed
to process surveillance samples.
I wish many take advantage of the 3 references for better understanding of the Neonatal infection, and
major limitations of Microbiologists and Microbiology departments in particular, However it is universally
practiced that Health care workers in the Intensive care must be trained and efficient with standard
operating procedures in collecting the samples when the clinical situation warrants, It is just of less utility
when the specimens are mechanically collected without a real purpose and should think does it make
any sense in prevention of infections in most critical care areas ?.
Ref 1Utility of Surveillance Cultures for Antimicrobial Resistant Organisms in Infants Transferred to the
Neonatal Intensive Care Unit
Theodore Macnow, MD;
Ref 2 Prospective Surveillance of Antibiotic Use in the Neonatal Intensive Care Unit
Results From the SCOUT Study
Joseph B. Cantey, MD; Phillip S. Wozniak; Pablo J. Snchez, MD
Ref The value of surveillance cultures on neonatal intensive care units.Jolley AE1. J Hosp Infect. 1993
Nov;25(3):153-9.
Utility of Surveillance Cultures for Antimicrobial Resistant Organisms in Infants Transferred to the
Neonatal Intensive Care Unit
Theodore Macnow, MD; etal (MEDSCAPE)
Dr.T.V.Rao MD Professor of Microbiology Freelance writer