Klebsiella Pneumoniae sepsis, clinical features and early outcome among Newborns in neonatal intensive care unit Zawia teaching hospital

Abstract

Background: Klebsiella pneumonia is one of the most common infections that cause neonatal sepsis globally. It is responsible for a significant proportion of hospital-acquired infections including septicemias, urinary tract infections, pneumonia, and soft tissue infections especially in the immunocompromised hosts such as the neonate. Aim of study: to identify, clinical features and the outcomes associated with K. pneumonia, in all newborn at NICU at Zawia teaching Hospital – Libya. Materials and Methods: Retrospective case series study conducted at neonatal intensive care unit in Zawia teaching hospital /Libya. during one year period (1^st of January -30^st December 2012). Four hundred and eleven neonates who were admitted to Intensive Care Unit (ICU) in pediatric department were selected. The following data was obtained from the patient’s medical records sex, birth weight, gestational age, mode of delivery, time of admission (Season), blood cultures strain of the isolates, maternal history, clinical diagnosis and features association problems mechanical ventilator, blood exchange, umbilical vein catheterization, respiratory distress syndrome, birth asphyxia, CRP for risk patient, CRP on deterioration, platelets concentrate transfusion and outcome. Result: The study results reported that 13 neonates had positive klebsiella pneumonia.9 (69.2%)  preterm,9(69.2%)were males 4(30.8%)were  females with 2:1 male to female ratio ,10 (76.9%) had low birth weight ,8(61.5%) were delivered by caesarean section , regarding maternal age 53.8% were between 31-40 years with  mean maternal age 32.15 years and 5.5 standard deviation ,61.5% were infected at the second half of the year p value,  History of PROM in 6( 46%), pre eclampsia (30.8 %) maternal fever in 1(7.7%),maternal infection (7.7%). 9(69.5%) had respiratory distress,53.8%,7 (53.8%) developed hyperbilirubenmia,4(30%) had necrotizing enterocolities ,1(7%) had acute myocarditis,1patient presented with fever and proved to have UTI with sepsis,  mechanical ventilation was needed in8 (61.5%).one patient developed  Pnemothorax (7.7%)and drained under water seal by  insertion of chest tube. Umbilical vein catheterization inserted only in one patient7.7% Exchange blood  transfusion was done in one baby 7.7%. all had negative CRP test on admission 13 (100%) and CRP was positive in all patients (100%) with positive klebsiella pneumoniae (p value 0.0001) when sepsis was suspected.10 (76.9%) of the neonates required platelets transfusion which indicate the higher rate of thrombocytopenia. Regarding neonatal outcome, the result reported that 10(76.9%) of neonates with positive klebsiella pneumonia were alive and only 3 (23.1%) died, Two due to respiratory failure and the 3^rd one died due acute myocarditis complicated by heart failure. The mortality rate  about 23%. 66.6%were preterm low birth weight .100% were males and due to ESBL producing strains. Conclusion: The main risk factors for the infection was preterm babies, males gender, low birth weight, caesarean section delivery, prolonged pre labor rupture of membrane (PR0M). mostly infected at the second half of the year and hospital stay, The clinical presentations are non specific, Acute myocarditis is a rare presentation with fatal prognosis. CRP is valuable for early detection of klebsiella pneumoniae infection. Thrombocytopenia is very common The mortality rate was relatively high and all deaths were male, due to ESBL producing K.pnemoniae strains  which was similar to many studies in other countries.