Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2005
Early-onset neonatal pneumococcal sepsis syndrome.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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McAdams Ryan M, Garza-Cox Sanjuanita, Yoder Bradley A
Аннотация
OBJECTIVE: To report two cases of severe early-onset neonatal sepsis due to Streptococcus pneumoniae, including, to our knowledge, the first reported case of sepsis due to penicillin-resistant S. pneumoniae presenting as early-onset neonatal sepsis.
DESIGN: Case reports.
SETTING: A level III military and civilian neonatal intensive care unit.
PATIENTS: Two infants (gestational ages of 38 and 35 wks), both of whom presented shortly after birth with severe septic shock presumed to be due to group B streptococcus.
INTERVENTIONS: Both infants were treated with high-frequency oscillatory ventilation and inhaled nitric oxide, with one infant requiring venoarterial extracorporeal membrane oxygenation.
RESULTS: Cultures of blood specimens from both infants yielded S. pneumoniae. For one infant, antibiotic sensitivity testing demonstrated resistance to penicillin, erythromycin, and trimethoprim/sulfamethoxazole. After treatment, both infants recovered well with normal results of examinations and neural imaging studies at the time of hospital discharge.
CONCLUSIONS: Clinicians should consider S. pneumoniae as a possible cause of fulminant nonresponsive sepsis in neonates. In areas where antimicrobial-resistant S. pneumoniae is prevalent, when culture results are known, or with a clinical course unresponsive to ampicillin, septic infants may require the addition of a penicillinase-resistant antibiotic to their therapeutic regimen until results of antibiotic sensitivity testing are known. Early transfer to a center with extracorporeal membrane oxygenation should be considered for symptomatic neonates.
DESIGN: Case reports.
SETTING: A level III military and civilian neonatal intensive care unit.
PATIENTS: Two infants (gestational ages of 38 and 35 wks), both of whom presented shortly after birth with severe septic shock presumed to be due to group B streptococcus.
INTERVENTIONS: Both infants were treated with high-frequency oscillatory ventilation and inhaled nitric oxide, with one infant requiring venoarterial extracorporeal membrane oxygenation.
RESULTS: Cultures of blood specimens from both infants yielded S. pneumoniae. For one infant, antibiotic sensitivity testing demonstrated resistance to penicillin, erythromycin, and trimethoprim/sulfamethoxazole. After treatment, both infants recovered well with normal results of examinations and neural imaging studies at the time of hospital discharge.
CONCLUSIONS: Clinicians should consider S. pneumoniae as a possible cause of fulminant nonresponsive sepsis in neonates. In areas where antimicrobial-resistant S. pneumoniae is prevalent, when culture results are known, or with a clinical course unresponsive to ampicillin, septic infants may require the addition of a penicillinase-resistant antibiotic to their therapeutic regimen until results of antibiotic sensitivity testing are known. Early transfer to a center with extracorporeal membrane oxygenation should be considered for symptomatic neonates.