University Publications

Now showing 1 - 2 of 2

A pilot randomized controlled trial comparing noradrenaline and adrenaline as a first-line vasopressor for fluid-refractory septic shock in neonates
(PUBMED, 2024-10-13) Reema Garegrat1 ,; Suprabha Patnaik; Sonali Suryawanshi; Chinmay Chetan; Nishant Banait; Pari Singh; Aditya Kallimath; Naharmal B. Soni; Yogen Singh; Pradeep Suryawanshi
Background and study design: Limited data exists on noradrenaline therapy in neonatal septic shock. We compared the efficacy of noradrenaline with adrenaline in neonatal septic shock. This single center, open label, pilot randomized controlled trial included neonates with clinical evidence of sepsis and shock. Study outcomes: Primary outcomes were: 1) resolution of shock one hour after treatment, and 2) mortality during hospital stay. Secondary outcomes included: need for additional vasopressors; hemodynamic stability without further administration of vasopressors for ≥2 h; changes in blood pressure and heart rate after 1 h of vasopressor treatment; and morbidities during the hospital stay. Results: Of 65 eligible neonates, 42 were randomized (21 each in adrenaline and noradrenaline treatment arms) between August 2020 and January 2022, at level III neonatal intensive care unit (NICU) of Bharati Vidyapeeth Deemed University Medical College and Hospital (BVDUMCH). The mean (SD) gestational age and mean (SD) birth weight were 36.1(4.2) weeks and 1.8 (0.2) kilograms birth weight for noradrenaline and 36.9 (4.1) weeks and 1.7 (0.7) kilograms for adrenaline. Shock resolved within 1 h of vasopressor therapy in 76.2% neonates in the noradrenaline arm and 61.9% in adrenaline arm (p value-0.53). Mortality during hospital stay was 28.6% (6/21) in noradrenaline group and 33.3% (7/21) in adrenaline group (p value- 0.58). Additional vasopressors were required in 23.8% neonates of the noradrenaline group compared to 38.1% neonates in adrenaline arm (p value-0.53). Median (SD) duration of intensive care stay was 6 (SD) days in the noradrenaline group and 10 (SD) days in the adrenaline group (p value-0.045). Conclusion: Among neonates with septic shock, the efficacy of noradrenaline was comparable to adrenaline in resolving septic shock after one hour of infusion and on the mortality during hospital stay
Elizabethkingia meningoseptica With Targeted Environmental Surveillance in a Tertiary Care Hospital: A Retrospective Cohort Study
(PUBMED, 2025-01-07) Garima Mittal; Rajender Singh; Manish Mittal; Mani Pant; Barnali Kakati; Saikat Patra
Introduction Elizabethkingia meningoseptica (E. meningoseptica) is a multidrug-resistant, non-fermenting Gram-negative bacillus increasingly associated with nosocomial infections, particularly in immunocompromised and critically ill patients. Its intrinsic resistance to multiple antibiotics limits treatment options and contributes to adverse clinical outcomes. Aim and objective The study aimed to investigate the clinical and microbiological characteristics of E. meningoseptica infections among ICU/NICU patients and to explore potential environmental sources through hospital-based surveillance. The objectives of this study were to describe the clinical and demographic profiles of ICU/NICU patients with E. meningoseptica infection; to assess the associated risk factors contributing to these infections; to analyze the antimicrobial susceptibility patterns of the isolated strains using standardized microbiological methods; to evaluate treatment outcomes including morbidity, mortality, and duration of ICU/NICU stay; and to identify potential environmental reservoirs of E. meningoseptica through surveillance activities coordinated by the Hospital Infection Control Committee (HICC). Methods A retrospective cohort study was conducted over 18 months (July 2023 to October 2024) at a tertiary care hospital. A total of 15 patients with culture-confirmed E. meningoseptica infection were included. Demographic, clinical, microbiological, and treatment data were collected. Identification and antimicrobial susceptibility testing were performed using the Vitek-2 automated identification system (bioMérieux, Marcy-l'Étoile, France). HICC conducted routine and targeted environmental sampling as per policy protocol. Results Among the 15 patients with E. meningoseptica infection, nine (60.0%) were adults, and 11 (73.3%) were male individuals. Sepsis was reported in nine (60.0%), and both ventilator-associated pneumonia and septic shock occurred in six patients each (40.0%). Hypertension and diabetes mellitus were present in six (40.0%) and three (20.0%) patients, respectively. Two neonates (13.3%) with low birth weight and prematurity required NICU admission. Outcomes included mortality in six patients (40.0%), discharge in five (33.3%), and four (26.7%) leaving against medical advice. Endotracheal secretions were the most frequent specimen (46.7%), followed by tracheostomy secretions (33.3%) and blood cultures (13.3%). All isolates (100%) were resistant to carbapenems, third-generation cephalosporins, aztreonam, and piperacillin-tazobactam. Resistance to gentamicin, colistin, and cotrimoxazole was observed in 73.3%, 66.7%, and 46.7% of isolates, respectively. Highest susceptibility was seen with minocycline (66.7%), vancomycin (60.0%), and fluoroquinolones (53.3%). Environmental surveillance, conducted from January to March 2023 as part of routine as well as targeted HICC monitoring (as an outbreak of suspected pathogens was suspected from the NICU and ICU), included 98 samples from high-risk ICU/NICU sites such as sinks, ventilators, humidifiers, and suction units. E. meningoseptica was identified in one sample (1.02%), isolated from a NICU sink. Conclusion E. meningoseptica infections are associated with high resistance and mortality. Minocycline, vancomycin, and fluoroquinolones may be effective. Early detection, targeted therapy, and HICC-led surveillance are essential for control.

University Publications

Browse

Filters

Settings

Sort By

Results per page

Search Results