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ENTEROBACTER AMNIGENUS : A NEW CAUSE FOR NEONATAL SEPSIS

ENTEROBACTER AMNIGENUS : A NEW CAUSE FOR NEONATAL SEPSIS. Yousef K. Abu-Osba*; Amer Ammari; Khalil Salameh; Mamoun Shalabi; Kamal El-Haj *Neonatal Medicine Services, Jordan Hospital, Amman, Jordan Neonatal Medicine Services, and Microbiology Section, Hamad General Hospital, Doha, Qatar.

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ENTEROBACTER AMNIGENUS : A NEW CAUSE FOR NEONATAL SEPSIS

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  1. ENTEROBACTER AMNIGENUS :A NEW CAUSE FOR NEONATAL SEPSIS Yousef K. Abu-Osba*; Amer Ammari; Khalil Salameh; Mamoun Shalabi; Kamal El-Haj *Neonatal Medicine Services, Jordan Hospital, Amman, Jordan Neonatal Medicine Services, and Microbiology Section, Hamad General Hospital, Doha, Qatar

  2. ENTEROBACTERAMNIGENUS NEONATAL SEPSISClinical Characteristics Case SEX APGAR B.W. AT Onset of sepsis 1 5 (g) Weight Age d.1 m 2 6 880 1120 47 2 f 7 9 1000 1020 14 3 f 7 8 1100 940 9 4 m 7 9 1020 1020 9 5 f 7 8 1040 1000 9

  3. ENTEROBACTER AMNIGENUS NEONATAL SEPSISClinical Presentation NO T. H.R A. Dis. Acidosis Glucose UVC UAC P.Line C mmol/L Pre / During 1 39 194 + - 4.2 +/- +/- + 2 36.7 180 + - 4.6 -/- +/- + 3 37 158 - + 13.4 +/- +/+ + 4 35 150 - - 9.7 +/+ -/- + 5 36.7 175 - - 9.8 +/+ +/+ +

  4. ENTEROBACTER AMNIGENUS NEONATAL SEPSISHematological Presentation NO WBC BAND RATIO Platelets Blood Tx (1.1-6.0) (500) (.12) (1000) • 9200 22/19 1.2 36 YES • 21000 16/61 .26 64 YES* • 28300 16/72 .22 33 YES* • 7600 0/46 0 26 YES • 12200 0/86 0 26 YES* Ref.: Revised Reference Ranges For Circulating Neutrophils in Very-Low Birth-Weight Neonates. (PEDIATRICS Vol. 94 No. 1 July 1994)

  5. ENTEROBACTER AMNIGENUS NEONATAL SEPSISImmunological Presentation NO IMMUNOGLOBULINS ESR CRP IgG IgA IgM mm> 6mg/L 1 660 16 62 25 + 2 208 7 22 27 + 3 - - - 9 + 4 465 10 12 2 + 5 419 33 31 8 +

  6. ENTEROBACTER AMNIGENUS NEONATAL SEPSISSepsis Episodes During Hospitalization Case BEFORE DURING AFTER (Age d.) (Age d.) (Age d.) 1 CANDIDA (40) E. FECALIS E. AGGLOMERANS (76) 2 K. PNEUMONIAE (11) -- SERRATIA MERSESCANS (30) S. EPIDERMIDIS (60) 3 -- S. EPIDERMIDIS -- 4 -- -- S. MERSESCANS (26) S. EPIDERMIDIS (75) 5 -- - E. FECALIS (49) MICROCOCCUS (79)

  7. ENTEROBACTER AMNIGENUS NEONATAL SEPSISAntibiotics Treatment Case Treatment* Culture -ve Previous During Sepsis Days Post Treatment 1 AMPH,AMP AMK (12D), CPX (1D) 8 D 2 - AMK (14D), CPX (14D) 5 D 3 - IMP (14D), AMK (19D) 13 D CPX (10D) 4 AMP, CPX AMK (15D), CPX (15D) 3 D 5 - IMP (15D), AMK (17D) 11D CPX (10D) * AMPH: Amphotericin, AMP: Ampicillin, CPX: Cephotaxime, IMP: Imipenem.

  8. ENTEROBACTER AMNIGENUS NEONATAL SEPSISENTEROBACTER AMNIGENUS BIOGROUP 2 (MIC) SENSITIVERESISTANT AMPICILLIN (>32/16) CEFOTITAN (>32) AMIKACIN SULBACTAM (>32/16) CEFTRIAXONE (>64) CPROFLOXACIN<.25) AMPICILLIN (>32) CEFTAZIDIME (>32) COTRIMOXAZOLE AUGMENTIN >32/16) CEFTIZOXIME (>32) GENTAMICIN AZTREONAM (>32) CEFUROXIME IMIPENEM(<.5) AZLOCILLIN (>64) CEPHALOTHIN NETILMICIN (4) CEFAMANDOLE (>32) CARBENICILLIN (128) CHLORAMPHENICOL (8) CEFONICID (>16) MEZLOCILLIN (>128) CEFOPERAZONE (>32) TICARCILLIN (>128) CEFOTAXIME (>64) TICARCILLIN (>128) PIPERACILLIN

  9. ENTEROBACTER AMNIGENUS NEONATAL SEPSISENTEROBACTER AMNIGENUS IDENTIFICATION REACTIONS AFTER 2 DAYS OF INCUBATION BIOGROUP 1 BIOGROUP 2  Lysine decarboxylase (LDC) - - Arginine dihydrolase (ADH) - v Ornithine decarboxylase (ODC) v + Growth in KCN + + Fermentation of: Sucrose + - D-sorbitol - + Raffinose + - Yellow Pigment - -

  10. ENTEROBACTER AMNIGENUS :A NEW CAUSE FOR NEONATAL SEPSIS SUMMARY - 1 • We report for the first time in our area sepsis secondary to ENTEROBACTER AMNIGENUS in 5 premature infants, who had positive blood cultures and suffered from clinical signs and symptoms of infection. • Enterobacter amnigenus was isolated from both the aerobic and anaerobic bottles on several occasions. Identification of the source of infection was difficult to ascertain.

  11. ENTEROBACTER AMNIGENUS :A NEW CAUSE FOR NEONATAL SEPSIS SUMMARY - 2 • Aggressive treatment with antibiotics and supportive measures were required. • All isolates were resistant to third generation cephalosporins and sensitive to amikacin and gentamicin. • All patients survived.

  12. ENTEROBACTER AMNIGENUS :A NEW CAUSE FOR NEONATAL SEPSIS Conclusions • Enterobacter amnigenus can cause sepsis in susceptible or immuno-compromised infants like very premature infants, which required aggressive therapy. • Amikacin, gentamicin and imipenem are the drug of choice. • Imipenem may be used if aminoglycosides are contraindicated.

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