Diagnostic Dilemma

Preterm with sepsis

A 30 week AGA born to a primigravida mother was referred to NICU for routine preterm care. His birth weight was 1.25 kg and he had cried immediately after birth but required oxygen after birth. Mother had pregnancy induced hypertension {PIH} and was on Alpha Methyl Dopa. Mother was also given Intravenous. Dexamethasone was given 3 days previous to deliver. On presentation, respiratory rate was 48, minute and heart rate was 110, min. Systemic examination was normal. Patient was started as routine preterm care and covered with antibiotics Ampicillin-Sublactum combination and Gentamicin. However, child had desaturation and unable to maintain oxygen next day. Thus, was intubated and required ionotropes. He was weaned off ventilator after 2 days. On Day 4 of life, he developed hyperbilirubinemia and required phototherapy. On Day 6 of life, he was started on oral feeds and required minimal oxygen. After 8 days of life, antibiotics were omitted. On Day 30 life, patient had aspiration and required bag and mask ventilation. He was started on Ceftriaxone-Sublactum and Ofloxacin antibiotics. His septic screen was positive. He required artificial ventilation. ET culture grew Gram negative bacilli. He was given antifungals empirically in view of prolonged hospital stay. However, the child expired on Day 37 of life.

What could be the cause of deterioration_? Is it fungal or bacterial_?
Expert Opinion :
Post mortem endotracheal secretions grew pseudomonas.
Answer Discussion :
ET tip culture cannot be extrapolated to systemic sepsis.. in this baby antibiotics were stopped on day 8 itself.. fungal sepsis is seen with prolonged use of broad spectrum antibiotics. hence possibility of nosocomial infection with staph aureus or any gram negative organism may be considered.. a blood culture could have been done
13 years ago
Dinesh Kumar
fungal sepsis, 1} its a LOS, 2} even after 7 days of ofloxacin 3} may be the trail antifungal may not had a sensitivity of the infected fungus,, 4} it would had been better if a fungal culture done form the tracheal aspirate.
13 years ago

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