Introduction Sepsis is a significant cause of mortality and morbidity in neonates. Diagnosis can be challenging as clinical features are nonspecific and the diagnostic tests have poor predictive accuracy.
Objectives To identify incidence of sepsis, risk factors and clinical presentation, sensitivity pattern of organisms, management and compare with local guidelines.
Project methodology Retrospective case notes analysis of babies up to 28 days age and presenting with features of sepsis during August 2011 to July 2013. Data collected on risk factors, clinical presentation, management and outcome.
Results 23 out of 88 babies had blood, urine or CSF positives for viral or bacterial organisms of which 11 were true positives. Significant number of babies presented with nonspecific symptoms. Risk factors for neonatal sepsis were not always documented. A significant number did not have urine or CSF cultures prior to starting antibiotics (urine 54% and CSF 77%). The total number of contaminants was 12/23 of which Coagulase negative staph was predominant.
Of the 12 true positives 3 had bacteraemia (1 died),1 had positive Group B streptococcus both in blood and CSF (died), 5 had urinary tract infection and 2 had CSF viral PCR positive (1 died).
Of the 9 various antibiotic combination used the most commonly used combination was Cefotaxime/Amoxicillin/Gentamicin (73%).
Conclusion The audit identified following areas for improvement:
· documentation of perinatal events,
· performing vital investigations like CSF and urine culture before starting antibiotics and ensuring strict aseptic technique in blood and CSF culture.