Sepsis with no focus

[Guest sameera_reddy]

1.7kg neonate born to non consanguineous parents,one of the twins with antenatal diagnosis of intestinal obstruction was operated on day 2 of life.A jejunal web was found intraoperatively. Baby tolerated procedure well. Post-op baby was on antibiotics of piperacillin and Tazobactum, Amikacin and metrogyl.Baby was started on PICC line for Tpn.septic parameters were negative. Baby was started on feeds after 8 days and slowly escalated. After 3 wkd post op CRP became positive and blood culture grew coagulase negative Staph. Picc line removed Baby was started on Vancomycin . CRP though showed a downward trend in the first 5 days suddenly increased 4 fold.Again thorough evaluation was done for sepsis and started on fluconazole,Amikacin and Piptaz was restarted.Serial CRP monitoring showed downward trend for a week and again started going up and this time baby develops thrombocytopenia 63,000/mm3.Now clinically baby has pallor, active on full breast feeds and ashen grey hue to skin colour.Baby has been gaining wt slowly and though baby is a month old it has not regained birth weight and she is now 1.6kg on supplements . I would request you all for your opinions regarding further management.

[Mehmet Malcok]

Premature infants who received prolonged antibiotic treatment is likely to develop fungal infection and candida infection may be resistant to the flukanazole should be added to amphotericin B therapy.it would be difficult to produce enfectionlarını culture of fungi in the catheter could be appropriate to send culture.

[Guest Nwachukwu Udo]

Check the blood level and think about blood transfusion. Check the antibotics the baby is on and know if to continue

[rajnandyal]

Check the blood level and think about blood transfusion. Check the antibotics the baby is on and know if to continue

If the repeat platelet count (by venipuncture) is still low, fungal sepsis is very likely, in view of several risk factors including use of multibroad spectrum antibiotics. I suggest investigating various foci/organs like renal, brain, liver etc, in addition to doing blood Cx, Urine Cx and CSF Cx. Obviously if any culture is positive, using two antifungal antibiotics is a good idea.

[Guest sameera_reddy]

Want to know if plain Amphotericin B can be used in preterms without sonication

[phalguni]

plain ampho-b can be used.liposomal ampho-b is to be used if renal dysfunction is an issue.it is better to give ampho-b as an infusion.

[ziad]

Vit E dif.can cause low platelets and I would consider it

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[JACK]

Reculture...Start Ampho-B...Get an Echo done....