We are thankful to the readers for giving us the opportunity to provide
clarifications on our research.
1. Polymicrobial bacterial infections are often
related to surgical interventions, complex congenital cardiac
diseases, abdominal surgeries and lipid infusions [1]. We have a
separate unit for surgical patients and we do not use lipid
infusions for parenteral nutrition. These factors might partly
explain absence of this phenomenon in our patients.
2. Difference in results from an earlier study
[2] has been attributed to inclusion of outborn babies referred from
other hospitals, difference in demographic features and antibiotic
usage rates in developed and developing countries. However, we agree
that it may also be due to gross differences in rates of culture
positivity between two studies.
3. Invasive candidiasis is an emerging cause of
neonatal sepsis; seen more in late onset group and in those who have
received broad spectrum antibiotics. Few other Indian studies on
neonatal sepsis [3,4] have also reported high incidence of
candidemia. This could be explained by more number of extramural
babies referred from other hospitals, and larger proportion of lower
birth weight and preterm neonates.
4. Problem of false positivity can be overcome by
time to culture positivity but our primary objective was to improve
diagnostic yield of blood culture. We agree that multiple blood
cultures may seem to increase the cost of treatment and manpower,
but as it improves yield, it may lead to more rational antibiotic
therapy in the unit. Early targeted therapy is essential for
reducing the burden of neonatal sepsis. Delay in diagnosis or
non-specific therapy may lead to antibiotic resistance.
References
1. Pammi M, Zhong D, Johnson Y, Revell P, Versalovic
J. Polymicrobial bloodstream infections in the neonatal intensive care
unit are associated with increased mortality: A case-control study. BMC
Infect Dis. 2014;14:390.
2. Sarkar S, Bhagat I, DeCristofaro JD, Wiswell TE,
Spitzer AR. A study of the role of multiple site blood cultures in the
evaluation of neonatal sepsis. J Perinatol. 2005;26:18-22.
3. Rani R, Mohapatra N P, Mehta G, Randhawa VS.
Changing trends of candida species in neonatal septicaemia in a tertiary
North Indian hospital. Indian J Med Microbiol. 2002;20:42-4.
4. Juyal D, Sharma M, Pal S, Rathaur VK, Sharma N.
Emergence of non-albicans Candida species in neonatal candidemia. N Am J
Med Sci. 2013;5:541-545.