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Mortensen N, Kristiansen MS, Tellefsen OA, Köpp UMS. Recovery of pathogens with implementation of a weight-based algorithm for pediatric blood cultures: an observational intervention study. BMC Pediatr 2024; 24:438. [PMID: 38982359 PMCID: PMC11232176 DOI: 10.1186/s12887-024-04930-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Recovering pathogenic bacteria and yeast from pediatric blood cultures and reliably distinguishing between pathogens and contaminants are likely to be improved by increasing the volume of blood submitted to microbiology laboratories for culturing beyond the low volumes that have historically have been used. The primary aim of this study was to assess whether the pathogen recovery rate would increase after implementation of a weight-based algorithm for determining the intended volume of blood submitted for culturing. Secondary aims were to: 1) evaluate the effects of the algorithm implementation on the blood culture contamination rate; 2) determine whether pathogens might be found more often than contaminants in several as opposed to single bottles when more than one bottle is submitted; and 3) describe the microbiological findings for pathogens and contaminants in blood cultures by applying a clinical validation of true blood culture positivity. METHODS A pre-post comparison of positivity and contamination rates after increasing the theoretical blood volume and number of blood culture bottles was performed, on the basis of a clinical validation of blood culture findings as pathogens vs contaminants. RESULTS We examined 5327 blood cultures, including 186 with growth (123 true positives and 63 contaminated). The rate of true positive blood cultures significantly increased from 1.6% (42/2553) pre to 2.9% (81/2774, p = .002) post intervention. The rate of contaminated blood cultures did not change significantly during the study period (1.4% [35/2553] pre vs 1.0% [28/2774], p = .222) post intervention), but the proportion of contaminated cultures among all positive cultures decreased from 45% (35/77) pre to 26% (28/109, p = .005) post intervention. A microorganism that grew in a single bottle was considered a contaminant in 35% (8/23) of cases, whereas a microorganism that grew in at least two bottles was considered a contaminant in 2% (1/49, p < .001) of cases. According to common classification criteria relying primarily on the identity of the microorganism, 14% (17/123) of the recovered pathogens would otherwise have been classified as contaminants. CONCLUSION Implementation of a weight-based algorithm to determine the volume and number of blood cultures in pediatric patients is associated with an increase in the pathogen recovery rate.
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Affiliation(s)
- Nicolay Mortensen
- Department of Child and Adolescent Medicine, Soerlandet Hospital, Kristiansand, Norway.
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway.
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Kotpal R, Jindal S. C-reactive protein and thrombocytopenia as essential early indicators: Subtle approach to neonatal sepsis. J Family Med Prim Care 2024; 13:2233-2236. [PMID: 39027849 PMCID: PMC11254089 DOI: 10.4103/jfmpc.jfmpc_1390_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 07/20/2024] Open
Abstract
Introduction Early diagnosis of neonatal sepsis is very essential part of newborn care to prevent mortality and decrease morbidity in newborns. Aim The aim of this study is to correlate an increase in C-reactive protein (CRP) titre and a decrease in platelet count with an increased incidence of neonatal septicemia, for an effective subtle approach in neonatal septicemia. Materials and Methods A retrospective study was conducted in the neonatal intensive care unit (NICU) of a tertiary care hospital from Jan 2022 to July 2023. Neonates admitted to the NICU with suspected sepsis were screened for sepsis. Screening was done by taking blood culture samples before administration of antibiotics, serum samples for CRP and blood samples for platelet count. Result A total of 270 newborns with suspected sepsis were included in the study. Blood culture positivity was seen in 27.7 (27/75) cases. About 32.9% (89/270) of the neonates with suspected sepsis and 61.3% (46/75) neonates with confirmed sepsis had raised CRP; 32.2% (87/270) neonates with suspected sepsis and 64% (48/75) with confirmed sepsis had decreased platelet count. Both an increase in CRP and a decrease in platelets were seen in 61.3% (46/75) of confirmed cases. Conclusion In our study, both raised CRP and decreased platelet count were seen in around 60% of confirmed cases of sepsis. So, CRP titre and platelet count can be used as early, rapid diagnostic markers for confirmed sepsis.
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Affiliation(s)
- Ruchi Kotpal
- Department of Microbiology, NCR Medical College, Meerut, Uttar Pradesh, India
| | - Sonal Jindal
- Department of Microbiology, LLRM Govt Medical College, Meerut, Uttar Pradesh, India
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Hue-Bigé A, François-Garret B, Casagrande F, Oertel J, Mayerus M, Eleni Dit Trolli S. Early procalcitonin assays may reduce antibiotic exposure in premature newborn infants. Acta Paediatr 2024; 113:939-946. [PMID: 38314886 DOI: 10.1111/apa.17137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
AIM The diagnosis of early-onset neonatal sepsis (EOS) remains difficult. The main aim was to study the effect of a new algorithm for EOS, which includes the level of procalcitonin in umbilical cord blood, on the exposure to antibiotic therapy of premature newborn infants. METHODS This was a monocentric, observational and retrospective study with before-and-after design. The duration and dose of antibiotic therapy provided as well as the morbidity and mortality were compared in two groups, one included 01 May 2015-30 November 2015 when procalcitonin was not used, and one after the change 01 November 2016-30 May 2017 when procalcitonin was used in a hospital setting in Nice, France. RESULTS Sixty newborn infants were included in the before group and 54 in the after group. Antibiotic therapy was stopped after 24 h for 18 newborn infants in the after group and four in the before group, and after 48 h for 26 newborn infants in the after group and 10 in the before group. CONCLUSION The implementation of a new decision-making algorithm including early procalcitonin assay of premature newborn infants significantly reduced exposure to antibiotics without modifying mortality or morbidity.
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Affiliation(s)
- Amandine Hue-Bigé
- Neonatal Intensive Care Unit, Nice University Hospital, Nice, France
| | | | | | - Julie Oertel
- Neonatal Intensive Care Unit, Nice University Hospital, Nice, France
| | - Mathilde Mayerus
- Neonatal Intensive Care Unit, Nice University Hospital, Nice, France
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Sturrock S, Sadoo S, Nanyunja C, Le Doare K. Improving the Treatment of Neonatal Sepsis in Resource-Limited Settings: Gaps and Recommendations. Res Rep Trop Med 2023; 14:121-134. [PMID: 38116466 PMCID: PMC10728307 DOI: 10.2147/rrtm.s410785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Neonatal sepsis causes significant global morbidity and mortality, with the highest burden in resource-limited settings where 99% of neonatal deaths occur. There are multiple challenges to achieving successful treatment of neonates in this setting. Firstly, reliable and low-cost strategies for risk identification are urgently needed to facilitate treatment as early as possible. Improved laboratory capacity to allow identification of causative organisms would support antimicrobial stewardship. Antibiotic treatment is still hampered by availability, but also increasingly by antimicrobial resistance - making surveillance of organisms and judicious antibiotic use a priority. Finally, supportive care is key in the management of the neonate with sepsis and has been underrecognized as a priority in resource-limited settings. This includes fluid balance and nutritional support in the acute phase, and follow-up care in order to mitigate complications and optimise long-term outcomes. There is much more work to be done in identifying the holistic needs of neonates and their families to provide effective family-integrated interventions and complete the package of neonatal sepsis management in resource-limited settings.
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Affiliation(s)
- Sarah Sturrock
- Centre for Neonatal and Paediatric Infection, St George’s, University of London, London, UK
| | - Samantha Sadoo
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Carol Nanyunja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, St George’s, University of London, London, UK
- UK Health Security Agency, Salisbury, UK
- Makerere University, Johns Hopkins University, Kampala, Uganda
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Romańska J, Wawrzoniak T, Hołowaty D, Mazanowska N, Krajewski P. Point-of-Care Verification of Blood Culture Volume in Neonates: A Feasibility Trial. JOURNAL OF MOTHER AND CHILD 2023; 27:83-92. [PMID: 37561917 PMCID: PMC10414768 DOI: 10.34763/jmotherandchild.20232701.d-22-00063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Blood cultures remain the gold standard for the diagnosis of sepsis. However, volumes of blood submitted for cultures often do not match the recommended values. We propose a simple intervention aimed to verify the volume of blood sampled using a scale. This study was undertaken in preparation for a future, multicenter, pre- and post-intervention trial. Our primary objective was to test the feasibility (uptake and retention) of this future intervention. MATERIALS AND METHODS This study was conducted at a neonatal department in Warsaw, Poland, over a period of eight months (May to December 2020). Before starting the study, we undertook an educational intervention focused on obtaining adequate blood volumes for culture. The culture bottles that were weighed in advance were distributed in all blood collection areas. Blood volume was verified by weighing the bottle immediately after blood inoculation. The calculated value was communicated to the collecting clinician and recorded. The primary outcome measure was the percentage of blood culture submissions for which the blood volume inoculated into the bottles was determined by weighing. RESULTS During the study period, 244 blood samples were collected for culture, out of which 205 samples were weighed (84.0%, CI95 [78.8% to 88.4%]). This high proportion remained stable throughout the study period. We have not observed any adverse events related to the study. CONCLUSIONS The point-of-care verification of blood culture volume using a scale was feasible to implement. Since we have met our pre-established criterion for success, a future, definitive trial is likely to proceed.
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Affiliation(s)
- Justyna Romańska
- Department of Obstetrics and Gynaecology, Division of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Wawrzoniak
- Department of Obstetrics and Gynaecology, Division of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Hołowaty
- Department of Obstetrics and Gynaecology, Division of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Natalia Mazanowska
- Department of Obstetrics and Gynaecology, Division of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Krajewski
- Department of Obstetrics and Gynaecology, Division of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
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Hajjar N, Ting JY, Shah PS, Lee KS, Dunn MS, Srigley JA, Khurshid F. Blood culture collection practices in NICU; A national survey. Paediatr Child Health 2023; 28:166-171. [PMID: 37205138 PMCID: PMC10186103 DOI: 10.1093/pch/pxac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/23/2022] [Indexed: 03/17/2024] Open
Abstract
Background Sepsis is the leading cause of mortality and morbidity in neonates. Blood cultures are the gold standard in diagnosing neonatal sepsis; however, there are currently no consensus guidelines for blood culture collection in neonates and significant practice variation exists in Neonatal Intensive Care Units (NICUs) globally. Objective To examine current practices in obtaining blood cultures in the evaluation of neonatal sepsis in NICUs across Canada. Methods A nine-item electronic survey was sent to each of the 29 level-3 NICUs in Canada, which are equipped to provide highly specialized care for newborns. Results Responses were received from 90% (26/29) of sites. Sixty-five percent (17/26) of sites have blood culture collection guidelines for the investigation of neonatal sepsis. Forty-eight percent (12/25) of sites routinely target 1.0 mL per culture bottle. In late-onset sepsis (LOS), 58% (15/26) of sites process one aerobic culture bottle, whereas four sites routinely add anaerobic culture bottles. In early-onset sepsis (EOS) in very low birth weight infants (BW <1.5 kg), 73% (19/26) of sites use umbilical cord blood, and 72% (18/25) use peripheral venipuncture. Two sites routinely collect cord blood for culture in EOS. Only one site applies the concept of differential time-to-positivity to diagnose central-line-associated bloodstream infection. Conclusions There is significant practice variation in methods used to obtain blood cultures in level-3 NICUs across Canada. Standardization of blood culture collection practices can provide reliable estimates of the true incidence of neonatal sepsis and help to develop appropriate antimicrobial stewardship strategies.
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Affiliation(s)
- Nicole Hajjar
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
| | - Joseph Y Ting
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kyong-Soon Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael S Dunn
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jocelyn A Srigley
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Faiza Khurshid
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
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Antimicrobial Peptides in Early-Life Host Defense, Perinatal Infections, and Necrotizing Enterocolitis—An Update. J Clin Med 2022; 11:jcm11175074. [PMID: 36079001 PMCID: PMC9457252 DOI: 10.3390/jcm11175074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
Host defense against early-life infections such as chorioamnionitis, neonatal sepsis, or necrotizing enterocolitis (NEC) relies primarily on innate immunity, in which antimicrobial peptides (AMPs) play a major role. AMPs that are important for the fetus and neonate include α and β defensins, cathelicidin LL-37, antiproteases (elafin, SLPI), and hepcidin. They can be produced by the fetus or neonate, the placenta, chorioamniotic membranes, recruited neutrophils, and milk-protein ingestion or proteolysis. They possess antimicrobial, immunomodulating, inflammation-regulating, and tissue-repairing properties. AMPs are expressed as early as the 13th week and increase progressively through gestation. Limited studies are available on AMP expression and levels in the fetus and neonate. Nevertheless, existing evidence supports the role of AMPs in pathogenesis of chorioamnionitis, neonatal sepsis, and NEC, and their association with disease severity. This suggests a potential role of AMPs in diagnosis, prevention, prognosis, and treatment of sepsis and NEC. Herein, we present an overview of the antimicrobial and immunomodulating properties of human AMPs, their sources in the intrauterine environment, fetus, and neonate, and their changes during pre- and post-natal infections and NEC. We also discuss emerging data regarding the potential utility of AMPs in early-life infections, as diagnostic or predictive biomarkers and as therapeutic alternatives or adjuncts to antibiotic therapy considering the increase of antibiotic resistance in neonatal intensive care units.
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Jethani S, Bhutani N, Yadav A. Diagnostic utility of combined immature and total neutrophil counts along with C-reactive protein in early detection of neonatal sepsis: A cross-sectional study. Ann Med Surg (Lond) 2022; 77:103589. [PMID: 35637988 PMCID: PMC9142396 DOI: 10.1016/j.amsu.2022.103589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction A timely diagnosis is critical for management of Neonatal sepsis. Blood Culture is considered to be the “Gold Standard” for its diagnosis, but it has some limitations. In recent times, highly sensitive and specific inflammatory markers like interleukins, ELISA, counter immune-electrophoresis etc. have been in use for its diagnosis. But these are impractical for developing countries, due to their high cost and requirement of sophisticated equipments. A combination of haematological parameters like total leucocyte count (TLC), immature to total neutrophil ratio (I/T ratio), absolute neutrophil count (ANC), platelet count and C-reactive protein (CRP) estimation provide an early diagnosis of bacteremia. This study was undertaken to evaluate the usefulness of the above mentioned parameters as indicators for early diagnosis of neonatal sepsis. Material and methods In the present cross-sectional study, we intent to analyse various hematologic parameters in 160 neonates admitted in the neonatal care unit of a tertiary care hospital in Delhi. We obtained data from the records of blood culture and complete blood counts of neonates from pathology and microbiology departments of the hospital. Out of 160 admitted neonates, 80 were taken as cases and remaining 80 were taken as controls. Medical records were studied to identify infants born at ≥ 34 weeks gestation. CBCs was analysed, blood cultures and CRP were done in department of Microbiology. CBC, CRP and Blood culture was done as per standard protocols and clinical assesment by paediatrician. The statistical analyses were performed using SPSS version 22 for windows. Results Among 80 neonates, who were in early neonatal sepsis, 44 cases (55%) were females, and 36 (45%) were males. The Microbiological profile of 80 septic neonates was analysed. The I/T value, ANC and CRP values were significantly higher in the neonates suffering from sepsis as compared to the control group. Among 80 septic neonates (cases), 30 (37.5%) were having normal ANC while 50 (62.5%) were having increased ANC and 34 (42.5%) were having normal I:T ratio while 46 (57.5%) were having increased I:T ratio. Out of 80 septic neonates (cases), 18 (22.5%) were having normal CRP while 62 (77.5%) were having increased CRP. Conclusion ANC, I/T Ratio and CRP are quick, simple and cost-effective routine laboratory tests which help in early diagnosis of neonatal sepsis. Although there are many serological markers available, ANC and I/T Ratio serves as a reliable predictor of neonatal sepsis. With a good sensitivity, high specificity and a good negative predictive value these parameters can therefore help in timely and early identification of neonatal sepsis. Making a timely diagnosis of Neonatal sepsis is critical for its management. Blood Culture is considered as the “Gold Standard” for its diagnosis, but it has some limitations. The bed side tests like total leucocyte count (TLC), immature to total neutrophil ratio (I/T ratio), absolute neutrophil count (ANC), platelet count and C-reactive protein (CRP) are cost-effective.
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Abstract
Neonatal bacterial meningitis is a devastating disease, associated with high mortality and neurological disability, in both developed and developing countries. Streptococcus agalactiae, commonly referred to as group B Streptococcus (GBS), remains the most common bacterial cause of meningitis among infants younger than 90 days. Maternal colonization with GBS in the gastrointestinal and/or genitourinary tracts is the primary risk factor for neonatal invasive disease. Despite prophylactic intrapartum antibiotic administration to colonized women and improved neonatal intensive care, the incidence and morbidity associated with GBS meningitis have not declined since the 1970s. Among meningitis survivors, a significant number suffer from complex neurological or neuropsychiatric sequelae, implying that the pathophysiology and pathogenic mechanisms leading to brain injury and devastating outcomes are not yet fully understood. It is imperative to develop new therapeutic and neuroprotective approaches aiming at protecting the developing brain. In this review, we provide updated clinical information regarding the understanding of neonatal GBS meningitis, including epidemiology, diagnosis, management, and human evidence of the disease's underlying mechanisms. Finally, we explore the experimental models used to study GBS meningitis and discuss their clinical and physiologic relevance to the complexities of human disease.
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Nakagawa Y, Otake S, Oue T, Ryu H, Kasai M. Case of infant invasive Streptococcus intermedius infection suggesting the need for anaerobic cultures. J Infect Chemother 2021; 28:437-439. [PMID: 34794869 DOI: 10.1016/j.jiac.2021.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/08/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
We report the case of an immunocompetent 6-month-old boy with a lung abscess and empyema caused by Streptococcus intermedius detected only from anaerobic cultures. Invasive S. intermedius infection in infants is rare. S. intermedius has been infrequently reported as a causative microorganism of lung abscess and empyema as most of the S. intermedius infections in children have been head and neck infections. While anaerobic cultures are often not performed for infant patients, we suggest the need for these cultures, including blood cultures, especially in cases of pediatric empyema, brain abscess, and liver abscess, which can be caused by S. intermedius.
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Affiliation(s)
- Yui Nakagawa
- Department of Clinical Laboratory, Hyogo Prefectural Kobe Children's Hospital, Japan
| | - Shogo Otake
- Division of Infectious Disease, Department of Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Japan.
| | - Tomoko Oue
- Department of Clinical Laboratory, Hyogo Prefectural Kobe Children's Hospital, Japan
| | - Hayato Ryu
- Department of Clinical Laboratory, Hyogo Prefectural Kobe Children's Hospital, Japan
| | - Masashi Kasai
- Division of Infectious Disease, Department of Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Japan
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Zamarano H, Musinguzi B, Kabajulizi I, Manirakiza G, Guti W, Muhwezi I, Hussein AA, Baweera A, Kabahinda B, Itabangi H, Bazira J, Kabanda T. Bacteriological profile, antibiotic susceptibility and factors associated with neonatal Septicaemia at Kilembe mines hospital, Kasese District Western Uganda. BMC Microbiol 2021; 21:303. [PMID: 34736415 PMCID: PMC8567569 DOI: 10.1186/s12866-021-02367-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Neonatal septicaemia is one of the most common leading causes of neonatal morbidity and mortality in developing countries. It is estimated to affect more than 30 million people worldwide annually, potentially leading to 6 million deaths. Objective(s) To determine the prevalence, bacteriological profile, antibiotic susceptibility and factors associated with neonatal septicaemia among neonates suspected to sepsis at Kilembe mines hospital. Methods We conducted a descriptive cross-sectional study, where purposive sampling technique was used and blood was drawn from 122 neonates suspected to sepsis attending Kilembe Mines Hospital during the period (July to November 2020). Specimens were inoculated in Brain heart infusion broth, transported to Fortportal Regional Referral Hospital, plated daily up to 7 days on blood, chocolate, MacConkey agar and incubated in aerobic and 5% carbondioxide. Pure colonies were identified by Gram stain, biochemical tests and antibiotic sensitivities obtained by Kirby Bauer disc diffusion method. Associations were tested using Chi square with Fisher’s exact or Yates correction tests where necessary and statistical significance was set at P < 0.05. Stata (version 14) used for statistical analysis. Results Blood cultures were positive in 59.0% cases with 55.5% male and 44.4% female. EOS was present in 56.9% and LOS 43.1% of the cases. Gram negative (56.9%) organisms were most implicated with neonatal septicaemia than Gram positives ones (43.1%). Gram positive organisms exhibited better susceptibility to amikacin, linezolid and vancomycin but more resistant to ampicillin and gentamicin. Of the aminoglycosides, amikacin exhibited a verge over netilmicin and gentamicin against Gram negative isolates. Risk factors of neonatal septicaemia were mother’s age of ≥25 years, employed mothers, tertiary-level of education, SVD, ANC attendance of ≥4 times, UTI during pregnancy, PROMS, foul Smelling liquor, urban residence, neonatal birth weight of ≥2500 g, Apgar score 1st and 5th min ≥6 and resuscitation. Conclusion Multi-drug resistant organisms were isolated. Therefore caution is required in selection of antibiotic therapy and avoid empirical treatment.
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Affiliation(s)
- Henry Zamarano
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
| | - Benson Musinguzi
- Department of Medical Laboratory Science, Faculty of Health Sciences, Muni University, P.O. Box 725, Arua, Uganda.,Department of Microbiology and Immunology, College of Health, Medicine and Life Sciences, King Ceasor University, P.O. Box 88, Kampala, Uganda
| | - Immaculate Kabajulizi
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Godfrey Manirakiza
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Walker Guti
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Ivan Muhwezi
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Ayan Ahmed Hussein
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Agnes Baweera
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Boaz Kabahinda
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Herbert Itabangi
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.,Department of Microbiology and Immunology, Faculty of Health Sciences, Busitema University, P.O Box 1460, Mbale, Uganda
| | - Joel Bazira
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Taseera Kabanda
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
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Ideal blood inoculant volume for neonatal sepsis evaluation: an alternative approach. Pediatr Res 2021; 90:930-933. [PMID: 34453121 DOI: 10.1038/s41390-021-01720-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/10/2021] [Accepted: 08/18/2021] [Indexed: 11/08/2022]
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13
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O'Hagan S, Nelson P, Speirs L, Moriarty P, Mallett P. How to interpret a paediatric blood culture. Arch Dis Child Educ Pract Ed 2021; 106:244-250. [PMID: 33637581 DOI: 10.1136/archdischild-2020-321121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 11/04/2022]
Abstract
Blood culture is one of the most important diagnostic tests in medicine, considering the significant morbidity and mortality associated with bloodstream infection (BSI). However, it is an often misused and misinterpreted test in everyday paediatric practice. In this article, we explore the evidence related to paediatric blood cultures, with the aim of providing clear and clinically-relevant recommendations for its judicious use.
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Affiliation(s)
- Shaun O'Hagan
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK shaun.o'
| | - Peter Nelson
- Clinical Microbiology, Belfast Health and Social Care Trust, Belfast, UK
| | - Lynne Speirs
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Paul Moriarty
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Peter Mallett
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
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James J, Tewari VV, Jain N. Diagnostic Accuracy of Clinical Tool 'STOPS' and Serum Procalcitonin for Optimizing Antibiotic Therapy in Neonates Born at ≥ 28 Weeks of Gestation with Neonatal Sepsis. Mediterr J Hematol Infect Dis 2021; 13:e2021019. [PMID: 33747400 PMCID: PMC7938925 DOI: 10.4084/mjhid.2021.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/10/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Antibiotic therapy is initiated in neonates on suspicion of sepsis. Optimizing therapy is a felt need of clinicians as prolonged injudicious use increases mortality and morbidity risk. OBJECTIVE To evaluate the diagnostic accuracy of clinical tool 'STOPS' and serum procalcitonin (PCT) for identifying neonates with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) and early discontinuation in those with no sepsis. METHODS The study had a prospective analytical design conducted at a tertiary care hospital. Consecutively admitted neonates with suspected EONS or LONS were enrolled. The 'STOPS' tool comprising sensorium, temperature, oxygenation, perfusion, skin color, and blood sugar was applied at 6 and 12 hours of enrollment. Serum PCT was sent at 12 hr. The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) were estimated. RESULTS The study enrolled 380 neonates, of which 330 were given antibiotics for EONS and 50 for LONS. Temperature disturbance in the EONS group at 12 hr showed a PPV of 100% and a PLR of 9.1 (7.7 - 18). Perfusion assessment at 12 hr had a PPV of 77% and PLR of 8.25 (2.3 - 29). Skin color assessment at 12 hr had a PPV of 100% and PLR of 13.5 (9.7 - 27). The diagnostic accuracy of PCT in the EONS group was unremarkable. In the LONS group, skin color at 12 hr had a PPV of 100% and PLR of 11.2 (8.6 - 19.5). The diagnostic accuracy of PCT in the LONS group showed a PPV of 82% and PLR of 7 (1.7 - 29). CONCLUSION Identifying abnormal STOPS parameters was superior to PCT alone in EONS and as good as PCT in LONS. The 'STOPS' tool allows early identification of neonates with no sepsis, thereby optimizing antibiotic use.
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Affiliation(s)
- Jemila James
- Neonatal Intensive Care Unit, King Hamad University Hospital, Al Muharraq, Kingdom of Bahrain
| | - Vishal Vishnu Tewari
- Department of Pediatrics, Command Hospital (SC) and Armed Forces Medical College, Pune, India
| | - Naveen Jain
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum, India
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Bianco B, François-Garret B, Butin M, Dalmasso C, Casagrande F, Mokhtari M, Eleni Dit Trolli S. Procalcitonin in Preterm Neonates: A Different Threshold and Prolonged Interpretation. Front Pediatr 2021; 9:623043. [PMID: 34079778 PMCID: PMC8165309 DOI: 10.3389/fped.2021.623043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/21/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate the positive threshold of PCT for neonates of <32 weeks of gestation for the diagnosis of early-onset sepsis and to determine if the level of PCT collected within 6 h of life could be used. Design: Retrospective and bicentric study from May 2016 to April 2018. Setting: Two groups were established, neonates evaluated for PCT at birth (CordPCT) and within 6 h of life (delPCT). Patients: Two hundred and sixty neonates of <32 weeks of gestation born in Nice and South Paris (Bicêtre) University Hospitals, had been evaluated for PCT level. Main Outcomes Measures: The value of the PCT positive threshold was determined for the total population and each groups thanks ROC curves. Results: The threshold level of PCT for the total population was 0.98 ng/mL. The threshold value of cordPCT group was 1.00 vs. 0.98 ng/mL for delPCT group. The area under the Receiver Operating Characteristics curve for PCT sampled in delPCT group was significantly higher than in cordPCT group (0.94 compared to 0.75). Conclusions: The threshold level of PCT was higher in this cohort of neonates of <32 weeks of gestation compared to the value generally described for term neonates. The secondary sampling PCT level seems to be usable in screening algorithm for early-onset neonatal sepsis.
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Affiliation(s)
- Blandine Bianco
- Neonatal Intensive Care Unit, CHU de Nice, Archet 2 Hospital, Nice, France
| | | | - Marine Butin
- Neonatal Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - Cyril Dalmasso
- Laboratoire de Mathématiques et Modélisation d'Evry (LaMME), Université d'Evry Val d'Essonne, UMR CNRS 8071, Evry, France
| | | | - Mostafa Mokhtari
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre Hospital, University Paris Sud, Kremlin-Bicêtre, France
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16
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Doo I, Staub LP, Mattke A, Haisz E, Seidler AL, Alphonso N, Schlapbach LJ. Diagnostic Accuracy of Infection Markers to Diagnose Infections in Neonates and Children Receiving Extracorporeal Membrane Oxygenation. Front Pediatr 2021; 9:824552. [PMID: 35155322 PMCID: PMC8826436 DOI: 10.3389/fped.2021.824552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/20/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Infections represent one of the most common complications in patients managed on Extracorporeal Membrane Oxygenation (ECMO) and are associated with poorer outcomes. Clinical signs of infection in patients on ECMO are non-specific. We assessed the diagnostic accuracy of Procalcitonin (PCT), C-reactive protein (CRP) and White cell count (WCC) to diagnose infection on ECMO. METHODS Retrospective single center observational study including neonates and children <18 years treated with ECMO in 2015 and 2016. Daily data on PCT, CRP and WCC were assessed in relation to microbiologically confirmed, and clinically suspected infection on ECMO using operating characteristics (ROC) curves. RESULTS Sixty-five ECMO runs in 58 patients were assessed. CRP had the best accuracy with an area under the ROC curve (AUC) of 0.79 (95%-CI 0.66-0.92) to diagnose confirmed infection and an AUC of 0.72 (0.61-0.84) to diagnose confirmed and suspected infection. Abnormal WCC performed slightly worse with an AUC of 0.70 (0.59-0.81) for confirmed and AUC of 0.66 (0.57-0.75) for confirmed and suspected infections. PCT was non-discriminatory. CONCLUSION The diagnosis of infections acquired during ECMO remains challenging. Larger prospective studies are needed that also include novel infection markers to improve recognition of infection in patients on ECMO.
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Affiliation(s)
- Irene Doo
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Lukas P Staub
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Adrian Mattke
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Haisz
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Anna Lene Seidler
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.,Department of Intensive Care Medicine and Neonatology, and Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Relevance of Biomarkers Currently in Use or Research for Practical Diagnosis Approach of Neonatal Early-Onset Sepsis. CHILDREN-BASEL 2020; 7:children7120309. [PMID: 33419284 PMCID: PMC7767026 DOI: 10.3390/children7120309] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/07/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
Abstract
Neonatal early-onset sepsis (EOS) is defined as an invasive infection that occurs in the first 72 h of life. The incidence of EOS varies from 0.5–2% live births in developed countries, up to 9.8% live births in low resource settings, generating a high mortality rate, especially in extremely low birth weight neonates. Clinical signs are nonspecific, leading to a late diagnosis and high mortality. Currently, there are several markers used for sepsis evaluation, such as hematological indices, acute phase reactants, cytokines, which by themselves do not show acceptable sensitivity and specificity for the diagnosis of EOS in neonates. Newer and more selective markers have surfaced recently, such as presepsin and endocan, but they are currently only in the experimental research stages. This comprehensive review article is based on the role of biomarkers currently in use or in the research phase from a basic, translational, and clinical viewpoint that helps us to improve the quality of neonatal early-onset sepsis diagnosis and management.
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18
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Singh MP, Balegar V KK, Angiti RR. The practice of blood volume submitted for culture in a neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2020; 105:600-604. [PMID: 32198199 DOI: 10.1136/archdischild-2019-318080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/09/2020] [Accepted: 02/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Neonatal sepsis is the leading cause of mortality and morbidity in neonatal intensive care units. The volume of blood taken for culture remains one of the most important factors in isolating microorganisms. OBJECTIVES To evaluate the impact of the intervention on the blood volume submitted for culture and to identify factors influencing the volume as determined by the phlebotomist. METHODS Blood culture volume was determined by weighing the culture bottle before and immediately after blood inoculation. A 3-month preintervention audit revealed that in 126/130 samples (96.9%), the volume of blood submitted was suboptimal. Multiple intervention measures were instituted, and volume was monitored over the next 9 months. RESULTS 637 blood culture samples were included in the study, 130 were in preintervention and 507 were in postintervention epochs. Following the intervention, suboptimal volume samples reduced from 96.9% (126/130 samples) to 25% (126/507 samples), p<0.0001 and the median (IQR) sample volume improved from 0.36 (0.23) ml to 0.9 (0.27) ml, p<0.0001. Poor blood flow was identified as the most common reason for an inadequate sample. CONCLUSION The study underscores the role of educational intervention in improving the blood culture volume in newborn infants. Poor backflow from the cannula is an important cause of inadequate volume collection.
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Affiliation(s)
- Moni Pankhuri Singh
- Neonatal Intensive Care Unit, Nepean Hospital, Penrith, New South Wales, Australia
| | - Kiran Kumar Balegar V
- Neonatal Intensive Care Unit, Nepean Hospital, Penrith, New South Wales, Australia .,The University of Sydney, Sydney Medical School Nepean, Sydney, New South Wales, Australia
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19
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Gomes S, Wood D, Ayis S, Haliasos N, Roland D. Evaluation of a novel approach to recognising community-acquired paediatric sepsis at ED triage by combining an electronic screening algorithm with clinician assessment. Emerg Med J 2020; 38:132-138. [PMID: 33127742 DOI: 10.1136/emermed-2019-208746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/19/2020] [Accepted: 09/27/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We report the utilisation and impact of a novel triage-based electronic screening tool (eST) combined with clinical assessment to recognise sepsis in paediatric ED. METHODS An electronic sepsis screening tool was implemented in the paediatric EDs of two large UK secondary care hospitals between June 2018 and January 2019. Patients eligible for screening were children < 16 years of ages excluding those with minor injuries or who were brought directly to resuscitation. Subsequently, a retrospective evaluation was performed to determine the performance of the tool alone and in combination with clinical assessment after triage, to identify septic patients, using sensitivity, specificity, positive, negative predictive values (PPV and NPV) and likelihood ratios. RESULTS 19 912 children were triaged during the study period, of whom 90 (0.45%) were classified as having sepsis. 99% of all eligible patients were screened. The eST alerted for 2651 (13.3%) patients. After immediate physician assessment, 151 were treated for sepsis in the ED, of whom 70 had a final diagnosis of sepsis. Eight patients who were not thought to be septic returned with sepsis within 24 hours. The eST showed a sensitivity of 86.7% (95% CI 77.5% to 92.6%), specificity 87.0% (95% CI 86.5% to 87.5%), PPV 2.94% (95% CI 2.35% to 3.68%), NPV 99.9% (95% CI 99.8% to 99.9%) which improved with combined clinical assessment to a sensitivity of 90.0% (95% CI 81.4% to 95.0%), specificity 99.4 (95% CI 99.3% to 99.5%), PPV 42.0 (95% CI 35.0% to 49.3%) and NPV 99.9% (95% CI 99.9% to 99.9%). CONCLUSION Utilisation of a novel triage-based eST allowed sepsis screening in over 99% of eligible patients. The screening tool showed good accuracy to recognise sepsis at triage in the ED, which was augmented further by combining it with clinician assessment. The screening tool requires further refinement through multicentre evaluation to avoid missing sepsis cases.
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Affiliation(s)
- Sylvester Gomes
- Paediatric Emergency Department, Evelina London Children's Hospital, London, UK
| | - Darryl Wood
- Emergency Department, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, London, UK
| | - Salma Ayis
- Medical Statistics, King's College London, London, UK
| | - Nikolaos Haliasos
- Emergency Department, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, London, UK
| | - Damian Roland
- Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Hospitals, Leicester, UK
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20
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Alemnew B, Biazin H, Demis A, Abate Reta M. Bacterial Profile among Patients with Suspected Bloodstream Infections in Ethiopia: A Systematic Review and Meta-Analysis. Int J Microbiol 2020; 2020:8853053. [PMID: 32963541 PMCID: PMC7501548 DOI: 10.1155/2020/8853053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The burden of bloodstream infections (BSIs) has been warranted in Ethiopia. Globally, the emergency and raised resistance rate of bacterial antimicrobial resistance is becoming a prominent problem, and it is difficult to treat patients having sepsis. In this review, we aimed to determine the pooled prevalence of bacterial isolates among presumptive patients with bloodstream infections in Ethiopia. METHODS A systematic search was performed from PubMed/MEDLINE, Scopus, HINARI, ScienceDirect, and Google Scholar electronic databases using PRISMA guidelines. The data analysis was carried out using STATATM version 14 after the records were cleaned and sorted out. RESULTS A total of 26 studies with 8,958 blood specimens and 2,382 culture-positive bacterial isolates were included for systematic review and meta-analysis. The meta-analysis derived a pooled culture-positive bacterial prevalence which was 25.78% (95% CI: 21.55-30.01%). The estimated pooled prevalence of Gram-positive and Gram-negative bacterial isolates was 15.50% (95% CI: 12.84-18.15%) and 10.48 % (95% CI: 8.32-12.63%), respectively. The two common Gram-positive bacteria isolated from patients suspected of BSIs were coagulase-negative Staphylococcus with a pooled prevalence of 5.75% (95% CI: 4.58-6.92%) and S. aureus 7.04 % (95% CI: 5.37-8.72%). Similarly, the common Gram-negative bacterial isolates and their estimated pooled prevalence were E. coli 1.69% (95% CI: 1.21-2.16%), Klebsiella species 7.04 % (95% CI: 5.37-8.72%), Pseudomonas species 0.39% (95% CI: 0.08-0.70%), Salmonella species 1.09% (95% CI: 0.79-1.38%), and Streptococcus pyogenes 0.88% (95% CI: 0.54-1.22%). CONCLUSION The prevalence of bacterial isolates among presumptive patients suspected to BSIs in Ethiopia remains high. Furthermore, we found a remarkable variation in the pathogen distribution across the study setting.
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Affiliation(s)
- Birhan Alemnew
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Habtamu Biazin
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asmamaw Demis
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Melese Abate Reta
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Sola A, Mir R, Lemus L, Fariña D, Ortiz J, Golombek S. Suspected Neonatal Sepsis: Tenth Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN). Neoreviews 2020; 21:e505-e534. [PMID: 32737171 DOI: 10.1542/neo.21-8-e505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Suspected neonatal sepsis is one of the most common diagnoses made in newborns (NBs), but very few NBs actually have sepsis. There is no international consensus to clearly define suspected neonatal sepsis, but each time that this suspected diagnosis is assumed, blood samples are taken, venous accesses are used to administer antibiotics, and the mother-child pair is separated, with prolonged hospital stays. X-rays, urine samples, and a lumbar puncture are sometimes taken. This is of concern, as generally <10% and no more than 25%-30% of the NBs in whom sepsis is suspected have proven neonatal sepsis. It seems easy to start antibiotics with suspicion of sepsis, but stopping them is difficult, although there is little or no support to maintain them. Unfortunately, the abuse of antibiotics in inpatient and outpatient NBs is foolish. Its negative impact on neonatal health and the economy is a public health problem of epidemiological and even epidemic proportions. This manuscript is a shortened version of the 10th Clinical Consensus of the Ibero-American Society of Neonatology (SIBEN) on suspected neonatal sepsis at the end of 2018, updated with publications from its completion to February 2020. This manuscript describes useful strategies for everyday neonatal practice when neonatal sepsis is suspected, along with important aspects about the indisputable value of clinical evaluation of the NB and about obtaining and interpreting blood cultures, urine cultures, and other cultures. Likewise, the low value of laboratory tests in suspected neonatal sepsis is demonstrated with evidence and clinical recommendations are made on the appropriate use of antibiotics.
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Affiliation(s)
- Augusto Sola
- Medical Director, Ibero-American Society of Neonatology, Wellington, FL
| | - Ramón Mir
- Neonatology Department Chief in Hospital de Clìnicas Universidad Nacional de Asunciòn, Paraguay
| | - Lourdes Lemus
- Departamento de Neonatología, Hospital de Pediatría UMAE, Instituto Mexicano del Seguro Social, Guadalajara Jalisco, México
| | - Diana Fariña
- Director of the Neonatal Intensive Care Unit, Hospital de Pediatría, Buenos Aires, Argentina
| | - Javier Ortiz
- Ángeles del Pedregal Hospital, Mexico City, Mexico
| | - Sergio Golombek
- Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, NJ
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Sari TK, Irwanto I, Etika R, Sampurna MTA, Mertaniasih NM. ASSOCIATION BETWEEN SEPSIS RISK CALCULATOR AND INFECTION PARAMETERS FOR NEONATES WITH RISK OF EARLY ONSET SEPSIS. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2020. [DOI: 10.20473/ijtid.v8i2.10712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
C-reactive protein (CRP) is an acute-phase reactant protein that is primarily induced by the IL-6 action during the acute phase of an inflammatory or infectious process. Bacterial infection is a potent stimulus, leading to a rapid elevation of CRP levels within hours while the CBC and symptom are often misleading and/or absent. American Academy of paediatrics (AAP) is recommended routine blood examination test Complete Blood Count (CBC), C-reactive protein (CRP), and blood culture along with empirical antibiotic in neonates with early onset sepsis risk (EOS) risk even asymptomatic. Previous study is showed there were no correlation of CRP and EOS risk. The aim of this study is to evaluate the CRP and CBC profile in neonate with risk of EOS. Methods of this study is using the sepsis risk calculator (SRC) to calculate the probability of neonatal early onset sepsis (EOS) based on maternal risk and infant’s clinical presentation. Neonates with ≥34 weeks of gestation who were started on antibiotic treatment after laboratory examination and blo odculture were taken. EOS risk estimation were compared including CRP, leukocyte, and thrombocyte count. ANOVA applied to distinguished laboratory examination between stratified risk groups. The result is showed using 82 subjects who met the inclusion and exclusion criterias, EOS risk level was stratified into green, yellow, and red group. The p value of CRP level, platelets, white blood cell were 0.35,0.54 and 0.48 where p value was considered as significant if < 0.5. The conclusion of this study is there were no correlation of CRP level and EOS riskASSOCIATION BETWEEN SEPSIS RISK CALCULATOR AND INFECTION PARAMETERS FOR NEONATES WITH RISK OF EARLY ONSET SEPSIS
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Bunduki GK, Adu-Sarkodie Y. The usefulness of C-reactive protein as a biomarker in predicting neonatal sepsis in a sub-Saharan African region. BMC Res Notes 2020; 13:194. [PMID: 32238170 PMCID: PMC7110732 DOI: 10.1186/s13104-020-05033-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/19/2020] [Indexed: 11/16/2022] Open
Abstract
Objective The early diagnosis of neonatal sepsis remains a challenge for physicians. The initiation or/and discontinuation of the empirical antibiotic therapy at neonates with sepsis is a dilemma due to the lack of definitive diagnosis and the fear of misdiagnosing a case with its serious outcomes, which can follow up. Therefore, this study aimed to assess the usefulness of C-reactive protein (CRP) as an inflammatory biomarker in the prediction of the neonatal sepsis diagnosis in Butembo, the Democratic Republic of the Congo, in sub-Saharan Africa. Blood culture and quantitative CRP measurements were performed for each neonate. Receiver operating characteristics (ROC) analyses were done in the assessment of CRP accuracy in diagnosing neonatal sepsis. Results Of the 228 neonates screened for sepsis, 69 (30.3%) had a positive blood culture. Of the 228 neonates with suspected sepsis, 94 (41.2%) had a positive CRP. Among the 69 cases with positive blood culture, CRP identified 66 cases. The sensitivity, specificity, positive and negative predictive values of CRP were 95.7%, 82.4%, 70.2%, and 97.8%, respectively. The area under the curve (AUC) for the CRP ROC analysis was 0.948. CRP showed its usefulness in the diagnosis of neonatal sepsis.
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Affiliation(s)
- Gabriel Kambale Bunduki
- Department of Infectious Diseases, Faculty of Medicine, Université Catholique du Graben, PO. Box 29, Butembo, North-Kivu, Democratic Republic of the Congo. .,Department of Clinical Microbiology, School of Medical Sciences, College of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Yaw Adu-Sarkodie
- Department of Clinical Microbiology, School of Medical Sciences, College of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Hackler J, Wisniewska M, Greifenstein-Wiehe L, Minich WB, Cremer M, Bührer C, Schomburg L. Copper and selenium status as biomarkers of neonatal infections. J Trace Elem Med Biol 2020; 58:126437. [PMID: 31778962 DOI: 10.1016/j.jtemb.2019.126437] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/16/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022]
Abstract
Neonatal infections are a major risk factor for neonatal mortality. A reliable diagnosis of early-onset sepsis (EOS) is hampered by the variable clinical presentations of the children. We hypothesized that changes in the Se or Cu status, or the biomarkers selenoprotein P (SELENOP) or ceruloplasmin (CP) alone or in combination may be informative of EOS. We generated a new human CP-specific non-competitive immunoassay (ELISA) suitable of analysing small sample volumes and validated the method with a commercial CP source. Using this novel CP assay, we analysed a case-control study of EOS (n = 19 control newborns, n = 18 suspected cases). Concentrations of Se, Cu, SELENOP, CP, interleukin-6 (IL-6), and C-reactive protein (CRP) along with the Cu/Se and CP/SELENOP ratios were evaluated by correlation analyses as biomarkers for EOS. Diagnostic value was estimated by receiver operating characteristic (ROC) curve analyses. The new CP-ELISA displayed a wide working range (0.10-6.78 mg CP/L) and low sample requirement (2 μL of serum, EDTA-, heparin- or citrate-plasma). Plasma CP correlated positively with Cu concentrations in the set of all samples (Pearson r = 0.8355, p < 0.0001). Three of the infected neonates displayed particularly high ratios of Cu/Se and CP/SELENOP, i.e., 3.8- to 6.9-fold higher than controls. Both the Cu/Se and the CP/SELENOP ratios correlated poorly with the early infection marker IL-6, but strongly and positively with the acute-phase protein CRP (Cu/Se-CRP: Spearman ϱ = 0.583, p = 0.011; CP/SELENOP-CRP: ϱ = 0.571, p = 0.013). The ROC curve analyses indicate that a combination of biomarkers for the Se and Cu status do not improve the early identification of EOS considerably. This study established a robust, highly precise, partly validated and scalable novel CP sandwich ELISA suitable for basic and clinical research, requiring minute amounts of sample. The ratio of circulating CP/SELENOP constitutes a promising new composite biomarker for detection of EOS, at least in a subset of severely diseased children.
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Affiliation(s)
- Julian Hackler
- Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Monika Wisniewska
- Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lennart Greifenstein-Wiehe
- Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Waldemar B Minich
- Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Malte Cremer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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25
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Tran P, Dowell E, Hamilton S, Dolan SA, Messacar K, Dominguez SR, Todd J. Two Blood Cultures With Age-Appropriate Volume Enhance Suspected Sepsis Decision-Making. Open Forum Infect Dis 2020; 7:ofaa028. [PMID: 32055641 PMCID: PMC7009551 DOI: 10.1093/ofid/ofaa028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/24/2020] [Indexed: 11/14/2022] Open
Abstract
Background Multiple blood cultures have been shown to improve pathogen yield and antimicrobial stewardship for adult patients with suspected serious bacterial infection (SBI). For children, the use of multiple blood cultures is less common and volume recommendations are more complicated, often resulting in single cultures with low volume. Methods In 2010, Children’s Hospital Colorado instituted electronic medical record (EMR) decision support to recommend collection of 2 blood cultures before administration of antibiotics for suspected SBI. Recommended blood culture volumes were calculated by age rather than weight. We evaluated all children admitted to inpatient units between 2008 and 2009 (pre-intervention) and 2011 and 2013 (postintervention) who received antibiotics in the hospital after having blood cultures drawn in the emergency department, excluding those with a length of stay >8 days. We compared blood culture yield, isolate classification (pathogen vs contaminant), and antimicrobial modifications before and after the interventions. Results A total of 3948 children were included in the study. EMR guidelines were associated with a significantly higher number of children with multiple blood cultures drawn before antibiotic administration (88.0% vs 12.3%; P < .001) and an increased percentage of blood cultures with the recommended volume (74.3% vs 15.2%; P < .001), resulting in a significantly higher pathogen isolation rate and improved antimicrobial decisions. Multiple cultures helped define the role of common contaminants in the clinical decision process. Conclusions Multiple blood cultures with age-based volumes taken before starting antibiotics increase pathogen isolation rates and appropriate modification of antimicrobial treatment in children.
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Affiliation(s)
- Paul Tran
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elaine Dowell
- Department of Pathology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Stacey Hamilton
- Department of Pathology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Susan A Dolan
- Department of Infectious Diseases and Epidemiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Kevin Messacar
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Samuel R Dominguez
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pathology, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Infectious Diseases and Epidemiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - James Todd
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Infectious Diseases and Epidemiology, Children's Hospital Colorado, Aurora, Colorado, USA
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Huber S, Hetzer B, Crazzolara R, Orth-Höller D. The correct blood volume for paediatric blood cultures: a conundrum? Clin Microbiol Infect 2019; 26:168-173. [PMID: 31654793 DOI: 10.1016/j.cmi.2019.10.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/04/2019] [Accepted: 10/05/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bloodstream infections (BSIs) are a major cause of morbidity and mortality in paediatric patients. For fast and accurate diagnosis, blood culture (BC) is the reference standard. However, the procedure for blood sampling in paediatric patients, particularly the optimal blood volume, is the subject of controversy stemming from a lack of knowledge of the bacterial load and because of several obstacles such as low intravascular volume and the risk of causing anaemia. AIMS The aim of this narrative review is to summarize current knowledge on blood sampling in paediatric patients for BC purposes, in particular blood volume and number and type of BC bottles needed for reasonable future guidelines/recommendations. SOURCES A comprehensive literature search of PubMed, including all publications in English, was performed in June 2019 using the search terms 'blood culture', 'blood volume', 'bloodstream infection', 'diagnostic', 'paediatric' and/or 'sepsis'. CONTENT The amount of inoculated blood determines the sensitivity, specificity and time to positivity of a BC, and low-level bacteraemia (≤10 cfu/mL) in paediatric patients is presumed to be more common than reported. Current approaches for 'adequate' blood volume for paediatric BC are mainly weight- or age-dependent. Of these recommendations, the scheme devised by Gaur and colleagues seems most appropriate and calls for a sample of 1-1.5 mL for children weighing <11 kg and 7.5 mL for a patient weight of 11-17 kg to be drawn into one BC bottle. Inclusion of a more detailed grading in the weight range 4-14 kg, as published by Gonsalves and colleagues, might be useful. IMPLICATIONS This review could be important for future guidelines on paediatric BC collection and thus could contribute to improving patient management and lowering the economic and global health burden associated with BSI. Furthermore, upcoming molecular-based approaches with low sample volumes might be an interesting alternative.
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Affiliation(s)
- S Huber
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - B Hetzer
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - R Crazzolara
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - D Orth-Höller
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.
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Afonso EDP, Blot S. Late onset sepsis in NICU - are we are all looking through the same lens? Infect Dis (Lond) 2019; 51:625-626. [PMID: 31165651 DOI: 10.1080/23744235.2018.1546898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Elsa da Palma Afonso
- a Neonatal Intensive Care Unit, Rosie Hospital , Cambridge University Hospitals NHS Trust , Cambridge , UK.,b Department of Internal Medicine, Faculty of Medicine & Health Science , Ghent University , Ghent , Belgium
| | - Stijn Blot
- b Department of Internal Medicine, Faculty of Medicine & Health Science , Ghent University , Ghent , Belgium.,c Burns, Trauma and Critical Care Research Centre , The University of Queensland , Brisbane , Australia
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Griffiths J, Jenkins P, Vargova M, Bowler U, Juszczak E, King A, Linsell L, Murray D, Partlett C, Patel M, Berrington J, Embleton N, Dorling J, Heath PT, McGuire W, Oddie S. Enteral lactoferrin to prevent infection for very preterm infants: the ELFIN RCT. Health Technol Assess 2019; 22:1-60. [PMID: 30574860 DOI: 10.3310/hta22740] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Infections acquired in hospital are an important cause of morbidity and mortality in very preterm infants. Several small trials have suggested that supplementing the enteral diet of very preterm infants with lactoferrin, an antimicrobial protein processed from cow's milk, prevents infections and associated complications. OBJECTIVE To determine whether or not enteral supplementation with bovine lactoferrin (The Tatua Cooperative Dairy Company Ltd, Morrinsville, New Zealand) reduces the risk of late-onset infection (acquired > 72 hours after birth) and other morbidity and mortality in very preterm infants. DESIGN Randomised, placebo-controlled, parallel-group trial. Randomisation was via a web-based portal and used an algorithm that minimised for recruitment site, weeks of gestation, sex and single versus multiple births. SETTING UK neonatal units between May 2014 and September 2017. PARTICIPANTS Infants born at < 32 weeks' gestation and aged < 72 hours at trial enrolment. INTERVENTIONS Eligible infants were allocated individually (1 : 1 ratio) to receive enteral bovine lactoferrin (150 mg/kg/day; maximum 300 mg/day) or sucrose (British Sugar, Peterborough, UK) placebo (same dose) once daily from trial entry until a postmenstrual age of 34 weeks. Parents, caregivers and outcome assessors were unaware of group assignment. OUTCOMES Primary outcome - microbiologically confirmed or clinically suspected late-onset infection. Secondary outcomes - microbiologically confirmed infection; all-cause mortality; severe necrotising enterocolitis (NEC); retinopathy of prematurity (ROP); bronchopulmonary dysplasia (BPD); a composite of infection, NEC, ROP, BPD and mortality; days of receipt of antimicrobials until 34 weeks' postmenstrual age; length of stay in hospital; and length of stay in intensive care, high-dependency and special-care settings. RESULTS Of 2203 enrolled infants, primary outcome data were available for 2182 infants (99%). In the intervention group, 316 out of 1093 (28.9%) infants acquired a late-onset infection versus 334 out of 1089 (30.7%) infants in the control group [adjusted risk ratio (RR) 0.95, 95% confidence interval (CI) 0.86 to 1.04]. There were no significant differences in any secondary outcomes: microbiologically confirmed infection (RR 1.05, 99% CI 0.87 to 1.26), mortality (RR 1.05, 99% CI 0.66 to 1.68), NEC (RR 1.13, 99% CI 0.68 to 1.89), ROP (RR 0.89, 99% CI 0.62 to 1.28), BPD (RR 1.01, 99% CI 0.90 to 1.13), or a composite of infection, NEC, ROP, BPD and mortality (RR 1.01, 99% CI 0.94 to 1.08). There were no differences in the number of days of receipt of antimicrobials, length of stay in hospital, or length of stay in intensive care, high-dependency or special-care settings. There were 16 reports of serious adverse events for infants in the lactoferrin group and 10 for infants in the sucrose group. CONCLUSIONS Enteral supplementation with bovine lactoferrin does not reduce the incidence of infection, mortality or other morbidity in very preterm infants. FUTURE WORK Increase the precision of the estimates of effect on rarer secondary outcomes by combining the data in a meta-analysis with data from other trials. A mechanistic study is being conducted in a subgroup of trial participants to explore whether or not lactoferrin supplementation affects the intestinal microbiome and metabolite profile of very preterm infants. TRIAL REGISTRATION Current Controlled Trials ISRCTN88261002. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 74. See the NIHR Journals Library website for further project information. This trial was also sponsored by the University of Oxford, Oxford, UK. The funder provided advice and support and monitored study progress but did not have a role in study design or data collection, analysis and interpretation.
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Affiliation(s)
- James Griffiths
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Paula Jenkins
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Monika Vargova
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Ursula Bowler
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Andrew King
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Louise Linsell
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - David Murray
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | | | | | - Janet Berrington
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Nicholas Embleton
- Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Paul T Heath
- St George's, University of London and St George's University Hospitals NHS Trust, London, UK
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sam Oddie
- Bradford Institute for Health Research, Bradford, UK
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Greer R, Safarulla A, Koeppel R, Aslam M, Bany-Mohammed FM. Can Fetal Umbilical Venous Blood Be a Reliable Source for Admission Complete Blood Count and Culture in NICU Patients? Neonatology 2019; 115:49-58. [PMID: 30300890 PMCID: PMC6621551 DOI: 10.1159/000491993] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/10/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Minimizing initial neonatal blood draws and their associated pain is important. The placenta has ample fetal blood that is otherwise discarded; obtaining admission laboratory evaluations from fetal umbilical venous blood (FUVB) may provide a suitable alternative. OBJECTIVE We hypothesized that obtaining an aerobic bacterial blood culture (BCX) and a complete blood count with manual differential (CBC/diff) from FUVB is feasible and yields results comparable to those obtained directly from the neonate. STUDY DESIGN BCX and CBC/diff were attempted on paired samples from FUVB (in the delivery room) and neonatal blood (shortly after NICU admission) of 110 patients. The paired t test, Pearson's correlation coefficient (R), and multivariable linear regression were used for data analysis. RESULTS Positive BCXs were found in 9 of 108 FUVB samples compared to 1 of 91 neonatal samples. Three out of 9 FUVB cultures were true pathogens, including 2 Escherichia coli and 1 viridans group streptococcus, all with negative corresponding paired neonatal cultures. There was 1 positive neonatal BCX, E. coli, with a negative paired FUVB culture. Neonatal hemoglobin (Hb), platelets (PLT), and white blood cells (WBC) all significantly (p < 0.0001) correlated with the paired FUVB samples (R = 0.50, 0.49, and 0.84, respectively). Hb, PLT, and WBC values were clinically comparable but statistically higher in neonatal blood (the differences were 2.3 g/dL, 30,000 cells/μL, and 2,800 cells/μL, respectively; p < 0.007 for all comparisons). CONCLUSIONS FUVB is suitable for obtaining CBC/diff. FUVB is an appropriate second source for BCX as it yields additional true pathogens. Our findings may support the presence of "culture-negative sepsis" in some neonates.
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Affiliation(s)
- Rocky Greer
- Division of Neonatology, Department of Pediatrics, University of California Irvine School of Medicine, Irvine, California, USA
| | - Azif Safarulla
- Division of Neonatology, Department of Pediatrics, University of California Irvine School of Medicine, Irvine, California, USA
| | - Robin Koeppel
- Neonatal Intensive Care Unit, University of California Irvine Medical Center, Orange, California, USA
| | - Muhammad Aslam
- Division of Neonatology, Department of Pediatrics, University of California Irvine School of Medicine, Irvine, California, USA
| | - Fayez M Bany-Mohammed
- Division of Neonatology, Department of Pediatrics, University of California Irvine School of Medicine, Irvine, California,
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30
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Bandyopadhyay T, Kumar A, Saili A, Randhawa VS. Distribution, antimicrobial resistance and predictors of mortality in neonatal sepsis. J Neonatal Perinatal Med 2018; 11:145-153. [PMID: 29991144 DOI: 10.3233/npm-1765] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study is to investigate etiological agents, patterns of antimicrobial resistance and predictors of mortality in culture proven neonatal sepsis. METHOD This is a twenty-four month retrospective cohort study of infants with culture proven sepsis. Demographic data, type of isolates and its sensitivity pattern were recorded. Multidrug resistant gram-negative isolates were defined as resistance to any three of five antibiotic classes: extended-spectrum cephalosporins, carbapenems, aminoglycosides, fluoroquinolones and piperacillin-tazobactam. RESULT A total of 183 case with culture positive sepsis were identified. Early onset sepsis occurred in 59% of cases. The majority of isolates (56.2%) were gram-positive but the most common individual isolates were klebsiella spp. (31.1%), Staphylococcus aureus (24.5%) and coagulase-negative staphylococci (CONS) (22.9%). The pathogen mix in early-onset did not differ from late-onset sepsis. High rates of multidrug resistance were observed in klebsiella spp. (49.1%), Escherichia coli (50%), citrobacter spp (50%), acinetobacter spp. (28.5%), pseudomonas spp. (100%) isolates. Methicillin resistance prevailed in 16.6% of coagulase-negative staphylococci, 24.4% of Staphylococcus aureus and 62.5% of enterococcus spp. Multivariate analysis revealed invasive ventilation and early onset sepsis to be independently associated with increased risk of mortality in contrast to breast milk feeding which is associated with decreased risk of mortality. CONCLUSION A high degree of antimicrobial resistance underscores the need to understand the pathogenesis of resistance, curtail the irrational prescription of antibiotics in neonates and the requirement for measures to prevent it in low-income and middle-income countries.
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Affiliation(s)
- T Bandyopadhyay
- Department of Neonatology, Lady Hardinge Medical College, New Delhi, India
| | - A Kumar
- Department of Neonatology, Lady Hardinge Medical College, New Delhi, India
| | - A Saili
- Department of Neonatology, Lady Hardinge Medical College, New Delhi, India
| | - V S Randhawa
- Department of Microbiology, Lady Hardinge Medical College, New Delhi, India
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Stranieri I, Kanunfre KA, Rodrigues JC, Yamamoto L, Nadaf MIV, Palmeira P, Okay TS. Assessment and comparison of bacterial load levels determined by quantitative amplifications in blood culture-positive and negative neonatal sepsis. Rev Inst Med Trop Sao Paulo 2018; 60:e61. [PMID: 30379228 PMCID: PMC6201740 DOI: 10.1590/s1678-9946201860061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/02/2018] [Indexed: 12/17/2022] Open
Abstract
Bacterial sepsis remains a major cause of mortality and blood cultures are the
gold standard of laboratory diagnosis even though they lack sensitivity in
neonates. Culturenegative sepsis, also known as clinical sepsis, has long been
considered a diagnosis in neonatal intensive care units because, as well as
culture-positive infants, culture-negative neonates have worse prognosis in
comparison with non-infected ones. Quantitative amplifications are used to
detect bacterial infections in neonates but results are considered only in a
qualitative way (positive or negative). The aim of the present study was to
determine and compare bacterial load levels in blood culture-positive and
culture-negative neonatal sepsis. Seventy neonates with clinical and laboratory
evidence of infection admitted at three neonatal intensive care units were
classified as blood culture-positive or culture-negative. Blood samples obtained
at the same time of blood cultures had bacterial load levels assessed through a
16S rDNA qPCR. Blood cultures were positive in 29 cases (41.4%) and qPCR in 64
(91.4%). In the 29 culture-positive cases, 100% were also positive by qPCR,
while in the 41 culture-negative cases, 35 (85.4%) were positive by qPCR.
Bacterial load levels were in general < 50 CFU/mL, but were significantly
higher in culture-positive cases (Mann-Whitney, p = 0.013), although clinical
and laboratory findings were similar, excepting for deaths. In conclusion, the
present study has shown that blood culture-negative neonates have lower bacteria
load levels in their bloodstream when compared to blood culture-positive
infants.
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Affiliation(s)
- Inês Stranieri
- Universidade Federal de Mato Grosso, Hospital Universitário Julio Muller, Laboratório de Análises Clínicas, Divisão de Microbiologia, Cuiabá, Mato Grosso, Brazil
| | - Kelly Aparecida Kanunfre
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Soroepidemiologia e Imunobiologia, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, LIM 48, São Paulo, São Paulo, Brazil
| | - Jonatas Cristian Rodrigues
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Soroepidemiologia e Imunobiologia, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, LIM 48, São Paulo, São Paulo, Brazil
| | - Lidia Yamamoto
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Soroepidemiologia e Imunobiologia, São Paulo, São Paulo, Brazil
| | - Maria Isabel Valdomir Nadaf
- Universidade Federal do Mato Grosso, Faculdade de Medicina, Departamento de Pediatria, Cuiabá, Mato Grosso, Brazil
| | - Patricia Palmeira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Laboratório de Pediatria Clínica, LIM 36, São Paulo, São Paulo, Brazil
| | - Thelma Suely Okay
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Soroepidemiologia e Imunobiologia, São Paulo, São Paulo, Brazil
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Khattab AA, El-Mekkawy MS, Helwa MA, Omar ES. Utility of serum resistin in the diagnosis of neonatal sepsis and prediction of disease severity in term and late preterm infants. J Perinat Med 2018; 46:919-925. [PMID: 29605824 DOI: 10.1515/jpm-2018-0018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/27/2018] [Indexed: 12/22/2022]
Abstract
Introduction Resistin is a proinflammatory hormone recently proposed as a sepsis biomarker. Our aim was to evaluate the diagnostic and prognostic values of this marker in neonatal sepsis. Methods This is a prospective observational study that includes 60 term and late preterm neonates with proven and possible sepsis besides 30 healthy controls. Resistin and other biomarkers, like C-reactive protein (CRP), were measured within 2 h of neonatal intensive care unit (NICU) admission. Infants were monitored and the primary outcome was 30-day mortality. Results Resistin was higher among septic neonates compared with controls (P<0.001). Resistin had an area under the receiver operating characteristic (ROC) curve of 0.994 for differentiating septic infants from controls. The area under the curve (AUC) for differentiating infants with culture-proven sepsis from controls was 0.999 compared with an AUC of 1 for CRP. The other markers, like platelet count, were inferior to resistin and CRP. Resistin was positively correlated with CRP [Spearman's correlation coefficient (rs)=0.55, P<0.001]. No significant differences in resistin levels were noted between survivors and non-survivors but resistin was higher among infants with severe sepsis (P=0.015) and among those who needed mechanical ventilation (P<0.001). Conclusion Resistin is useful for the diagnosis of neonatal sepsis. Resistin failed to predict mortality but was associated with indicators of disease severity.
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Affiliation(s)
- Ahmed Anwar Khattab
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Mohamed Ahmed Helwa
- Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Anegundi R, Kulkarni RD, Patil SS, Chitharagi VB, Ajantha GS. Evaluation of a modified protocol that decreases the turnaround time of positive blood cultures. IRANIAN JOURNAL OF MICROBIOLOGY 2018; 10:281-286. [PMID: 30675323 PMCID: PMC6339999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Neonatal septicemia can be rapidly fatal if not treated promptly. A speedy laboratory diagnosis would improve the outcome. The BacT/ALERT 3D system (bioMerieux, Durham, North Carolina) is currently being used for laboratory diagnosis of blood stream infections. In the present study, a modified protocol was employed in which the broth was subcultured into two nutrient broth tubes and these tubes were used for biochemical tests and antimicrobial susceptibility testing to decrease the turnaround time. MATERIALS AND METHODS A prospective study was conducted in the Department of Microbiology, SDM College of Medical Sciences and Hospital, Dharwad from October 2010 to July 2012 after receiving clearance from the institutional ethics committee. Automated blood cultures of 250 neonates admitted to the Neonatal Intensive Care Unit (NICU), clinically diagnosed to have septicemia, were performed using BacT/ALERT 3D. Bottles flagged positive within 72 hours of loading were processed for identification and antibiotic susceptibility testing using a modified protocol. The results were assessed for time saved in reporting in comparison with standard protocol. Student's t test was used for statistical analysis. RESULTS Of the 250 cases studied, 117 cases yielded a positive blood culture giving a yield of 46.8%. The number of cases yielding monomicrobial growth were 73, which were included for further analysis. Of the remaining samples, 133 did not show growth, 11 were polymicrobial while 33 samples were flagged positive after 72 hours. Candida spp. grew in 34 cases, Gram negative bacilli grew in 28 cases and Gram positive cocci grew in 11 cases. In four cases, 66 hours were saved, 60 and 54 hours were saved in 18 cases each, 48 hours were saved in 27 cases, and 24 hours were saved in 6 cases. Methicillin resistant Staphylococcus aureus and Klebsiella pneumoniae were the most common isolates among Gram positive cocci and Gram negative bacilli, respectively, while C. guilliermondii was the most common Candida isolate. All Gram positive isolates were susceptible to vancomycin and linezolid. Most of the Gram negative isolates were susceptible to imipenem. CONCLUSION This method can be employed in peripheral laboratory settings where there is no complete automation. Modification in processing blood culture can provide speedy identification and sensitivity report in blood stream infections. Time saved in reporting would play a crucial role in improving morbidity and mortality rates in neonatal septicemia.
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Affiliation(s)
- Renuka Anegundi
- Department of Microbiology, Kasturba Medical College, Manipal, Karnataka, India,Corresponding author: Renuka Anegundi, Ph.D, Department of Microbiology, Kasturba Medical College, Manipal, Karnataka, India. Tel: +91-820 2922717,
| | | | - Satish S Patil
- Department of Microbiology, SS Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India
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Harewood FC, Curtis N, Daley AJ, Bryant PA, Gwee A, Connell TG. Adequate or Inadequate? The Volume of Blood Submitted for Blood Culture at a Tertiary Children's Hospital. Clin Pediatr (Phila) 2018; 57:1310-1317. [PMID: 29808741 DOI: 10.1177/0009922818778042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The volume of blood sampled for culture critically influences the results. This study aimed to determine (1) the volume of blood submitted for culture, (2) the proportion of blood cultures with adequate volume, (3) whether measured improvement from a previous educational intervention had been sustained, and (4) the impact of blood volume on culture result. The volume of blood submitted for cultures was determined over a 13-month period by weighing bottles before and after collection and before and after an educational intervention. The volume of blood submitted in 5127 culture bottles were measured. Fewer than 50% of all cultures were deemed adequate. A significant pathogen was isolated in 4.7% of blood cultures, and low-volume cultures were more likely to yield contaminant isolates (47/2422 [1.9%] vs 22/2705 [0.8%], P = .0005). Subsequently, the higher rate of contaminant isolates from low-volume cultures may affect selection and rationalization of antibiotic therapy.
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Affiliation(s)
- Freya C Harewood
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- 3 University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel Curtis
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- 3 University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew J Daley
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amanda Gwee
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- 3 University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas G Connell
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Dierig A, Berger C, Agyeman PKA, Bernhard-Stirnemann S, Giannoni E, Stocker M, Posfay-Barbe KM, Niederer-Loher A, Kahlert CR, Donas A, Hasters P, Relly C, Riedel T, Aebi C, Schlapbach LJ, Heininger U. Time-to-Positivity of Blood Cultures in Children With Sepsis. Front Pediatr 2018; 6:222. [PMID: 30135859 PMCID: PMC6092514 DOI: 10.3389/fped.2018.00222] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/18/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Blood cultures are essential for the diagnosis and further appropriate treatment in children with suspected sepsis. In most hospitals, children will be empirically treated or closely monitored for at least 48 h awaiting results of blood cultures. Several studies have challenged the optimal duration of empiric treatment in the era of continuously monitored blood culture systems. The aim of our study was to investigate time-to-positivity (TTP) of blood cultures in children with proven sepsis. Methods: The Swiss Pediatric Sepsis Study prospectively enrolled children 0-16 years of age with blood culture positive sepsis between September 2011 and October 2015. TTP was prospectively assessed in six participating academic pediatric hospitals by fully automated blood culture systems. Results: In 521 (93%) of 562 bacteremia episodes (493 children, median age 103 days, range 0 days-16.9 years) a valid TTP was available. Median TTP was 12 h (IQR 8-17 h, range 0-109 h). By 24, 36, and 48 h, 460 (88%), 498 (96%), and 510 (98%) blood cultures, respectively, were positive. TTP was independent of age, sex, presence of comorbidities, site of infection and severity of infection. Median TTP in all age groups combined was shortest for group B streptococcus (8.7 h) and longest for coagulase-negative staphylococci (16.2 h). Conclusion: Growth of bacteria in blood cultures is detectable within 24 h in 9 of 10 children with blood culture-proven sepsis. Therefore, a strict rule to observe or treat all children with suspected sepsis for at least 48 h is not justified.
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Affiliation(s)
- Alexa Dierig
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp K. A. Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Eric Giannoni
- Department Mother-Woman-Child, Service of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Klara M. Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Alex Donas
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Paul Hasters
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Riedel
- Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luregn J. Schlapbach
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
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Gross I, Gordon O, Benenson S, Abu Ahmad W, Shimonov A, Hashavya S, Eventov-Friedman S. Using anaerobic blood cultures for infants younger than 90 days rarely showed anaerobic infections but increased yields of bacterial growth. Acta Paediatr 2018; 107:1043-1048. [PMID: 29405376 DOI: 10.1111/apa.14262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/13/2017] [Accepted: 01/30/2018] [Indexed: 11/29/2022]
Abstract
AIM The use of anaerobic blood cultures in infants suspected of bacteraemia is controversial. Our children's hospital uses both aerobic and anaerobic media, regardless of the risk of anaerobic infection, and the aim of this study was to re-evaluate the use of anaerobic cultures in infants. METHODS We collected retrospective data from 2002 to 2016 on all blood cultures taken from infants younger than 90 days in the Hadassah-Hebrew University Medical Centre, Jerusalem, Israel. The incidence and characteristics of infants with positive anaerobic blood cultures were assessed. RESULTS During the study period, 51 035 blood cultures were drawn from 44 304 infants. Of these, 1496 (2.9%) were clinically significant positive cultures. Pathogenic obligatory anaerobic bacteraemia was extremely rare, with only 37 positive cultures (0.07%) from all of the cultures drawn. No specific risk factors for obligatory anaerobic bacteraemia could be defined, but as many as 174 (11.6%) clinically significant isolates were only detected in the anaerobic culture bottle. CONCLUSION True anaerobic bacteraemia was extremely rare in neonates. Nevertheless, using anaerobic culture media may increase the overall yield of bacterial culture growth by isolating anaerobic-facultative bacteria. This should be weighed up against increasing the volume of blood used for the aerobic culture.
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Affiliation(s)
- Itai Gross
- Department of Paediatric; Hadassah and The Hebrew University Medical Centre; Jerusalem Israel
| | - Oren Gordon
- Department of Paediatric; Hadassah and The Hebrew University Medical Centre; Jerusalem Israel
- Department of clinical microbiology and Infectious Diseases; Hadassah and The Hebrew University Medical Centre; Jerusalem Israel
| | - Shmuel Benenson
- Department of clinical microbiology and Infectious Diseases; Hadassah and The Hebrew University Medical Centre; Jerusalem Israel
| | - Wiessam Abu Ahmad
- School of Public Health and Community Medicine; Hadassah and The Hebrew University Medical Centre; Jerusalem Israel
| | - Amir Shimonov
- Faculty of Medicine; Hadassah and The Hebrew University Medical Centre; Jerusalem Israel
| | - Saar Hashavya
- Department of Paediatric Emergency Medicine; Hadassah and The Hebrew University Medical Centre; Jerusalem Israel
| | - Smadar Eventov-Friedman
- Department of Neonatology; Hadassah and The Hebrew University Medical Centre; Jerusalem Israel
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Abstract
BACKGROUND Anaerobic bacteremia is rare in children and current recommendations advocate against the routine use of anaerobic cultures in children. However, the incidence of anaerobic bacteremia and the utility of anaerobic blood cultures in children have not been assessed in recent years. Our pediatric emergency department (PED) policy still supports the use of both aerobic and anaerobic blood cultures in all cases of suspected bacteremia. This allowed us to re-evaluate the yield of anaerobic cultures in PED settings. METHODS Retrospective data of all blood cultures taken in the PED in a single tertiary center from 2002 to 2016 were collected. The incidence and characteristics of children with positive anaerobic blood cultures were assessed. Risk factors for anaerobic bacteremia were defined. RESULTS Of the 68,304 blood culture sets taken during the study period, 971 (1.42%) clinically significant positive cultures were found. Pathogenic obligatory anaerobic bacteria were isolated in 33 (0.05%) cultures. The leading risk factors for anaerobic bacteremia were head and neck abscess and intra-abdominal infection. Of all the true positive cultures, 187 (22%) were only detected in the anaerobic culture and would have otherwise been missed. CONCLUSIONS True anaerobic bacteremia is extremely rare in children admitted to the PED. Nevertheless, using anaerobic cultures may increase the overall yield of blood cultures.
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Prevalence and Impact of Bacterial Infections in Children With Liver Disease-A Prospective Study. J Clin Exp Hepatol 2018; 8:35-41. [PMID: 29743795 PMCID: PMC5938332 DOI: 10.1016/j.jceh.2017.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 08/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Risk of infections is increased in patients with Acute Liver Failure (ALF) and Decompensated Chronic Liver Disease (DCLD). We evaluated the frequency, site, type and risk-factors for bacterial infections in children with ALF and DCLD and its effect on outcome. METHODS ALF or DCLD children were enrolled prospectively. Clinical and laboratory details were recorded. Cultures (blood, urine and ascites) and chest X-ray were done at admission followed by weekly surveillance cultures. RESULTS 173 patients, 68 ALF and 105 DCLD were enrolled. Infections were more common in DCLD than ALF (60/105 [57.1%] vs. 27/68 [39.7%]; P = 0.02). Ascitic fluid infection, pneumonia, urinary tract infection and bacteremia were seen in 19%, 17.9%, 13.2% and 12.1% patients respectively. Healthcare-Associated (HCA) infections were most frequent (39/87, 44.8%), followed by Nosocomial (NC, 32%) and Community-Acquired (CA, 23%). Nearly 3/4th of bacterial isolates were resistant to cephalosporins and quinolones, 23% being Multiresistant Bacteria (MRB). DCLD patients with infection had higher Child-Pugh Score (10 [6-14] vs. 7 [6-14]; OR 3.2 [1.77-5.10]: P = 0.007), need for ICU care (26/60 vs. 3/45; OR 10.70 [2.98-38.42]: P = 0.01), in-hospital mortality (24/60 vs. 8/45;OR 3.08 [1.22-7.75]: P = 0.04) and mortality at 3 month follow-up (32/60 vs. 9/45; OR 4.57 [1.87-11.12]: P = 0.00). Infection did not affect the outcome in ALF. CONCLUSION Infections develop in 40% ALF and 57% DCLD children. HCA and NC infections account for 77% of infections. Most culture isolates are resistant to cephalosporins and fluoroquinolones and 23% have MRB. Risk of infections is higher in DCLD patients with advanced liver disease.
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Key Words
- ALF, Acute Liver Failure
- CA, Community Acquired
- DCLD, Decompensated Chronic Liver Diseases
- GIB, Gastrointestinal Bleeding
- GNB, Gram Negative Bacilli
- GPC, Gram Positive Cocci
- HCA, Healthcare Associated
- HE, Hepatic Encephalopathy
- ICU, Intensive Care Unit
- INR, International Normalized Ratio
- MRB, Multiresistant Bacteria
- NC, Nosocomial
- SBP, Spontaneous Bacterial Peritonitis
- UTI, Urinary Tract Infection
- chronic liver disease
- infections
- liver failure
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Klingenberg C, Kornelisse RF, Buonocore G, Maier RF, Stocker M. Culture-Negative Early-Onset Neonatal Sepsis - At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship. Front Pediatr 2018; 6:285. [PMID: 30356671 PMCID: PMC6189301 DOI: 10.3389/fped.2018.00285] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/17/2018] [Indexed: 01/21/2023] Open
Abstract
Sepsis is a leading cause of mortality and morbidity in neonates. Presenting clinical symptoms are unspecific. Sensitivity and positive predictive value of biomarkers at onset of symptoms are suboptimal. Clinical suspicion therefore frequently leads to empirical antibiotic therapy in uninfected infants. The incidence of culture confirmed early-onset sepsis is rather low, around 0.4-0.8/1000 term infants in high-income countries. Six to 16 times more infants receive therapy for culture-negative sepsis in the absence of a positive blood culture. Thus, culture-negative sepsis contributes to high antibiotic consumption in neonatal units. Antibiotics may be life-saving for the few infants who are truly infected. However, overuse of broad-spectrum antibiotics increases colonization with antibiotic resistant bacteria. Antibiotic therapy also induces perturbations of the non-resilient early life microbiota with potentially long lasting negative impact on the individual's own health. Currently there is no uniform consensus definition for neonatal sepsis. This leads to variations in management. Two factors may reduce the number of culture-negative sepsis cases. First, obtaining adequate blood cultures (0.5-1 mL) at symptom onset is mandatory. Unless there is a strong clinical or biochemical indication to prolong antibiotics physician need to trust the culture results and to stop antibiotics for suspected sepsis within 36-48 h. Secondly, an international robust and pragmatic neonatal sepsis definition is urgently needed. Neonatal sepsis is a dynamic condition. Rigorous evaluation of clinical symptoms ("organ dysfunction") over 36-48 h in combination with appropriately selected biomarkers ("dysregulated host response") may be used to support or refute a sepsis diagnosis.
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Affiliation(s)
- Claus Klingenberg
- Pediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Tromsø, Norway.,Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - René F Kornelisse
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University of Marburg, Marburg, Germany
| | - Martin Stocker
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, Lucerne, Switzerland
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Afonso EDP, Blot S. Effect of gestational age on the epidemiology of late-onset sepsis in neonatal intensive care units - a review. Expert Rev Anti Infect Ther 2017; 15:917-924. [DOI: 10.1080/14787210.2017.1379394] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Elsa Da Palma Afonso
- Neonatal Intensive Care Unit, Rosie Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Stijn Blot
- Department of Internal Medicine, Ghent University, Gent, Belgium
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Abstract
OBJECTIVE To evaluate efficacy of two blood cultures taken simultaneously from two different sites as compared to standard practice of single blood culture in diagnosis of neonatal sepsis. STUDY DESIGN Prospective cohort study. Setting A tertiary-care center at a public hospital. PARTICIPANTS 475 neonates admitted to intensive care unit with suspected sepsis, from August 2014-July 2015. INTERVENTION Two blood cultures drawn from two different peripheral veins in patients with suspected neonatal sepsis. MAIN OUTCOME MEASURES Increase in culture-positivity rate with use of two blood cultures. RESULTS 475 babies with suspected sepsis were enrolled. 185 patients had only first culture positive (38.9%). When we added second culture positivity, yield increased to 221 (46.5%). Adding on second culture increased the culture yield by 36 (7.6%; 95% CI 2.41 to 12.79; P=0.018). The most common organisms isolated were E. coli, S. aureus and Candida spp. Major morbidities and mortality were more common in blood culture positive patients Contamination was ruled out in 25 babies who grew Coagulase negative Staphylococcus (CONS) (n=10) and Candida spp. (n=15) in either of the two cultures. CONCLUSION Two blood cultures taken simultaneously from two different sites improve rate of pathogen detection as compared to routine practice of single blood culture.
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van Vliet R, van den Tooren-de Groot HK, Van Rossum AP. Flow cytometric white blood differential using CytoDiff™ in the diagnosis of neonatal early-onset infection. J Matern Fetal Neonatal Med 2016; 30:2626-2632. [PMID: 27834108 DOI: 10.1080/14767058.2016.1260113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Neonatal early-onset infection is a life-threatening disease, requiring early diagnosis and treatment. Newborns at risk are identified by a combination of risk factors, clinical signs of infection and laboratory parameters such as white blood cell count and C-reactive protein (CRP). This method is labor-intensive, time consuming and has a variable reproducibility. New reliable diagnostic markers are needed to identify neonatal infection. This study presents additional leukocyte differential parameters produced by the automated flow cytometry and processing software using CytoDiff™ reagent (Beckman Coulter) in newborns suspected for early-onset infection. METHODS An analytic prospective observational case-control study was performed in which 185 newborns were included and retrospectively allocated into two groups, "infection likely" and "infection unlikely". Leukocyte parameters of the CytoDiff™ technique were compared with microscopic slide differentiation and routine tests. RESULTS We showed significant lower numbers of monocytes, CD16(-) monocytes and lymphocytes (including T+/NK-lymphocytes) in neonates suspected for early-onset infection using CytoDiff™ technique. The manual counting did not demonstrate changes with respect to the number of monocytes in these neonates. CONCLUSIONS The automated routine CytoDiff™ leukocyte differential provides an interesting additional diagnostic tool, next to routine laboratory diagnostics, in the diagnosis of neonatal early-onset infection.
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Affiliation(s)
- R van Vliet
- a Department of Paediatrics, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - A P Van Rossum
- b Department of Clinical Chemistry , Haaglanden Medical Center , The Hague , The Netherlands
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Kobayashi M, Vekemans J, Baker CJ, Ratner AJ, Le Doare K, Schrag SJ. Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries. F1000Res 2016; 5:2355. [PMID: 27803803 PMCID: PMC5070600 DOI: 10.12688/f1000research.9363.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 01/07/2023] Open
Abstract
Globally, group B Streptococcus (GBS) remains the leading cause of sepsis and meningitis in young infants, with its greatest burden in the first 90 days of life. Intrapartum antibiotic prophylaxis (IAP) for women at risk of transmitting GBS to their newborns has been effective in reducing, but not eliminating, the young infant GBS disease burden in many high income countries. However, identification of women at risk and administration of IAP is very difficult in many low and middle income country (LMIC) settings, and is not possible for home deliveries. Immunization of pregnant women with a GBS vaccine represents an alternate pathway to protecting newborns from GBS disease, through the transplacental antibody transfer to the fetus in utero. This approach to prevent GBS disease in young infants is currently under development, and is approaching late stage clinical evaluation. This manuscript includes a review of the natural history of the disease, global disease burden estimates, diagnosis and existing control options in different settings, the biological rationale for a vaccine including previous supportive studies, analysis of current candidates in development, possible correlates of protection and current status of immunogenicity assays. Future potential vaccine development pathways to licensure and use in LMICs, trial design and implementation options are discussed, with the objective to provide a basis for reflection, rather than recommendations.
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Affiliation(s)
- Miwako Kobayashi
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, USA
| | - Johan Vekemans
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Carol J. Baker
- Department of Pediatrics, Baylor College of Medicine, Houston, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, USA
- Center for Vaccine Awareness and Research, Texas Children's Hospital, Houston, USA
| | - Adam J. Ratner
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York, USA
| | - Kirsty Le Doare
- Centre for International Child Health, Imperial College, London, UK
| | - Stephanie J. Schrag
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, USA
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Midan DA, Abo El Fotoh WMM, El Shalakany AH. The potential role of incorporating real-time PCR and DNA sequencing for amplification and detection of 16S rRNA gene signatures in neonatal sepsis. J Matern Fetal Neonatal Med 2016; 30:1476-1483. [PMID: 27484181 DOI: 10.1080/14767058.2016.1219994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aimed to explore whether 16S rRNA gene amplification by real time PCR and sequencing could serve as genetic-based methods in rapid and accurate diagnosis of neonatal sepsis. PATIENTS AND METHODS This case control study was conducted on 40 neonates suffering from sepsis like manifestations recruited from the neonatal intensive care unit of Menoufia university hospital over a period of 6 months. Their blood samples were used for paired analysis of bacterial growth using BACTEC 9050 instrument and real time PCR assay with subsequent DNA sequencing for bacterial species identification. RESULTS The detection rate of culture proven sepsis was 70%. By using real time 16S r RNA PCR amplification method, the detection of bacteria was improved to 80%. Real time PCR revealed sensitivity, specificity, positive predictive value and negative predictive value of [100%, 66.7%, 87.5% and 100%] respectively. Compared to culture, the 16S rRNA real time PCR demonstrated a high negative value for ruling out neonatal sepsis. There was significant statistical difference between the PCR positive and negative cases as regards the hematological sepsis score. The results demonstrated the ability of DNA sequencing to recognize 4 pathogens which were negative by blood culture. The time consumed to detect sepsis using blood culture was up to 5 days while it took up to 16 h only by PCR and sequencing methods. CONCLUSION 16S rRNA gene amplification by real time PCR and sequence analysis could be served as ideal and reliable genetic-based methods to diagnose and rule out sepsis with provision of additional data that cannot be obtained by routine laboratory tests with a shorter turnaround time than those with culture-based protocols.
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Affiliation(s)
- Dina A Midan
- a Department of Pediatrics , Faculty of Medicine, Menoufia University , Shebin el kom , Menoufia , Egypt and
| | | | - Abeer H El Shalakany
- b Department of Clinical Pathology , Faculty of Medicine, Menoufia University , Shebin el kom , Menoufia , Egypt
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Hernández-Bou S, Álvarez Álvarez C, Campo Fernández M, García Herrero M, Gené Giralt A, Giménez Pérez M, Piñeiro Pérez R, Gómez Cortés B, Velasco R, Menasalvas Ruiz A, García García J, Rodrigo Gonzalo de Liria C. Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications, collection, processing and interpretation. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.anpede.2015.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vasudevan C, Oddie SJ, McGuire W. Early removal versus expectant management of central venous catheters in neonates with bloodstream infection. Cochrane Database Syst Rev 2016; 4:CD008436. [PMID: 27095103 PMCID: PMC7173748 DOI: 10.1002/14651858.cd008436.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Uncertainty exists regarding the management of newborn infants with a bloodstream infection and a central venous catheter in place. The central venous catheter may act as a nidus for infecting organisms and observational studies have suggested that early removal of the catheter is associated with a lower incidence of persistent or complicated infection. However, since central venous catheters provide secure vascular access to deliver nutrition and medications, the possible harms of early removal versus expectant management also need to be considered. OBJECTIVES To determine the effect of early removal versus expectant management of central venous catheters on morbidity and mortality in newborn infants with bloodstream infections. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 11), MEDLINE (1966 to October 2015), EMBASE (1980 to October 2015), CINAHL (1982 to October 2015), conference proceedings and previous reviews. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared early removal versus expectant management of central venous catheters in neonates with bloodstream infections. DATA COLLECTION AND ANALYSIS We used the standard methods of the Cochrane Neonatal Review Group. MAIN RESULTS We did not identify any eligible randomised controlled trials. AUTHORS' CONCLUSIONS There are no trial data to guide practice regarding early removal versus expectant management of central venous catheters in newborn infants with bloodstream infections. A simple and pragmatic randomised controlled trial is needed to resolve the uncertainty about optimal management in this common and important clinical scenario.
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Affiliation(s)
| | - Sam J Oddie
- Bradford Royal InfirmaryDuckworth LaneBradfordUKBD9 6RJ
| | - William McGuire
- Hull York Medical School & Centre for Reviews and Dissemination, University of YorkYorkY010 5DDUK
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Negussie A, Mulugeta G, Bedru A, Ali I, Shimeles D, Lema T, Aseffa A. Bacteriological Profile and Antimicrobial Susceptibility Pattern of Blood Culture Isolates among Septicemia Suspected Children in Selected Hospitals Addis Ababa, Ethiopia. INTERNATIONAL JOURNAL OF BIOLOGICAL AND MEDICAL RESEARCH 2015; 6:4709-4717. [PMID: 26997847 PMCID: PMC4793966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Blood stream infections are major cause of morbidity and mortality in children in developing countries. The emerging of causative agents and resistance to various antimicrobial agents are increased from time to time. The main aim of this study was to determine the bacterial agents and antimicrobial susceptibility patterns among children suspected of having septicemia. METHODS A cross sectional study involved about 201 pediatric patients (≤ 12 years) was conducted from October 2011 to February 2012 at pediatric units of TikurAnbessa Specialized Hospital and Yekatit 12 Hospital. Standard procedure was followed for blood sample collection, isolate identifications and antimicrobial susceptibility testing. RESULTS Among 201 study subjects 110 (54.7%) were males. Majority 147 (73.1%) of them were neonates (≤ 28 days). The mean length of hospital stay before sampling was 4.29 days. Out of the 201 tested blood samples, blood cultures were positive in 56 (27.9%).Gram negative and Gram positive bacteria constituted 29(51.8%) and 26(46.4%), respectively. The most frequent pathogen found was Staphylococcus aureus 13 (23.2%), followed by Serratia marcescens 12(21.4%), CoNS 11(19.6%), klebsiella spp 9(16%) and Salmonella spp 3(5.4%). Majority of bacterial isolates showed high resistance to Ampicillin, Penicillin, Co-trimoxazole, Gentamicin and Tetracycline which commonly used in the study area. CONCLUSION Majority of the isolates were multidrug resistant. These higher percentages of multi-drug resistant emerged isolates urge us to take infection prevention measures and to conduct other large studies for appropriate empiric antibiotic choice.
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Affiliation(s)
- Adugna Negussie
- Department of Medical Laboratory Science, Addis Ababa University, Addis Ababa, Ethiopia
- College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Gebru Mulugeta
- Department of Medical Laboratory Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Bedru
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Ibrahim Ali
- Department of Medical Laboratory Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damte Shimeles
- Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Davis J, Christie S, Fairley D, Coyle P, Tubman R, Shields MD. Performance of a Novel Molecular Method in the Diagnosis of Late-Onset Sepsis in Very Low Birth Weight Infants. PLoS One 2015; 10:e0136472. [PMID: 26305781 PMCID: PMC4549273 DOI: 10.1371/journal.pone.0136472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To compare the use of a generic molecular assay to ‘standard’ investigations used to assist the diagnosis of late onset bacterial sepsis in very low birth weight infants (VLBW, <1500g). Methods VLBW infants, greater than 48 hours of age, who were clinically suspected to have sepsis were investigated using standard tests (full blood count, C-reactive protein (at presentation) and blood culture), in addition, blood was taken for a universal molecular assay (16S rRNA reverse transcriptase PCR) for comparison. Clinical data were recorded during the suspected infection episode. A validated sepsis score (NEO-KISS) was used to retrospectively determine the presence of sepsis (independent of blood culture). The performance of each of the tests were compared by sensitivity, specificity, positive/negative likihood ratios (+/-LR) and postive/negative predictive values (PPV/NPV). Results Sixty-five babies with suspected clinical sepsis were prospectively included. The performance indicators are presented with 95% confidence limits. For the detection of bacteria, blood culture had sensitivity of 0.57 (0.34–0.78), specificity of 0.45 (0.30–0.61); +LR of 1.05 (0.66–1.66) and—LR of 0.94 (0.52–1.7); PPV of 33.3 (18.56–50.97) and NPV of 68.97 (49.17–87.72). Serum CRP had sensitivity of 0.92 (0.64–1) and specificity of 0.36 (0.17–0.59); +LR of 1.45 (1–2.1) and-LR of 0.21 (0.03–1.5); PPV of 44.46 (26.6–66.6) and NPV of 88.9 (51.8–99.7). The universal molecular assay had sensitivity of 0.76 (0.53–0.92), specificity of 0.95 (0.85–0.99); +LR of 16.8 (4.2–66.3) and-LR of 0.25 (0.1–0.5); PPV of 88.9 (65.3–98.6) and NPV of 89.4 (76.9–96.5). Conclusions In VLBW infants this universal molecular assay performed better in the diagnosis of late onset sepsis (LOS) than blood culture and CRP. Further development is required to explore and improve the performance of the assay in real-time diagnosis.
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Affiliation(s)
- Jonathan Davis
- St Michael’s Hospital, University Hospitals Bristol, Foundation Trust, Bristol, United Kingdom
| | | | - Derek Fairley
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Peter Coyle
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Richard Tubman
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Michael D. Shields
- Belfast Health & Social Care Trust, Belfast, United Kingdom
- The Queen’s University of Belfast, Belfast, United Kingdom
- * E-mail:
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49
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Hernández-Bou S, Álvarez Álvarez C, Campo Fernández MN, García Herrero MA, Gené Giralt A, Giménez Pérez M, Piñeiro Pérez R, Gómez Cortés B, Velasco R, Menasalvas Ruiz AI, García García JJ, Rodrigo Gonzalo de Liria C. [Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications, collection, processing and interpretation]. An Pediatr (Barc) 2015; 84:294.e1-9. [PMID: 26227314 DOI: 10.1016/j.anpedi.2015.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/17/2015] [Indexed: 12/11/2022] Open
Abstract
Blood culture (BC) is the gold standard when a bacteraemia is suspected, and is one of the most requested microbiological tests in paediatrics. Some changes have occurred in recent years: the introduction of new vaccines, the increasing number of patients with central vascular catheters, as well as the introduction of continuous monitoring BC systems. These changes have led to the review and update of different factors related to this technique in order to optimise its use. A practice guideline is presented with recommendations on BC, established by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases. After reviewing the available scientific evidence, several recommendations for each of the following aspects are presented: BC indications in the Emergency Department, how to obtain, transport and process cultures, special situations (indications and interpretation of results in immunosuppressed patients and/or central vascular catheter carriers, indications for anaerobic BC), differentiation between bacteraemia and contamination when a BC shows bacterial growth and actions to take with a positive BC in patients with fever of unknown origin.
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Affiliation(s)
- S Hernández-Bou
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP).
| | | | - M N Campo Fernández
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP)
| | - M A García Herrero
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP)
| | - A Gené Giralt
- Servicio de Microbiología, Hospital Sant Joan de Déu, Barcelona, España
| | - M Giménez Pérez
- Servicio de Microbiología, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, España
| | | | - B Gómez Cortés
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP)
| | - R Velasco
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP)
| | | | - J J García García
- Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP)
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50
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Bedford Russell AR, Kumar R. Early onset neonatal sepsis: diagnostic dilemmas and practical management. Arch Dis Child Fetal Neonatal Ed 2015; 100:F350-4. [PMID: 25425652 DOI: 10.1136/archdischild-2014-306193] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/05/2014] [Indexed: 11/03/2022]
Abstract
Early onset neonatal sepsis is persistently associated with poor outcomes, and incites clinical practice based on the fear of missing a treatable infection in a timely fashion. Unnecessary exposure to antibiotics is also hazardous. Diagnostic dilemmas are discussed in this review, and suggestions offered for practical management while awaiting a more rapidly available 'gold standard' test; in an ideal world, this test would be 100% sensitive and 100% specific for the presence of organisms.
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Affiliation(s)
| | - R Kumar
- Neonatal Unit, Birmingham Women's NICU, Birmingham, UK
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