1
|
Cantey JB, Prusakov P. A Proposed Framework for the Clinical Management of Neonatal "Culture-Negative" Sepsis. J Pediatr 2022; 244:203-211. [PMID: 35074307 DOI: 10.1016/j.jpeds.2022.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/17/2021] [Accepted: 06/12/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Joseph B Cantey
- Divisions of Neonatology and Allergy, Immunology, and Infectious Diseases, Department of Pediatrics, University of Texas Health San Antonio, San Antonio, TX.
| | - Pavel Prusakov
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
2
|
Doualeh M, Payne M, Litton E, Raby E, Currie A. Molecular Methodologies for Improved Polymicrobial Sepsis Diagnosis. Int J Mol Sci 2022; 23:ijms23094484. [PMID: 35562877 PMCID: PMC9104822 DOI: 10.3390/ijms23094484] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 12/19/2022] Open
Abstract
Polymicrobial sepsis is associated with worse patient outcomes than monomicrobial sepsis. Routinely used culture-dependent microbiological diagnostic techniques have low sensitivity, often leading to missed identification of all causative organisms. To overcome these limitations, culture-independent methods incorporating advanced molecular technologies have recently been explored. However, contamination, assay inhibition and interference from host DNA are issues that must be addressed before these methods can be relied on for routine clinical use. While the host component of the complex sepsis host–pathogen interplay is well described, less is known about the pathogen’s role, including pathogen–pathogen interactions in polymicrobial sepsis. This review highlights the clinical significance of polymicrobial sepsis and addresses how promising alternative molecular microbiology methods can be improved to detect polymicrobial infections. It also discusses how the application of shotgun metagenomics can be used to uncover pathogen/pathogen interactions in polymicrobial sepsis cases and their potential role in the clinical course of this condition.
Collapse
Affiliation(s)
- Mariam Doualeh
- Centre for Molecular Medicine & Innovative Therapeutics, Murdoch University, Murdoch, WA 6150, Australia;
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA 6009, Australia
- Women and Infants Research Foundation, Perth, WA 6008, Australia;
| | - Matthew Payne
- Women and Infants Research Foundation, Perth, WA 6008, Australia;
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, WA 6008, Australia
| | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, WA 6150, Australia;
- Intensive Care Unit, St. John of God Hospital, Subiaco, WA 6009, Australia
| | - Edward Raby
- State Burns Unit, Fiona Stanley Hospital, Murdoch, WA 6150, Australia;
- Microbiology Department, Path West Laboratory Medicine, Murdoch, WA 6150, Australia
| | - Andrew Currie
- Centre for Molecular Medicine & Innovative Therapeutics, Murdoch University, Murdoch, WA 6150, Australia;
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA 6009, Australia
- Women and Infants Research Foundation, Perth, WA 6008, Australia;
- Correspondence: ; Tel.: +61-(08)-9360-7426
| |
Collapse
|
3
|
Determining the Clinical Utility of 16S rRNA Sequencing in the Management of Culture-Negative Pediatric Infections. Antibiotics (Basel) 2022; 11:antibiotics11020159. [PMID: 35203762 PMCID: PMC8868208 DOI: 10.3390/antibiotics11020159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
The use of 16S rRNA sequencing in culture-negative infections has improved identification of bacterial pathogens in select scenarios, but its clinical impact requires further elucidation, especially in the pediatric population. This retrospective study aims to determine the clinical utility of 16S rRNA sequencing on the clinical management of pediatric culture-negative infections in our institution. Significant clinical utility was identified in 30 (40.5%) of 74 clinical samples (p < 0.0001). Of all specimens, pulmonary samples yielded the most clinical utility (n = 9, 30%), followed equally by joint fluid (n = 6, 20%) and bone (n = 6, 20%), with no difference between fluid and fresh tissue specimens (p = 0.346). Although the difference was not statistically significant (p = 0.4111), the overall use of broad-spectrum coverage was decreased. The median number of antibiotics was decreased from two to one (p < 0.0001) based on 16S rRNA sequencing results. The results suggest that 16S rRNA sequencing has a significant impact on decreasing the number of antibiotics used in the treatment of pediatric culture-negative infections. 16S rRNA sequencing performed on pulmonary specimens has the highest likelihood of identifying a pathogen compared to other specimen types. Additional cost–benefit analysis needs to be completed to further determine clinical benefit.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Perepelitsa SA. Etiologic and Pathogenic Perinatal Factors for the Development of Intrauterine Infections in Newborns (Review). ACTA ACUST UNITED AC 2018. [DOI: 10.15360/1813-9779-2018-3-54-67] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
For many decades, the world community’s efforts have been aimed at reducing the neonatal and infant mortality from intrauterine infections. In 1990, the United Nations and the World Health Organization set out the priority of decreasing children mortality by 2015 году. In spite of impressive success in newborn treatment, mortality due to sepsis decreases slowly; when survive, postnatal children develop central nervous system impairments of different level of severity. In the recent decade, new data have emerged concerning the methods of intrauterine infections prophylaxis, diagnosis, and treatment. The purpose of the review is to present data concerning specifics of pregnancy course when infections develop, contemporary diagnostic methods including studies of interleukins, placenta morphology, allelic genes, and to reflect the current approach to the treatment of intrauterine infections in newborns.
Collapse
|
6
|
Sharma D, Farahbakhsh N, Shastri S, Sharma P. Biomarkers for diagnosis of neonatal sepsis: a literature review. J Matern Fetal Neonatal Med 2017; 31:1646-1659. [PMID: 28427289 DOI: 10.1080/14767058.2017.1322060] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sepsis is an important cause of mortality and morbidity in neonatal populations. There has been constant search of an ideal sepsis biomarker that have high sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), so that both the diagnosis and exclusion of neonatal sepsis can be made at the earliest possible and appropriate antibiotics can be started to neonate. Ideal sepsis biomarker will help in guiding us when not to start antibiotics in case of suspect sepsis and total duration of antibiotics course in case of proven sepsis. There are numerous sepsis biomarkers that have been evaluated for early detection of neonatal sepsis but till date there is no single ideal biomarker that fulfills all essential criteria's for being an ideal biomarker. The most commonly used biomarkers are C-reactive protein (CRP) and procalcitonin (PCT), but both have shown varied sensitivity, specificity, PPV and NPV in different studies. We conducted literature search for various neonatal sepsis biomarkers and this review article will cover briefly all the markers with current available evidence.
Collapse
Affiliation(s)
- Deepak Sharma
- a Department of Neonatology , National Institute of Medical Sciences , Jaipur , Rajasthan , India
| | - Nazanin Farahbakhsh
- b Department of Pulmonology , Mofid Pediatrics Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Sweta Shastri
- c Department of Pathology , N.K.P. Salve Medical College , Nagpur , Maharashtra , India
| | - Pradeep Sharma
- d Department of Medicine , Mahatma Gandhi Medical College , Jaipur , Rajasthan , India
| |
Collapse
|