Application of a sepsis flow chip (SFC) assay for the molecular diagnosis of paediatric sepsis

A delay in detecting sepsis pathogens is a problematic issue for determining definitive antibiotic therapy for the causative pathogens. The gold standard method for sepsis is blood culture but this requires 3 days to detect the definitive pathogen. Molecular methods offer rapid identification of pathogens. We evaluated the use of sepsis flow chip (SFC) assay for identifying pathogens from children with sepsis. Blood samples from children with sepsis were collected and incubated in a culture device. Positive samples were subjected to amplification-hybridization using SFC assay and culture. A total of 94 samples from 47 patients were recovered, from which 25 isolates were recovered, including Klebsiella pneumoniae (11) and Staphylococcus epidermidis (6). From 25 positive blood culture bottles subjected to SFC assay, 24 genus/species and 18 resistance genes were detected. The sensitivity, specificity and conformity was 80, 94.2 and 94.68 % respectively. SFC assay offers promise to identify pathogens from positive blood culture in paediatric patients with sepsis and may support the antimicrobial stewardship programme in hospitals.

Cause and risk factors of early neonatal death in Ethiopia

Background

Globally, three fourth of neonatal deaths occur during the early neonatal period, this makes it a critical time to reduce the burden of neonatal death. The survival status of a newborn is determined by the individual (neonatal and maternal), and facility-level factors. Several studies were conducted in Ethiopia to assess early neonatal death; however, most of the studies had limited participants and did not well address the two main determinant factors covered in this study. In response to this gap, this study attempted to examine factors related to early neonatal death based on perinatal death surveillance data in consideration of all the possible determinants of early neonatal death.

Methods

The national perinatal death surveillance data were used for this study. A total of 3814 reviewed perinatal deaths were included in the study. Bayesian multilevel parametric survival analysis was employed to identify factors affecting the survival of newborns during the early neonatal period. Adjusted time ratio (ATR) with 95% Bayesian credible intervals (CrI) was reported and log-likelihood was used for model comparison. Statistical significance was declared based on the non-inclusion of 1.0 in the 95% CrI.

Result

More than half (52.4%) of early neonatal deaths occurred within the first two days of birth. Per the final model, as gestational age increases by a week the risk of dying during the early neonatal period is reduced by 6% [ATR = 0.94,95%CrI:(0.93–0.96)]. There was an increased risk of death during the early neonatal period among neonates deceased due to birth injury as compared to neonates who died due to infection [ATR = 2.05,95%CrI:(1.30–3.32)]; however, perinates who died due to complication of an intrapartum event had a lower risk of death than perinates who died due to infection [ATR = 0.87,95%CrI:(0.83–0.90)]. As the score of delay one and delay three increases by one unit, the newborn’s likelihood of surviving during the early neonatal period is reduced by 4% [ATR = 1.04,95%CrI:(1.01–1.07)] and 21% [ATR = 1.21,95%CrI:(1.15–1.27)] respectively. Neonates born from mothers living in a rural area had a higher risk of dying during the early neonatal period than their counterparts living in an urban area [ATR = 3.53,95%CrI:(3.34–3.69)]. As compared to neonates treated in a primary health facility, being treated in secondary [ATR = 1.14,95%CrI:(1.02–1.27)] and tertiary level of care [ATR = 1.15,95%CrI:(1.04–1.25)] results in a higher risk of death during the early neonatal period.

Conclusion

The survival of a newborn during the early neonatal period is determined by both individual (gestational age, cause of death, and delay one) and facility (residence, type of health facility and delay three) level factors. Thus, to have a positive early neonatal outcome, a tailored intervention is needed for the three major causes of death (i.e Infection, birth injury, and complications of the intrapartum period). Furthermore, promoting maternal health, improving the health-seeking behaviour of mothers, strengthening facility readiness, and narrowing down inequalities in service provision are recommended to improve the newborn’s outcomes during the early neonatal period.

Bactericidal Properties of Copper-Tin Nanoparticles on Escherichia coli in a Liquid Environment

In this research, copper-tin alloy nanoparticles were made by a mechanical alloying method and were examined by two well-known and common bactericidal tests, optical density, and colony-forming units count in terms of bactericidal properties. To confirm the results, two different percentages were used as Sn-50Cu and Sn-83Cu, and standard amounts of these alloys were added to the Escherichia coli bacterial culture medium. The results of optical density show that with the addition of more values to the culture medium for bacteria, witnessing the destruction of bacteria, and also the results of colony counting tests can be seen that the number of colonies has decreased over time, even close to zero, which means the environment is free of bacteria. These standard values were different for both alloys; for the Sn-50Cu alloy, the maximum value was 4.5 mg, and for the Sn-83Cu alloy, it was 2.75 mg, which did not make any difference with the addition of these nanoparticles to the bacterial culture medium.

Determinants of neonatal mortality at neonatal intensive care unit in Northeast Ethiopia: unmatched case-control study

Background

Globally, in 2016, about 38% and 3% of all neonatal death were recorded in sub-Saharan Africa and Ethiopia, respectively. In the same year, 47 neonates out of 1000 live births were not surviving in the first 28 days of age in the Amhara region, Ethiopia. Despite the highest burden of neonatal death in the region, specific or the proximate determinants of neonatal death in the neonatal intensive care unit were not well identified.

Objective

This study aimed to identify the determinants of neonatal mortality at neonatal intensive care unit in Dessie Referral Hospital, Northeast Ethiopia.

Methods

An institution-based unmatched case-control study was conducted on neonates admitted to the neonatal intensive care unit of Dessie Referral Hospital, from January 1, 2016, to December 30, 2017. A total of 390 charts (130 cases and 260 controls) were selected by simple random sampling technique. The data were abstracted from the facility-based data abstraction form. A binary logistic regression analysis was fitted to identify the determinants of neonatal mortality.

Results

Pregnancy-induced hypertension (AOR = 4.57; 95% CI 1.45–14.43), prolonged rupture of membrane (AOR = 2.04; 95% CI 1.13–3.68), very low birth weight (AOR = 7.00; 95% CI 2.10–23.35), and low birth weight (AOR = 2.12; 95% CI 1.10–4.20) were identified factors. Moreover, respiratory distress syndrome (AOR = 3.61; 95% CI 1.10–12.04), perinatal asphyxia (AOR = 2.27; 95% CI 1.18–4.39), meconium aspiration syndrome (AOR = 2.35; 95% CI 1.12–4.97), and infection (AOR = 2.26; 95% CI 1.34–3.82) were also significantly associated with neonatal death.

Conclusions

Pregnancy-induced hypertension, prolonged rupture of membrane, low birth weight, respiratory distress syndrome, perinatal asphyxia, meconium aspiration syndrome, and infections were the major determinants of neonatal mortality. Therefore, special attention will be given to small and sick babies. Moreover, early anticipation of complications and management of mothers who had pregnancy-induced hypertension and prolonged rupture of the membrane would save neonates.

Assessment of clinical outcome of children with sepsis outside the intensive care unit

In 2016, in order to identify adult patients with sepsis who are likely to have poor outcomes, the Third International Consensus Definitions Task Force introduced a new bedside index, called the quick Sepsis-related Organ Failure Assessment (qSOFA) score. However, these new criteria have not been validated in the pediatric population. In this study, we sought to assess the qSOFA score for children with sepsis, who are being treated outside the pediatric intensive care units. The qSOFA criteria were revised and applied to a study population of 89 pediatric patients with sepsis, admitted in a pediatric tertiary referral center from 2006 to 2016. The analysis of prognostic performance of qSOFA score for the prediction of severe sepsis showed a sensitivity of 46% (95% CI, 27-67%), a specificity of 74% (95% CI, 62-85%), a positive predictive value of 43% (95% CI, 34-52%), and a negative predictive value of 77% (95% CI, 71-82%). The area under ROC curve for qSOFA score ≥ 2 was 0.602 (95% CI 0.492-0.705).Conclusion: The qSOFA score showed a low accuracy to identify children in the pediatric ward at risk for severe sepsis. Clinical tools are needed to facilitate the diagnosis of impending organ dysfunction in pediatric infection outside of the ICU. What is Known: • One of the major challenges for clinicians is to identify and recognize children with sepsis and impending organ dysfunction, in the emergency and in the pediatric department. • In 2016, members of the Sepsis-3 task force proposed qSOFA, an empirically derived score using simple clinical criteria, to assist clinicians in identifying adult patients with sepsis at risk for poor outcome. What is New: • qSOFA demonstrated insufficient clinical value to be recommended as a screening tool for pediatric sepsis outside ICU. • D-dimer level and blood glucose may be useful biomarkers to identify children at risk for severe sepsis.