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Clinical signs and CRP values associated with blood culture results in neonates evaluated for suspected sepsis
Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0001-6328-5494
Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
2010 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 11, p. 1635-1640Article in journal (Refereed) Published
Abstract [en]

Aim: To identify which clinical signs at presentation are most predictive of sepsis subsequently confirmed by blood culture and to investigate whether the predictive power of the clinical signs varies by gestational age.

Methods: Among 401 newborn infants <28 days of age with suspected sepsis, nine signs of sepsis and C-reactive protein (CRP) values were prospectively recorded. Logistic regression assessed the association of these signs and laboratory values with a subsequently confirmed diagnosis of sepsis by positive blood culture. The analysis was stratified by gestational age with mutual simultaneous adjustment for the signs and sex.

Results: Five of the nine clinical signs (feeding intolerance, distended abdomen, blood pressure, bradycardia and apnoea), along with CRP were statistically significantly associated with a positive blood culture. After simultaneous adjustment for all of the signs, apnoea, hypotension and CRP were independently predictive of positive blood culture. When the material was stratified by gestational age, differences in the association with positive blood culture were found for bradycardia, tachypnea and irritability/seizures.

Conclusion: In this selected population of infants with suspected sepsis, apnoea and hypotension are independently predictive of a confirmed diagnosis, while bradycardia is more predictive among preterm infants and tachypnea among term infants.

Place, publisher, year, edition, pages
Malden, USA: Wiley-Blackwell, 2010. Vol. 99, no 11, p. 1635-1640
Keyword [en]
Diagnosis, logistic regression, neonatal sepsis, neonatology
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-12721DOI: 10.1111/j.1651-2227.2010.01913.xISI: 000282641600008PubMedID: 20560896Scopus ID: 2-s2.0-78649728350OAI: oai:DiVA.org:oru-12721DiVA: diva2:378432
Available from: 2010-12-15 Created: 2010-12-15 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Aspects on early diagnosis of neonatal sepsis
Open this publication in new window or tab >>Aspects on early diagnosis of neonatal sepsis
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis presents four studies, all designed to improve the problematic diagnostic situation concerning infants with suspected sepsis. Study I included 401 neonates with suspected sepsis. Nine signs of sepsis and C-reactive protein were prospectively recorded and logistic regression was used to assess associations between these signs and a subsequently confirmed diagnosis of sepsis. C-reactive protein and five of the clinical signs were statistically significantly associated with a positive bloodculture. When the material was stratified by gestational age, differences between premature and full term infants were detected.Studies II and III were prospective studies that used samples collected from neonates with suspected sepsis to evaluate a novel real-timepolymerase chain reaction (PCR) method. The results where compared with simultaneously collected blood cultures. Study II used plasma samples and resulted in a sensitivity of 42% and specificity of 95%. In study III, the protocol was improved and adapted to whole blood samples which resulted in a sensitivity of 79% and specificity of 90%. Both protocols included species-specific probes and study III indicated that PCR has the potential to detect bacteria in culture-negative sepsis.Staphylococcus epidermidis is the most common pathogen in neonatal sepsis, but there is still a lack of typing methods suitable for large materials of S. epidermidis. In Study IV we therefore evaluated a new S. epidermidisgenotyping method based on PCR for the repeat regions of four genes thatencode for cell wall anchoring proteins. The method was applied to 49well-defined neonatal blood isolates of S. epidermidis. The combination ofsdrF and aap seemed to be optimal, resulting in a diversity index of 0.92.Conclusions

• Bradycardia, apnoea, low blood pressure, feeding intolerance and distended abdomen are obvious early signs of neonatal sepsis. Premature and full-term infants differ in terms of the signs they display in neonatal sepsis.

• Blood is superior to plasma for developing PCR methods for bacterial DNA detection. The PCR method described in study III can detect neonatal bacteraemia, but it can be further improved before it is used in routine care.

• There has been a lack of useful typing methods for S. epidermidis.We can now present PCR of the genes for the cell wall anchoring proteins sdrF and aap as a novel and feasible approach when there is a need to type a large number of S. epidermidis isolates.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2010. p. 77
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 49
National Category
Medical and Health Sciences Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:oru:diva-11928 (URN)978-91-7668-770-3 (ISBN)
Public defence
2010-12-10, Wilandersalen, Universitetssjukhuset Örebro, Fakultetsgatan 1, Örebro, 09:00
Opponent
Supervisors
Available from: 2010-09-27 Created: 2010-09-27 Last updated: 2017-10-17Bibliographically approved

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Ohlin, AndreasBjörkqvist, MariaMontgomery, Scott M.Schollin, Jens

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